Psychiatry Flashcards
(222 cards)
1
Q
what is an illusion?
A
misconception of a real external stimulus
affect driven
2
Q
what is a hallucination?
A
disorder of perception
- experienced in the ABSENCE of external stimuli
3
Q
types of hallucination
A
- 2nd person auditory- talking to them
- 3rd person auditory- talking about it
- visual
- olfcatory
- hypnogogic (occur on falling asleep)
- hyponopompic (occur on waking up)
- autoscopic- visualising yourself
- reflex- stimulation in one modality produces hallucination in another
4
Q
what is a pseudo-hallucination?
A
perceptual experience which originates in space of own mind
5
Q
what is a delusion?
A
- disorder of thought
- a belief that if firmly held, not affected by rational argument or evidence, not a conventional belief
6
Q
what is a persecutory delusion?
A
believing that you are going to be/ are being intentionally harmed
7
Q
what are grandiose delusions?
A
inflated self-importance- e.g. belief that you are a god
8
Q
what are delusions of reference?
A
certain events/ actions can have special significance (e.g. believing that black cars are following you)
9
Q
what is a nihilistic delusion?
A
delusion of nothingness- believes they have no money, nothing inside of them etc
10
Q
what is an ertomanic (De Clerambaults) delusion?
A
belives they are of a high social standing/ everyone is in love with them
11
Q
what is a morbid jealousy/ orthello delusion?
A
delusion that a sexual partner is unfaithful, can lead to violence
12
Q
what is a delusion of misidentification (Capgras)
A
delusion that a close relative has been replaced by an imposter
13
Q
what is a cotard delusion?
A
belief they are dead/ do not exist
14
Q
what is a folie a deux delusion?
A
shared delusion with someone else
15
Q
what is an ekboms delusion?
A
delusion of infestation
16
Q
what is psychosis?
A
a severe mental disorder in which thought and emotions are so impaired that contact is lost with external reality
17
Q
what is neurosis?
A
symptoms of stress (depression, anxiety, OCD etc) but no radical loss of touch with reality
18
Q
what is passivity phenomena?
A
feeling that ones actions/ thoughts are not their own and are controlled by someone else
19
Q
what is somatic passivity?
A
belief that they are a recipient of bodily sensations from an external force- e.g. someone else is making their arm hurt
20
Q
what is catatonia?
A
significantly excited/ inhibited motor activity
21
Q
what is stupor?
A
loss of activity with no response to stimuli
22
Q
what is psychomotor retardation?
A
slowing of thoughts/ movements
23
Q
what are some types of thought alienation?
A
o Thought Insertion
o Thought Withdrawal - someone/thing removing thoughts from head
o Thought Broadcast - thoughts made available to others
o Thought Echo
o Thought Block - abrupt stop in middle of thought - may not be able to continue idea
24
Q
what is concrete thinking?
A
lack of abstract thinking
25
what is loosening of association?
lack of logical association between thoughts- incoherent speech
26
what is circumstantiality ?
going into ridiculous detail to make a point
27
what is perseveration?
repetition of a word, theme or action beyond the point of it being relevant/ appropriate
28
what is confabulation?
giving a false account to fill gap in memory
29
what is tangeliality?
wandering off topic
30
what is flight of ideas?
rapidly skipping from one thought to a distantly related idea
31
what is echolalia?
meaningless repetition of another persons spoken words
32
what are clang associations?
ideas that are linked by rhyme or the similarity of words
33
what is pressure of speech?
rapid speech with unusual associations
34
what is anhedonia?
inability to experience pleasure from activities that would normally cause this
35
what is incongruity of affect?
patients emotional response is grossly out of tune with the situation/subject- e.g. smiling when talking about death
36
what is a flat affect?
no emotion
37
what is blunting of affect?
reduced emotional expression/ response
38
what is Belle indifference?
relative lack of concern about the nature/ implication of the patients symptoms
39
what is depersonalisation?
detached from body- world has become vague/ dream like
can observe themselves
40
what is derealisation
external world feels unreal
41
what is conversion?
manifestation of mental illness as a physical order disease
42
what is dissociation?
disruptions in aspects of conciousness, identity, memory
43
what are mannerisms?
repeated involuntary movements that are goal directed
44
what is akathisia?
feeling of inner restlessness- rocking., marching on spot etc
45
what is tardive dyskinesia?
