Psychiatry

Question 1

name the parts of a psychiatric functional inquiry

Answer 1

mood
organic
anxiety
psychosis
safety

Question 2

what would you ask about in PC and HPC in a psych hx

Answer 2

• Reason for seeking help that day
• Current symptoms - onset, duration and course
• Stressors
• Supports
• Functional status
• Relevant associated symptoms
• Current medication use including doses and adherence
• Safety screen
○ Endangering self or others, dependents at home, ability to drive safely, ability to care for self

Question 3

what would you go into during a developmental hx for psych?

Answer 3

• Prenatal and perinatal hx
○ desired vs unwanted pregnancy, maternal and foetal health, domestic violence, maternal substance use and exposures, complications of pregnancy/delivery
• Early childhood to 3 yrs
○ Developmental milestones, activity/attention level, family stability, attachment figures
• Middle childhood to 11 yrs
○ School performance, peer relationships, fire setting, stealing, incontinence
• Late childhood to adolescence
○ Drugs/alcohol, legal problems, peer and family relationships
• History of physical or sexual abuse
• Adulthood - education, occupations, relationships
• Premorbid personality
• Psychosexual hx
○ Puberty, first sexual encounter, romantic relationships, gender roles, sexual dysfucntion

Question 4

what additional parts is there to a psych hx?

Answer 4

forensic
developmental
past psych hx

Question 5

name the components of a mental status exam

Answer 5

appearance
behaviour
speech
mood and affect
perception
thought content
insight
cognition

Question 6

what would you comment on in appearnace of a MSE

Answer 6

• Posture
	• Gait
	• Grooming
	• Hygiene
	• Clothing
	• Body habitus
	• Facial expression
	• Chronological vs apparent age
Relaxed or in distress

Question 7

what parts are there to behaviour in the MSE?

Answer 7

• Psychomotor activity - agitation, retardation
  
  • Abnormal movements or lack thereof - tremors, akathisia, tardive dyskinesia, paralysis
  • Attention level and eye contact
  • Attitude towards examiner - ability to interact, level of cooperation

Question 8

what do you comment on speech in a MSE

Answer 8

rate
rhythm
tone
spontaneity

Question 9

how can you describe affect?

Answer 9

euthymic, depressed, elevated, anxious, irritable
full, restricted, flat, blunted
fixed, labile
congruencr

Question 10

how would you describe thought process and form?

Answer 10

coherence

logic

Question 11

what kind of things would you comment on in thought content?

Answer 11

suicide/homicidal
delusions
obsessions
magical thinking
ideas of reference
overvalued ideas
broadcasting

Question 12

what is a psychotic condition?

Answer 12

Characterised by a significant impairment in reality testing, delusions or hallucinations (with/without insight into their pathological nature behaving in a disorganised way so that it is reasonable to infer that reality testing is disturbed

Question 13

list the first

rank symptoms of schizophrenia

Answer 13

auditory hallucinations
broadcasting
controlled thought
delusional perception

Question 14

age of onset schizophrenia

Answer 14

15-35

Question 15

positivie symptoms of schizophrenia

Answer 15

hallucinations
delusions
disordered thinking

Question 16

negative symptoms of schizophrenia

Answer 16

apathy
lack of interest
lack of emotions
amotivation
paucity of though

Question 17

good prognostic factors of schizophrenia

Answer 17

• Absence of family history
• Good premorbid function – stable personality, stable relationships
• Clear precipitant
• Acute onset
• Mood disturbance
• Prompt treatment
Maintenance of initiative, motivation

Question 18

poor prognostic factors of schizophrenia

Answer 18

• Slow, insidious onset and prominent negative symptoms
• Mortality is 1.6x higher than the general population
• Shorter life expectancy is linked to CV disease, resp disease and cancer
• Suicide risk is 9 x higher
• Death from violent incidents is twice as high
• 36% of patients have substance misuse problems
Childhood onset