involuntary, repetitive jerky movement of head/ neck
46
what are pharmacokinetics?
what the body does to the drug
47
what are pharmacodynamics?
what a drug does to the body
48
what are 'positive' symptoms?
an excess or a distortion of normal functioning (delusions, hallucinations, disorganised speech/ behaviour, catatonic behaviour)
49
what are negative symptoms?
decrease/ loss of functioning (e.g. decreased emotions, loss of interest, flat affect, alogia)
50
what are some positive symptoms that can be seen in Schizophrenia?
delusions (usually persecutory), hallucinations, formal thought disorder
51
what are some negative symptoms that can be seen in Schizophrenia?
impairment of motivation and loss of volition
| loss of awareness of socially appropriate behaviour/ social withdrawal
52
what are the first rank symptoms in schizophrenia?
- 3rd person auditory hallucinations
- delusional perception- delusions of passivity, influence or control
- thought disorders- withdrawal, insertion, broadasting
- passivity phenomenia
53
ICD-10 classification in schizophrenia
One or more of
- 3rd person auditory hallucintion
- Thought echo, insertion, withdrawal, broadcasting
- Delusional perception
- Passivity phenomena
Or two or more of
- Any persistent hallucination
- Catatonic behaviour - stupor, waxy flexibility
- negative symptoms
- breaks in train of thought
- impaired sight
- neologisms (making up words)
54
subtypes of schizophrenia
Paranoid- auditory hallucinations, no thought disorders, grandiose delusions
Hebephrenic- thought disorder and flat affect
catatonic- subject may be immobile
residual- 1 year of chronic negative symptoms which much have been preceded by at least one clear psychotic episode in the past
55
investigations in schizophrenia
- U&E's- rule out drug cause
- LFT, FBC- rule out alcohol as a cause
- serological test- rule out syphilis
- CT head- brain lesion
56
what 4 things are assessed in a psychosis risk assessment?
- risk to self
- risk to others
- risk from others
- risk of criminal damage to property
57
epidemiology of Schizophrenia
- 15/100,000
- slightly more common in men
- age of onset- late-teens/ mid- twenties, can be a bit later in women
- increased prevalence in lower socio-economic classes
58
what are some motor symptoms seen in schizophrenia?
- catatonic rigidity (maintaining a fixed position and resisting being moved)
- catatonic posturing (adopting an unusual position for a period of time)
- catatonic negativism (patients resist all instructions to move)
- catatonic excitement (excitable motor activity with no external stimulus)
- catatonic stupor (presentation of akinesis, mutism and extreme unresponsiveness)
59
how is schizophrenia caused?
excess dopamine
overactivity of neurones- mesolimbic- results in hallucinations and delusions
under activity fo neurones- mesocortical- blunted, anhedonia, apathy
60
what do mesolimbic and mesocortical mean?
mesolimbic= positive symptoms
mesocortical= negative symptoms
61
what are some extra-pyramidal side effects of the treatment of schizophrenia?
- acute- acute dystonic reaction (muscle spasms)
- few weeks- Parkinsonism
- 6-60 days- akasthesia (inner restlessness)
- long term use- tardive dyskinesia
62
how are the extra-pyramidal side effects of schiophrenia treatment treated?
procycladine
propanolol +/- cyproheptadine
tetrabenazine
63
in schizophrenia what is procycladine used for?
EPSE- treatment of acute dystonia/ parkinsonism
64
in schizophrenia what is propanolol/cyproheptadine used for?
EPSE- treatment of akathesia
65
in schizophrenia what is tetrabenazine used for?
EPSE- treatment of tardive dyskinesia
66
what 1st generation antipsychotics are used in schizophrenia?
haloperidol
chloropromazine
67
what are some atypical/ new antiphyscotics used in schizophrenia?
olanzapine, risperidone, quetiapine, clozapine
68
what are the main dopamine and serotonin receptors?
Dopamine- D2
serotonin- 5HT2a
69
what does dopamine inhibit?
prolactin
70
what are some symptoms of hyperprolactinaemia?
- galactorrhoea
- amenorrhoea
- infertility
- sexual dysfunction
71
which antipsychotics can cause weight gain?
- all atypical
| - clozapine/ olanzapine
72
side effects of clozapine
- weight gain
- agranulocytosis- high risk of infection
- reduced seizure threshold
- sedating
- postural hypotension
- extreme salivating
- cardiomyopathy
- toxic megacolon
73
which pathway causes excess proclactin?
tuberoinfundibulnar
74
which pathway causes movement disorders?
nigrostriatal
75
schizophrenia- signs and symptoms of neuroleptic malignant syndrome?
- reduced activity
- fever, altered mental status, muscle rigidity, autonomic dysfunction
- signs- elevated creatine Kinase, raised WCC, metabolic acidosis
76
schizophrenia- what drugs can cause neuroleptic malignant syndrome?
haloperidol
| chloropromazine
77
what is schizoaffective disorder?
presentation of both schizophrenic and mood (depressed/ mania) symptoms that present in the same episode of illness
78
what are the 3 'phases' of schizophrenia?
- prodromal- withdrawn
- active- severe symptoms- positive
- residual phase- cognitive symptoms
79
what is generalised anxiety disorder (GAD)?
anxiety that is generalised and persistent- not isolated to any specific environmental circumstance
80
what are some risk factors of GAD?
- early/ middle age
- more common in females
- divorced/ separated
- live alone
81
what are clinical features are needed for a diagnosis of GAD?
3 of:
- restlessness
- irritability
- easily fatigued
- difficulty concentrating
- muscle tension
- sleep disturbance
+4 symptoms of someone with anxiety (imagine typical patient- palpitations, increased HR, sweating, difficulty concentrating, numbness etc)
82
investigations in GAD
- exclude physical illness- hyperthyroid, pheochromocytoma, cardiac disease
- medication review- salbutamol, theophylline, corticosteroids
- rule out withdrawl symptoms of alcohol and benzodiazepines
- exclude PTSD, OCD, depression, schizophrenia, dementia, personality disorder
83
how is GAD managed?
1- lifestyle- exercise etc
2- low intensity psychological support, guided self help
3- CBT, medication
4- specialist input
84
what medications are used in GAD?
rapid response- benzodiazepines (lorazepam etc)
long-term- SSRI sertraline, clomipramine
85
what is a panic attack?
period of intense fear characterised by a group of symptoms that develop rapidly
dont last longer than 20-30 minutes
86
what is panic disorder?
recurrent panic attacks not secondary to substance misuse, medical conditions, another psychiatric disorder
87
what comorbidities can correlate with panic disorder?
agoraphobia
anxiety
bipolar
88
differential diagnosis of a panic attack
- anxiety/ anxiety related disorders
- substance/ alcohol misuse and withdrawal
- mood disorder
- psychiatric disorder secondary to a medical condition
89
management of panic disorder
1- recognition
2- primary care treatment- CBT, SSRI- sertraline, clomipramide
3- review and consideration to alt. treatment
4- review and referral to specialist mental health
5- care in specialist mental health services
90
what is agoraphobia?
anxiety/ panic symptoms associated with places or situations where escape may be difficult/ embarrassing- this leads to avoidance of situation
91
management of agoraphobia
- SSRI's
- benzodiazepines
- pshycological- exposure techniques, cognitive methods
92
what is OCD?
obsessive compulsive disorder
obsessions are unwanted intrusive thoughts, images or urges that repeatedly enter the persons mind
compulsions are repetitive behaviours that the person feels a drive to perform
i.e.- the OBSESSION is being clean whereas the COMPULSION is washing their hands regularly
93
Treatment of OCD
- CBT- exposure and response prevention
SSRI- fluoxetine/ sertraline
TCA- Clomipramine
94
difference between OCPD and OCD
OCPD= obsessive compulsive personality disorder- they're okay with it
OCD- egodystonic (they do not like the obsessions and complusions)
95
risk factors of PTSD
```
low education
lower social class
female
afro Caribbean/ hispanic
FH
previous traumatic events
```
96
clinical features of PTSD
- re-experiencing- flashbacks, nightmares etc
- avoidance- avoiding people, situations and circumstances resembling the event
- hyperarousal- sleep problems, hypervigiilance for threat, exaggerated startle response
- emotional numbing
97
treatment of PTSD
- psychological- CBT, EMDR (eye movement desensitisation and reprocessing)
- pharm- SSRI- sertralline
- sleep disturbance- mirtazapine
98
PTSD- diagnosis
ICD 10
symptoms arise within 6 months of event
symptoms present for at least 1 month
99
what are neuroses?
class of functional mental disorders with chronic distress, in the absence of delusions and hallucinations
100
what are the common causes of delirium?