Question 19

ICD10 criteria for schizophrenia

Answer 19

For more than a month in absence of organic or affective disorder:
• At least one of the following:
• Alienation of thought as thought echo, thought insertion or withdrawal, or thought broadcasting (other people have access to thoughts, leaking out).
• Delusions of control, influence or passivity, clearly referred to body or limb movements actions, or sensations; delusional perception.
• 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.
• Persistent delusions of other kinds that are culturally inappropriate and completely impossible (e.g. being able to control the weather)
• Or at least two of the following:
• Persistent hallucinations in any modality, when occurring every day for at least one month.
• Neologisms (making up words), breaks or interpolations in the train of thought, resulting in incoherence or irrelevant speech.
○ Schizophasia – just words put together, makes no sense
• Catatonic behaviour, such as excitement, posturing or waxy flexibility, negativism, mutism and stupor.
• “Negative” symptoms such as marked apathy, paucity of speech, and blunting or incongruity of emotional responses.

Question 20

common comorbidities in schizophrenia

Answer 20

substance related disorders
anxiety disorders
reduced life expectanc due to: obesity, diabetes, metabolic syndrome, CV/pulmonary disease

Question 21

management of schizophrenia

Answer 21

• Biological / somatic
  
  • Acute treatment and maintenance: antipsychotics (haloperidol, risperidone, olanzapine, paliperidone; clozapine if refractory); often regiments of IM q2-4 wk used in severe cases to ensure adherence
  • Adjunctive: ± mood stabilizers (for aggression/impulsiveness - lithium, valproate, carbamazepine) ± anxiolytics ± ECT
  • Treat for at least 1-2 years after the first episode, at least 5 years after multiple episodes (relapse causes severe deterioration)
• Psychosocial
  
  • Psychotherapy (individual, family, group), supportive, CBT (see Table 14, PS41)
  • ACT (Assertive Community Treatment): mobile mental health teams that provide individualized treatment in the community and help patients with medication adherence, basic living skills, social support, job placements, resources
  • Social skills training, employment programs, disability benefits
  • Housing (group home, boarding home, transitional home)

Question 22

list the psychological symptoms of depression

Answer 22

• Change in mood
○ Depression – may find diurnal variation
○ Anxiety – inability to relax
○ Perplexity – particularly in puerperal illness (post-natal), bewildered or overwhelmed
○ Anhedonia – not being able to experience pleasure in the things you would usually enjoy
• Change in thought content
○ Guilt – unjustified
○ Hopelessness
○ Worthlessness
○ Any neurotic symptomatology e.g. hypochondriasis, agoraphobia, obsessions + compulsions, panic attacks o Ideas of reference – connecting things around you to negative things about you e.g. laughing at
Delusions and hallucinations if severe – psychotic symptoms

Question 23

list the physical symptoms of depression

Answer 23

• Change in bodily function 
		○ Energy – fatigue 
		○ Sleep – often insomnia, not being able to get to sleep, disturbed sleep, early waking
		○ Appetite – weight loss 
		○ Libido 
		○ Constipation 
		○ Pain 
	• Change in psychomotor functioning 
		○ Agitation 
Retardation – abnormal slowness of thought and action

Question 24

list the social symptoms of depression

Answer 24

• Loss of interests
• Irritability
• Apathy
• Withdrawal, loss of confidence, indecisive
Loss of concentration, registration and memory

Question 25

what is the ICD10 criteria for a diagnosis of depression?

Answer 25

• Last for at least 2 weeks • No hypomanic or manic episodes in lifetime • Not attributable to psychoactive substance use or organic mental disorder If psychotic symptoms or stupor then severe depression with psychotic symptoms

Question 26

what is somatic syndrome?

Answer 26

Somatic syndrome is a marked loss of interest or pleasure in activities that are normally pleasurable. There is a lack emotional reactions to events or activities that normally produce an emotional response. Patients often wake 2 hours before the normal time and find that the depression is worse in the morning. Objective evidence of psychomotor agitation or retardation. Marked loss of appetite with weight loss (5% + of body weight in a month). Often marked loss of libido.

Question 27

lsit the general criteria for depression

Answer 27

○ Depressed mood that is abnormal for most of the day almost every day for the past two weeks, largely uninfluenced by circumstances ○ Loss of interest or pleasure Decreased energy or increased fatigability

Question 28

list the additional criteria for depression

Answer 28

○ Depressed mood that is abnormal for most of the day almost every day for the past two weeks, largely uninfluenced by circumstances ○ Loss of interest or pleasure Decreased energy or increased fatigability

Question 29

how many symptoms do you need to be diagnosed with mild depression?