PINCH ME
```
Pain
Infection/ intoxication
Nutrition (B12/thiamine def.)
Constipation
Hypoxia/hydration
```
Medication/drugs/substance abuse
Environmental
101
clinical features of delirium
- acute
- fluctuating
- inattention
- reduced comprehension
- disorientation
- anterograde amnesia
- labile affect
- visual hallucination
- paranoid delusions
102
what are the 3 subtypes of delirium?
- hypoactive
- hyperactive
- mixed
103
differential diagnosis of delirium
- dementia
- alcohol withdrawal
- mania
- post-ictal
- psychosis
- anxiety
104
how can delirium and dementia be determined from eachother?
- onset- delirium= acute, dementia= gradual
- pathology- delirium= outside brain, dementia= brain
- course of disease- delirium= can improve, dementia= progressively worse
- attention- delirium= impaired consciousness/ innattention, dementia= preserved conciousness
- fluctuations- delirium= throughout day, dementia= minor
- aetiology- delirium= secondary to something, dementia= normally primary except for lewy body and vascular
- treatable?- delirium= yes, dementia= no
105
investigations in delirium
- bloods- FBC, U&E, LF, glucose, TFT
- blood cultures (MC&S)
- Blood gases
- ecg
- CT/ LP
- CXR
106
Management of delirium
- treat precipitating course
- support- sleep hygiene, side room, adequate lighting, clocks and calendars etc
- sedation- haloperidol (if the pt does not have parkinsons!)- if they do, give lorazepam
107
how long must symptoms of depression be present for a diagnosis?
everyday for 2 weeks
108
what are the 3 core symptoms of depression?
- low mood
- low energy (anergia)
- loss of enjoyment (anhedonia)
109
give some clinical features of depression (pneumonic)
DEADSWAMP
Depressed mood most of day
Energy low
Anhedonia
Death thoughts (suicidal)
```
Sleep disturbance (insomnia)
Worthlessness/ guilt
Appetite/ weight change
Mentation decreased (lack of concentration)
Psychomotor agitation/ retardation
```
110
what are the criteria for defining depression?
- mild- 2 core + 2 other clinical features
- moderate- 2 core + 3+ other
- severe- 3 core, 4+ others
111
risk factors of depression
- biopsychosocial
- genetic
- childhood experiences- abuse, loss of parent, lack of care
- social- marriage problems, socio-economic status
- chronic disease
- personality- anxiety, obsessionality
112
how is depression assessed?
- PHQ-9= patient health questionnaire
| - HADs= Hospital Anxiety and Depression scale
113
management of mild depression
- lifestyle- activity, sleep hygiene, reduce stress, CBT
114
management of moderate depression
lifestyle, anti-depressants, CBT
115
management of severe depression
specialist mental health assessment (consider inpatient admission), ECT- electroconvulsive therapy
116
pharmacological management of depression
1st line- SSRI- fluoxetine, citalopram, sertraline
2nd- alterate SSRI
3rd:
- NaSSA- mirtazapine
- SNRI- velafaxine/ duloxetine
4th line:
- TCA's- amitryptilline, clomipramine
- anti-cholinergic/ muscarinic
- MAOIs- moclobemide
117
what medication used in depression can cause QT prolongation?
Citalopram
118
what medication used in depression can cause drowsiness and weight gain?
Mirtazapine (NaSSA)
119
what 2 hormones are reduced in depression?
serotonin and noradrenaline
120
what medication classes are used in the treatment of depression?
- SSRI- selective serotonin reuptake inhibitor
- SNRI- serotonin noradrenaline reuptake inhibitor
- MOAI- monoamine oxidase inhibitors
- TCA- tricyclic antidepressants
- NaSSA= Noradrenergic and Specific Seritonergic Antidepressants
121
summarise postpartum depression (presentation, screening, treatment etc)
- peaks at 3 months
- Edinburgh post natal depression scale to screen
- Tx- reassurance and support, CBT, SSRI's (sertraline/ paroxetine), tricyclics
122
what are pharmacokinetics?
what the body does to the drug (absorption, distribution, elimination)
123
what are pharmacodynamics?