Answer 29

at least 2 general | total 4

Question 30

how many symptoms do you need to be diagnosed with moderate depression?

Answer 30

2 general | total 6

Question 31

how many symptoms do you need to be diagnosed with severe depression?

Answer 31

3 general | total 8

Question 32

name two measurement tools for depression

Answer 32

SCID | SCAN

Question 33

define bipolar 1

Answer 33

at least 1 manic episode commonly accompanied by at least 1 major depressive episode

Question 34

define bipolar 2

Answer 34

at least one major depressive 1 hypomanic no manic

Question 35

psychological treatment for bipolar

Answer 35

``` ○ Supportive psychotherapy ○ CBT ○ IPT ○ Interpersonal social rhythm therapy Family therapy ```

Question 36

social treatment for bipolar

Answer 36

``` ○ Vocational rehab ○ Consider leave of absence ○ Assess capacity to manage finances ○ Drug and alcohol cessation ○ Sleep hygiene ○ Social skills training ○ Education and recruitment of family members ```

Question 37

psychological treatments for depression

Answer 37

○ CBT, IPT, individual dynamic psychotherapy, family therapy

Question 38

what is panic disorder

Answer 38

* A disorder in which an individual experiences recurrent, unexpected panic attacks and persistent concern about having additional panic attacks. Agoraphobia is not a component of this disorder. * A state of extreme acute, intense anxiety and unreasoning fear accompanied by disorganization of personality function.

Question 39

treatment of panic disorder

Answer 39

``` • Psychological ○ CBT ○ Cognitive restructuring ○ Relaxation techniques • Pharmacological ○ SSRIs ○ SNRI ○ Up to 12 weeks for response ○ Treat for 1 yr after symptoms resolve to avoid relapse Other antidepressants - mirtazapine, MAOIs ```

Question 40

what is agoraphobia

Answer 40

a type of anxiety disorder in which you fear and avoid places or situations that might cause you to panic and make you feel trapped, helpless or embarrassed

Question 41

treatment for agoraphobia

Answer 41

SSRI SNRI Mirtazapine

Question 42

what is generalised anxiety disorder?

Answer 42

his is a persistent (several months) presence of symptoms that are not confined to a situation or object. All the symptoms of human anxiety mentioned earlier can occur. Dominant symptoms are variable but include tremor, palpitations, epigastric pain, worried thoughts, fear, trembling.

Question 43

treatment of GAD

Answer 43

counselling relaxation training SSRI, TCA CBT

Question 44

what is social phobia

Answer 44

Marked and persistent (>6 mo) fear of social or performance situations in which one is exposed to unfamiliar people or to possible scrutiny by others; fearing he/she will act in a way that may be humiliating or embarrassing (e.g. public speaking, initiating or maintaining conversation, dating, eating in public)

Question 45

diagnostic criteria for phobic disorders

Answer 45

• Exposure to stimulus almost invariably provokes an immediate anxiety response; may present as a panic attack • Person recognizes fear as excessive or unreasonable • Situations are avoided or endured with anxiety/distress Significant interference with daily routine, occupational/social functioning, and/or marked distress

Question 46

treatment of phobic disorders

Answer 46

CBT Exposure therapy behavioural therapy fluoxetine, paroxetine, sertraline, venlafaxine, MAOIs

Question 47

what is OCD?

Answer 47

The core features of OCD are experiences of recurrent obsessional thoughts and or compulsive acts. Obsessional thoughts: • Ideas, images or impulses • Occurring repeatedly not willed • Unpleasant and distressing (often the antithesis of personality type) ○ Obscene ○ Violent or senseless • Recognised as the individual’s own thoughts • Usual key anxiety symptoms arise because of distress of the thoughts or attempts to resist. Compulsive acts or rituals: • Stereotypical behaviours repeated again and again • Not enjoyable • Not helpful i.e. do not result in useful activity • Often viewed by the sufferer as: ○ Preventing some harm to self or others “magical undoing” ○ Viewed as pointless and resisted with key anxiety symptoms accompanying resistance

Question 48

management of OCD

Answer 48

``` education SSRI Clomipramine CBT psychosurgery ```

Question 49

what is PTSD

Answer 49

delayed or protracted reaction to a stressor of exceptional severity

Question 50

what are the 3 key elements in PTSD

Answer 50

hyperarousal re-experiencing phenomena avoidance

Question 51

features of hyperarousal in PTSD

Answer 51

persistent anxiety irritability insomnia poor concentration

Question 52

vulnerability factors for PTSD

Answer 52

mood disorders previous trauma esp children lack of social support female

Question 53

protective factors against PTSD

Answer 53

higher education | social group good paternal relationship

Question 54

CAGE questionnaire

Answer 54

Ever felt the need to Cut down on drinking? Ever felt Annoyed at criticism of your drinking? Ever feel Guilty about your drinking? Ever need an Eye opener?

Question 55

alcohol withdrawal: 12-18hrs

Answer 55

``` shakes tremor sweating agitation anorexia cramps diarrhoea sleep disturbance ```

Question 56

alcohol withdrawal: 7-48hrs

Answer 56

seizures usually tonic clonic

Question 57

alcohol withdrawal: >48hrs

Answer 57

visual, auditory, olfactory, tactile hallucinations

Question 58

alcohol withdrawal: 3-5 daus

Answer 58

``` DT confusion delusions hallucinations agitation tremors autonomic overactivity ```

Question 59

symptoms of delirium tremens

Answer 59

``` • Autonomic hyperactivity (diaphoresis, tachycardia, increased respiration) • Hand tremor • Insomnia • Psychomotor agitation • Anxiety • Nausea or vomiting • Tonic-clonic seizures • Visual/tactile/auditory hallucinations Persecutory delusions ```

Question 60

what causes wernicke and korsakoffs syndrome

Answer 60

thiamine deficiency

Question 61

triad of wernickes encephalopathy

Answer 61

oculomotor dysfunction gait ataxia confusion

Question 62

korsakoffs syndrome

Answer 62

anterograde amnias | confabulations

Question 63

treatment of alcohol dependence

Answer 63

naltrexone disulfaram - antabuse acamprosate - campral

Question 64

risk factors for developing an eating disorder

Answer 64

1. Physical a. Obesity b. Chronic medical illness 2. Psychological a. Career b. Family history - mood disorders, ED, substance abuse c. Hx of sexual abuse (bulimia) d. Homosexual males e. Competitive athletes Concurrent mental illness (depression, OCD, anxiety, substance abuse)

Question 65

SCOFF questionnaire

Answer 65

1. Do you make yourself Sick because you feel uncomfortably full? 2. Do you worry you have lost Control over how much you eat? 3. Have you recently lost more than One stone in 3 months? 4. Do you believe yourself to be Fat when others say you are too thin? Would you say Food dominates your life?

Question 66

what is anorexia nervosa?

Answer 66

There is an obsessive fear of fatness with avoidance of food and other sources of calories and a range of compulsive “compensatory” behaviours when food cannot be avoided. In time, these behaviours are the only way to avoid the experience of anxiety and there are secondary physical and psychological consequences of starvation.

Question 67

symptoms of anorexia nervosa

Answer 67

``` • Restriction of intake to reduce weight • Relies on compulsive compensatory behaviours when food cannot be avoided, Self-induced vomiting, laxative abuse, excessive exercise, abuse of appetite suppressants / diuretics • Considered anorexic if he/she is 15% below ideal body weight/BMI 17.5 or < • Fear of weight gain • [In postmenarchal females, absence of the menstrual cycle or amenorrhoea (greater than 3 cycles)] – no longer part of diagnostic criteria • Cold intolerance – core body temperature, and low HR • Blue hands and feet • Constipation – gut wall becomes thinner and slower • Bloating • Delayed puberty • Primary or secondary amenorrhea • Dry skin • Fainting • Hypotension • Lanugo hair • Scalp hair loss • Early satiety • Weakness, fatigue • Short stature Osteopenia & osteoporosis ```

Question 68

management of anorexia

Answer 68

• Psychotherapy: individual, group, family to address food and body perception, coping mechanisms and health effects Medications of little value

Question 69

what is bulimia nervosa?