what the drug does to the body
124
what are the 4 key neurotransmitters in the brain
dopamine
serotonin
acetylcholine
glutamate
125
treatment of neuroleptic malignant syndrome
bromocriptine- reduces dopamine blockade (dopamine agonist)
dantrolene (reduced muscle spasms)
126
what can cause serotonin syndrome?
serotonergics (SSRI's, MAOI's, ecstasy)
127
symptoms of serotonin syndrome
increased activity- clonus, hyperreflexia, tremor, muscle rigidity, dilated pupils
autonomic dysfunction- tachycardia and an unstable BP
acute onset
128
what is seen in the bloods of a pt with serotonin syndrome?
elevated CK and WCC
derranged LFT's
metabolic acidosis
129
treatment of serotonin syndrome
cyproheptadine (5HT-2a antagonist)
benzodiazepines
130
what are the features of dependence?
- compulsion to drink
- tolerance
- difficulties controlling consumption
- physiological withdrawal
- neglect of alternatives
- persistent use despite harm
131
risk factors for dependence
- men
- low education
- unemployment
- younger age of usage
- mental illness
- peer pressure
- low self esteem
- high stress
- FH
- genetic susceptibility
132
assessment of alcoholism
CAGE- ever been asked to Cut down?, do you get Annoyed when people criticise your drinking, do you feel Guilty? Eye-opener- i.e. drinking first thing in the morning etc?
audit
133
what is the TWEAK assessment in alcoholism?
```
Tolerance (>6 drinks, 2 points)
Worried (yes= 2 points)
Eye-opener ( 1 point)
Amnesia (1 point)
Cut Down (1 point)
```
>3= problem with alcohol use
134
consequences of alcoholism
- liver damage
- pancreatitis
- diabetes
- cancer
- CNS disturbances- peripheral neuropathy
+ loads more
135
how will a pt with alcoholism present on examination?
- acute- vomiting, nausea, sweating, unsteady gait, ataxia, agitation
- chronic- clubbing, hepatomegaly, spider naevi, palmar erythema, gynecomastia, dupuytrens
136
investigations in alcoholism
- raised MCV- macrocytic anaemia
- B12 and folate deficiency
- derranged LFT's
137
management of alcohol dependance
- acomprosate to reduce cravings
- disulfiram
- naltrexone
- CBT
138
management of alcohol withdrawal
- chlordiazepoxide
- IV pabinex 5 dayss
- thiamine 100mg
139
symptoms of alcohol withdrawal
- symptoms develop 6-12 hours after cessation
- tremors
- sweating
- nausea/ vomiting
- hyperacusis (sound sensitivity)
- mood disturbance- anxiety
- autonomic hyperactivity
140
investigations in alcohol withdrawal
- raised MCV- macrocytic anaemia
- deranged LFTs- GGT, AST/ALT
- thrombocytopenia- reduced platelets
141
what is delirium tremens?
- fatal form of alcohol withdrawal
| - altered consciousness and marked cognitive impairment
142
symptoms of delirium tremens
- vivid hallucinations and illusions in any sensory modality
- lilliputian- visual hallucinations of small humans/ animals
- formications- insects crawling on skins
- paranoid delusions
- marked tremor
- autonomic arousal- heavy sweating, raised pulse, raised BP
143
what triad of symptoms is seen in Wernicke's encephalopathy?
- delirium
- ocular signs (opthalmoplegia, mystagmus)
- wide based gait ataxia
144
how is Wernicke's treated?
IV Pabrinex and chlordiazepoxide
145
what causes Wernicke's encephalopathy?
thimaine deficiency- most commonly seen in alcoholics
146
what can untreated Wernicke's lead to?
Korsakoff's syndrome
147
what is Korsakoff's syndrome?
chronic state of thiamine deficiency
148
triad seen in Korsakoff's
- anterograde amnesia
- confabulation
- psychosis
149
treatment of Korsakoff's
same as Wernicke's- IV pabrinex and chlordiazepoxide
150
symptoms of opiate intoxication
- drowsiness
- mood change
- bradycardia
- HTN
- pupillary constriction
- respiratory depression
- decreased body temp
151
symptoms of opiate withdrawal
- muscle cramps
- low mood
- insomnia
- agitation
- diarrhoea
- shivering
- flu-like symptoms
152
complications of opioid misuse
- viral infection secondary to sharing needles- hiv, HEP b/c
- bacterial infection- infective endocarditis, septic arthritis
- overdose- respiratory depression and death
153
management of:
- opoid misuse
- opioid dependance
- misuse= IV naloxone
| - if dependence- methadone and buprenophrine
154
diagnostic criteria for anorexia
- weight <85% predicted
- BMI <17.5kg/m2
- intense fear of gaining weight or becoming fat with persistent behaviour that interferes with weight gain
- feeling fat when underweight
155
clinical signs of anorexia
- general- fatigue, decreased cognition, cold intolerance, altered sleep cycle
- dental caries
- CV- bradycardia, low BP, QT prolongation
- dermatological- lanugo hair (fine downy hair), yellow skin, dry and brittle hair
- GI- constipation
- sexual health- subfertility and amenorrhoea
- haemaotlogical- low WCC, low hb, low platelets
- endocrine- low glucose etc
156
what is the SCOFF questionarre?
```
>2 indicates anorexia nervosa/ bulimia
Sick (making yourself)
Control of eating lost
One stone loss in 3 months
Feel fat
Food (dominates your life)
```
157
red flags for anorexia
- BMI <13 or below 2nd centile
- weight loss >1kg/ week
- temp <34.5
- BP <80/50
- Sa02 <92%
- long QT, flat T
- muscle weakness
158
what is re-feeding syndrome?
drop in phosphate due to the rapid initation of food after >10 days of malnutrition
159
clinical signs of re-feeding syndrome
- rhabdomyolysis
- respiratory/ cardiac failure
- low bp
- arrythmia's
- seizures
160
management of re-feeding syndrome
- slow re-feeding
- thiamine/ vitamin B
- monitor for low phosphate and potassium, high glucose and magnesium
161
management of anorexia
- restore nutritional balance
- treat complications of starvation
- involve family
- admit if severe
- psychological therapies
162
what psychological therapies are offered to adults and children with anorexia?
- Adults- ED-CBT (eating disorder focused CBT), MANTRA (Maudsley anorexia nervosa treatment for adults)
- children- first line -anorexia focused family therapy, 2nd line- CBT
163
what is bulimia?
recurrent episodes of binge eating with a preoccupation with the control of body weight.
regular use of mechanisms to overcome binging- vomiting, starvation, laxatives, excessive exercise
164
clinical signs of bulimia
same as anorexia plus:
- oesophagitis (due to vomiting)
- Russell's sign
- oedema
- gastric dilation
- CM (due to laxatives)
- metabolic alkalosis
165
what is Russell's sign?
callouses/ scars (excoriations) on the back of the knuckles and hands, due to repeated contact of the fingers with teeth during self-induced vomiting episodes
seen in bulimia
166
management of bulimia
- support
- referral to EDU
- SSRI's- fluoxetine- can reduce binging and purges
167
what is bipolar?
manic depression
requires at least 2 episodes, of which one must be mania/ hypomania for diagnosis
168
what are the 3 subtypes of bipolar?
bipolar 1= mania+ depression, psychotic symptoms
Bipolar II= hypomania- more episodes of depression and no psychosis
Cyclothymia= cyclic mood swings with subclinical features
169
features of mania (>1 week)
- extreme uncontrollable elation
- overactivity
- pressure of speech
- impaired judgement
- extreme risk taking behaviour
- social disinhibition
- inflated self-esteem and grandiosity
- psychotic symptoms
170
features of hypomania (4+ days)
- elevated mood
- increased energy
- increased talkativeness
- poor concentration
- mild reckless behaviour
- overfamiliarity
- sexual disinhibition
- increased confidence
- decreased sleep
171
aetiology of bipolar disorder
- female (commonly post-partum)
- asylum seekers
- LGBTQ+
- traumatic life events
- FH of depression, bipolar, suicide
- substance/ alcohol abuse
- serious/ chronic illness
172
treatment of acute mania in bipolar
severe/ life threatening= ECT (electroconvulsive therapy)
lithium (max 2 weeks)
additional antiphyscotics/ benzo's required:
- risperidone
- olanzapine
- haloperidol
173
long term treatment of bipolar
1st line:
- lithium
- check TSH, U&E's and hydration status every 6 months
2nd line:
- valporate// lamotrigine
- CBT
ECT in severe mania
174
what is lithium toxicity and describe its course?