Answer 69

Episodes of binge eating with a sense of loss of control Binge eating is followed by compensatory behaviour of the purging type (self-induced vomiting, laxative abuse, diuretic abuse) or nonpurging type (excessive exercise, fasting, or strict diets). Binges and the resulting compensatory behaviour must occur a minimum of two times per week for three months Dissatisfaction with body shape and weight Not taking insulin is considered to be non-purging behaviour

Question 70

signs and symptoms of bulimia nervosa

Answer 70

``` • Mouth sores • Pharyngeal trauma • Dental caries • Heartburn, chest pain • Oesophageal rupture • Impulsivity: ○ Stealing ○ Alcohol abuse ○ Drugs/tobacco • Muscle cramps • Weakness • Bloody diarrhoea • Irregular periods • Fainting • Swollen parotid glands Hypotension ```

Question 71

what is binge eating disorder?

Answer 71

Binge eating disorder is similar to bulimia nervosa; but with absence of purging behaviours. Ongoing and/or repetitive cycles also include: • Unusually fast eating, usually alone • Unusually large amounts consumed • Uncomfortably full; often buzzed after eating Embarrassment, shame, guilt, depression

Question 72

when does bulimia nervosa become anorexia nervosa binge-purge subtype?

Answer 72

BMI < 17.5

Question 73

general features of cluster A PD

Answer 73

odd, eccentric, withdrawn

Question 74

defence mechanisms in cluster A PD

Answer 74

intellectualisation projection magical thinking

Question 75

paranoid PD

Answer 75

Pervasive distrust and suspiciousness of others, interpret motives as malevolent, Blame problems on others an seem angry and hostile >= 4 of: (SUSPECT) 1. Suspicious that others are exploiting or deceiving them 2. Unforgiving - bears grudges 3. Spousal infidelity suspected without justification 4. Perceive attacks on character, counterattacks quickly 5. Enemies or friends? Preoccupied with acquaintance trustworthiness 6. Confiding in others is feared Threats interpreted in benign remarks

Question 76

schizotypal PD

Answer 76

Pattern of eccentric behaviours, peculiar thought patterns >= 5 of: (ME PECULIAR) 1. Magical thinking 2. Experiences unusual perceptions (including body illusions) 3. Paranoid ideation 4. Eccentric behaviour or appearance 5. Constricted or inappropriate affect 6. Unusual thinking/speech (e.g. vague, stereotyped) 7. Lacks close friends 8. Ideas of reference Anxiety in social situations

Question 77

schizoid PD

Answer 77

Neither desires nor enjoys close relationships including being a part of a family, prefers to be alone Lifelong pattern of social withdrawal >= 4 of: (DISTANT) 1. Detached/flat affect, emotionally cold 2. Indifferent to praise or criticism 3. Sexual experience of little interest 4. Tasks done solitarily 5. Absence of close friends 6. Neither desires nor enjoys close relationships including family Takes pleasure in few, if any, activities

Question 78

common features of cluster B PD

Answer 78

dramatic, emotional, inconsistent

Question 79

defence mechanisms in cluster B PD

Answer 79

``` denial acting out regression (histrionic) splitting (borderline) projective identification idealisation/devaluation ```

Question 80

borderline PD

Answer 80

Unstable moods and behaviour, feel alone in the world, problems with self-image. History of repeated suicide attempts, self-harm behaviours. Inpatients commonly report hx of sexual abuse. Tends to fizzle out as patients age >= 5 of: (IMPULSIVE) 1. Impulsive (min of 2 self-damaging ways, e.g. sex/drugs/spending) 2. Mood/affect instability 3. Paranoia or dissociation under stress 4. Unstable self-image 5. Labile intense relationships 6. Suicidal gestures/self-harm 7. Inappropriate anger 8. aVoiding abandonment (real or imagined, frantic efforts to) Emptiness (feelings of)

Question 81

Narcissistic PD

Answer 81

Sense of superiority, needs constant admiration, lacks empathy, but with fragile sense of self. Consider themselves "special" and will exploit others for personal gain >=5 of: (GRANDIOSE) 1. Grandiose 2. Requires excessive admiration 3. Arrogant 4. Needs to be special (and associate with other specials) 5. Dreams of success, power, beauty, love 6. Interpersonally exploitive 7. Others: lacks empathy, unable to recognise feelings/needs of 8. Sense of entitlement Envious or believes others are

Question 82

antisocial PD

Answer 82

``` Lack of remorse for actions, manipulative and deceitful, often violate the law. May appear charming on first impression. Pattern of disregard for others and violation of other's rights. Must present before the age of 15; however diagnosis cannot be made until 18. strong association with conduct disorder, hx of trauma/abuse common >=3 of: (CORRUPT) 1. Cannot conform to law 2. Obligations ignored (irresponsible) 3. Reckless disregard for safety 4. Remorseless 5. Underhanded (deceitful) 6. Planning insufficient (impulsive) Temper (irritable and aggressive) ```

Question 83

histrionic PD

Answer 83

Attention-seeking behaviour and excessively emotional. Are dramatic, flamboyant, and extroverted. Cannot form meaningful relationships. Often sexually inappropriate >= 5 of: (ACTRESS) 1. Appearance used to attract attention 2. Centre of attention (else uncomfortable) 3. Theatrical 4. Relationships believed to be more than they are 5. Easily influenced 6. Seductive behaviour 7. Shallow expression of emotions (which rapidly shift) Speech (impressionistic and vague)

Question 84

common features of cluster C PD

Answer 84

anxious, fear

Question 85

defence mechanisms in cluster C PD

Answer 85

isolation avoidance hypochondriasis

Question 86

avoidant PD

Answer 86

Timid and socially awkward with a pervasive sense of inadequacy and fear of criticism. Fear of embarrassing or humiliating themselves in social situations so remain withdrawn and social inhibited. >= 4 of: (CRINGES) 1. Criticism or rejection preoccupies thoughts in social situations 2. Restraint in relationships due to fear of being shamed 3. Inhibited in new relationships due to fear of inadequacy 4. Needs to be sure of being liked before engaging socially 5. Gets around occupational activities requiring interpersonal contact 6. Embarrassment prevents new activity or taking risks Self-viewed as unappealing or inferior

Question 87

obsessive compulsive PD

Answer 87

Preoccupation with orderliness, perfectionism, and mental and interpersonal control. Is inflexible, closed off and inefficient >= 4 of: (SCRIMPER) 1. Stubborn 2. Cannot discard worthless objects 3. Rule/detail obsessed to point of activity lost 4. Inflexible in matters of morality, ethics, values 5. Miserly 6. Perfectionistic 7. Excludes leisure due to devotion to work Reluctant to delegate to others

Question 88

dependent PD

Answer 88

Pervasive and excess need to be taken care of, excessive fear of separation, clinging and submissive behaviours. Difficulty in making everyday decisions. Useful to set regulated treatment schedule (regular, brief visits) and being firm about in between issues. Encourage patient to do more for themselves, engage in own problem solving >= 5 of: (RELIANCE) 1. Reassurance required for everyday decisions 2. Expressing disagreement difficult 3. Life responsibilities assumed by others 4. Initiating projects difficult due to lack of confidence 5. Alone feels helpless and uncomfortable 6. Nurturance goes to excessive lengths to obtain 7. Companionship sought urgently Exaggerated fears of being left to care for sel

Question 89

cluster A PD

Answer 89

schizoid schizotypal paranoid

Question 90

cluster B PD

Answer 90

borderline narcissistic histrionic antisocial

Question 91

cluster C PD

Answer 91

avoidant dependent obsessive-compulsive

Question 92

define learning disability

Answer 92

a condition of arrested or incomplete development of the mind, which is especially characterised by impairment of skills manifested during the developmental period, which contributes to the overall level of intelligence

Question 93

what is the criteria to be diagnosed with a learning disability?

Answer 93

IQ < 70 social or adaptive dysfunction with deficits in 2 or more areas < 18 yrs

Question 94

classification of learning disability IQ: mild

Answer 94

50-69

Question 95

classification of learning disability IQ: moderate

Answer 95

35-49

Question 96

classification of learning disability IQ: severe

Answer 96

20-34

Question 97

classification of learning disability IQ: profound

Answer 97

<20

Question 98

causes of learning disability: genetic

Answer 98

fragile X, PKU, Retts syndrome DiGeorge, Prader-Willi, Angelman Down syndrome

Question 99

causes of learning disability: infective

Answer 99

rubella, zika | meningitis, encephalitis

Question 100

causes of learning disability: toxic

Answer 100

FAS

Question 101

causes of learning disability: trauma

Answer 101

birth asphyxia, head injury, cerebral palsy

Question 102

what is the most common cause of learning disability?

Answer 102

unknown

Question 103

common conditions associated with learning disability

Answer 103

``` epilepsy sensory impairments obesity swallowing problems, reflux oesophagitis, helicobacter pylori, constipation chest infections, aspiration pneumonia cerebral palsy joint contractures, osteoporosis dermatological dental ```

Question 104

common mental health problems in learning disability

Answer 104

``` schizophrenia/psychosis mood disorders OCD Autism ADHD challenging behaviour and self injury forensics ```

Question 105

HEADASSS questionnaire

Answer 105

``` HOME ENVIRONMENT EDUCATION/EMPLOYMENT ACTIVITIES DRUGS/DIET SEX SAFETY SUICIDE ```

Question 106

presentation of mood disorders in children

Answer 106

• Only difference in diagnostic criteria is that irritable mood may replace depressed mood • Physical factors ○ Insomnia (children), hypersomnia (adolescents ○ Somatic complaints ○ Substance abuse ○ Decreased hygiene • Psychological factors ○ Irritability, boredom, anhedonia, low self-esteem, deterioration in academic performance, social withdrawal, lack of motivation, listlessness • Comorbid diagnoses Anxiety, ADHD, ODD, conduct disorder, eating disorders

Question 107

treatment of mood disorders in children

Answer 107

• Majority don’t seek • Individual (CBT, IPT) family therapy, education SSRIs - fluoxetine

Question 108

common anxiety disorders in children

Answer 108

separation anxiety | social anxiety

Question 109

treatment of anxiety in children

Answer 109

• Family psychotherapy, predictive and supportive environment • CBT: child and parental education, relaxation techniques, exposure/desensitisation, recognising and correcting anxious thoughts Fluoxetine

Question 110

features of separation anxiety in children

Answer 110

* Excessive and developmentally inappropriate anxiety on real, threatened, or imagined separation from primary caregiver or home, with physical or emotional distress for at least 4 week * School refusal and comorbid major repression common * Persistent worry, refusal to sleep alone, clinging, nightmares involving separation, somatic symptoms

Question 111

features of social anxiety in children

Answer 111

• Anxiety, fear and/or avoidance provoked by situations where child feels under the scrutiny of others • Must distinguish between shy child, child with issues functioning socially (e.g. autism) and child with social anxiety ○ Diagnosis only if anxiety interferes significantly with daily routine, social life, academic functioning or if markedly distressed. Must occur in settings with peers not just adults • Features: ○ Temper tantrums, freezing, clinging, mutism, excessively timid, stays on periphery, refuses to be involved in group play ○ Significant implication for future QoL if untreated, lower levels of satisfaction in leisure activities, higher rates of school dropouts, poor work performance

Question 112

areas of deficits in ASD

Answer 112

social emotional reciprocity nonverbal communicative behaviours developing and maintaining relationships

Question 113

restricted, repetitive patterns of behaviour, interests or activities. manifested by 2 or more of In ASD

Answer 113

1. Stereotyped or repetitive motor movements 2. Insistence on sameness 3. Highly restricted fixated interests Hyper/hypo reactivity to sensory input

Question 114

DDx for ASD

Answer 114

1. Developmental disability 2. Childhood schizophrenia 3. Social phobia 4. OCD 5. Communication disorder 6. Nonverbal learning disorder 7. ADHD 8. Abuse 9. Hearing or visual impairment 10. Seizure disorder Motor impairment

Question 115

DDx of ADHD

Answer 115

1. Learning disorders 2. Hearing/visual defects 3. Thyroid 4. Atopic conditions 5. Congenital syndromes (FAS, fragile X) 6. Lead poisoning 7. Hx of head injury Traumatic life events

Question 116

diagnosis of ADHD

Answer 116

• Onset < 12 yrs. • Persistent symptoms > 6 months • Symptoms present in at least 2 settings (i.e. home, school, work) Interferes with academic, family and social functioning

Question 117

domains of ADHD

Answer 117

inattention hyperactivity impulsibiyu

Question 118

treatment of ADHD

Answer 118

stimulants - methylphenidate atomoxetine bupropion

Question 119

indications for antidepressants

Answer 119

* Unipolar and bipolar depression * Organic mood disorders * Schizoaffective disorder * Anxiety disorders including OCD * Panic * Social phobia * PTSD * Premenstrual dysphoric disorder * Impulsivity associated with personality disorders

Question 120

how long would you continue antidepressants for?

Answer 120

first episode - 6 months to 1 yr second - 2 yrs 3rd - life long

Question 121

name tertiary TCAs

Answer 121

imipramine amitriptyline doxepin clomipramine

Question 122

name the main mental health law

Answer 122

mental health (Care and treatment) (Scotland) Act 2003

Question 123

according to the law what is a mental disorder?

Answer 123

any mental illness, personality disorder, learning disability, however caused or manifested. Not only by: sexual orientation, sexual deviancy, transexualism, transvestism, drug/alcohol dependence, acting as no prudent person doses

Question 124

how long does an emergency detention certificate last?

Answer 124

72 hrs

Question 125

who can issue an EDC?

Answer 125

registered medical practitioner

Question 126

general criteria for detaining someone under the mental health act

Answer 126

has a mental disorder because of the mental disorder the patients decision making ability with regard to medical treatment for that disorder is significantly impaired it is necessary to detain the patient in hospital for the purpose of treatment there would be significant risk to the patient or others if not detained it is necessary

Question 127

how long does a short term detention certificate last?

Answer 127

28 days

Question 128

who can issue a STDC?

Answer 128

approved medical practitioner

Question 129

how long does a compulsory treatment order last?

Answer 129

6 months

Question 130

who can issue a CTO?

Answer 130

mental health officer

Question 131

How long does a nurses holding power last?

Answer 131

3 hrs

Question 132

name the act dealing with incapacity

Answer 132

adults with incapacity (Scotland) act 2000

Question 133

criminal justice and licensing (Scotland) act 2010: criminal responsibility of persons with mental disorder

Answer 133

a person is not criminally responsibile for conduct if at the time unable by mental disorder to understand the nature or wrongness

Question 134

criminal justice and licensing (Scotland) act 2010: unfittness for trial

Answer 134

person is incapable by reason of a mental or physical condition, of participating effectively in the trial

Question 135

criminal justice and licensing (Scotland) act 2010: diminished responsibility

Answer 135

a person who would otherwise be convicted of murder is instead convicted of culpable homicide on grounds of diminished responsibilty if the person's ability to determine or control conduct for which the person would otherwise be convicted of murder was, at the time of the conduct, substantially impaired by reaon of bnormality of mind

Question 136

assessment order

Answer 136

court is statisfed that there are reasonable grounds that: mental disorder detention necessary civil risk treatment bed within 7 days could not be undertaken if not in hospital

Question 137

how long does a treatment order last?

Answer 137

until final disposal or another order is granted

Question 138

what is CBT?

Answer 138

how thoughts relate to feelings and behaviour

Question 139

what is CBT good for?

Answer 139

``` depression anxiety phobias OCD PTSD ```

Question 140

what is behavioural activation?

Answer 140

focus on avoided activities | on what predicts and maintains an unhelpful response

Question 141

what is interpersonal therapy good for?

Answer 141

depression | anxiety

Question 142

what is interpersonal therapy

Answer 142

sick role given construct an interpersonal map focus area maintained

Question 143

what is motivational interviewing

Answer 143

promotes behaviour change

Question 144

principles of motivational interviewing

Answer 144

express empathy avoid argument support self-efficacy

Question 145

describe the cycle of change

Answer 145

``` precontemplation contemplation planning action maintenance relapse ```