- levels >1.0mmol/L
- sudden onset
- course- tremor, hyperreflexia, seizures, heart block
also nausea, vomiting, ataxia, muscle weakness, nystagmus, dysarthria, impaired consciousness, hypotension, coma
175
side effects of lithium in bipolar disorder
- thirst, polyuria, polydipsia
- weight gain
- fine tremor
- hypothyroidism
- impaired renal function
- T wave flattening/ inversion
176
definition of personality disorders
a severe disturbance in the characterological condition and behavioural tendencies of an individual, usually involving several areas of the personality and nearly alway associated with considerable personal and social disruption
177
what is required for a diagnosis of a personality disorder?
inhibition of functioning ! (work/relationships/ day to day life)
178
risk factors for a personality disorder
- sexual/ physical/ emotional abuse
- neglect
- bullied
- early childhood trauma
- truanting
- deliberate self harm
179
management of personality disorders
- non pharmacological- dialectical behavioural therapy (DBT)
CBT
interpersonal therapy (IPT)
benzo's can be used in short-term management
180
what are the 3 clusters of personality disorders?
A- eccentric= paranoid (delusional), schizoid (socially withdrawn), schizotypical (distorted reality)
B- Flamboyant= borderline, dissocial, narcissistic, histrionic
C- Fearful/ anxious= avoidant, dependent, anakastic
181
features of a cluster A paranoid personality disorder
- sensitive/ easily offended
- suspicious
- self entitlement
- unsubstantial conspirational explanations
- distrusts loyalty
- bears grudges
- guarded/ defensive
182
features of a cluster A schizoid personality disorder
- no pleasure from activities
- emotional coldness
- indifferent to praise or criticism
- little interest in sexual experiences
- fantasises
- solitary activities
- indifferent/ solitary/ humourless
183
features of a cluster A schizotypical personality disorder
- social and interpersonal deficits
- daydreaming
- unusual perceptions
- vague, circumstantial and suspicious
- excess social anxiety
- eccentric/ bizarre lifestyle
184
features of a cluster B borderline personality disorder
- act without regard to consequences
- quarrelsome
- anger outburst
- self image uncertainty
- unstable relationships
- self harm
- manipulative
185
features of a cluster B dissocial personality disorder
- unconcerned by feelings of others
- irresponsibility
- incapacity to maintain relationships
- low tolerance to frustration, anger and violence
- incapacity to feel guilt
- prone to blame others
- impulsive
186
features of a cluster B narcissistic personality disorder
- persuasive grandiosity
- lack of empathy
- preoccupied with fantasies
- requires excessive admiration (sense of entitlement)
- special and unique
- envious of others
- egotistical/ arrogant
187
features of a cluster B histrionic personality disorder
- self dramatisation
- easily influenced
- shallow and liable affectivity
- preoccupied with physical attractiveness
- inappropriately seductive
- attention seeking
- shallow/ vein/ dramatic
188
features of a cluster C avoidant personality disorder
- tense and apprehensive
- inferiority complex
- preoccupied with sense of rejection and criticism
- unwillingness to get involved
- avoidance of social and occupational activities
- need for security
189
features of a cluster C dependent personality disorder
- allowing others to make important life decisions
- subordination
- unwilling to make demands
- uncomfortable or helpless alone
190
features of a cluster C anakastic (OCPD) personality disorder
- rigid conformity to rules
- perfectionism
- inflexibility
- everything has to go to their plan
191
what is the difference between an avoidant and schizoid personality disorder?
schizoid voluntarily withdraw from social situations
avoidant- desire compannonshship but cant- afraid of rejection
192
what are some secondary causes of insomnia?
- narcolepsy
- sleep apnoea
- circadian rhythm disorders
- parasomnia
- stress
- psych- depression, bipolar, GAD, PTSD
193
management of insomnia
- CBT
- sleep hygiene advice- limit caffiene and alcohol, exercise, less screen use etc
- short acting benzo's- lorazepam, nitrazepam
194
how is a patients suicide risk assessed?
SAD PERSONS
Sex (males)
Age (peaks at young and old)
Depression
```
Previous attempts
Ethanol abuse (alcohol)
Rational thinking loss (schizo)
Support network less
Organised plans (note etc)
No significant others
Sickness
```
0-2- keep watch
3-4- send home but check up on
5-6- consider hospitalisation
7-10- definitely hospitalise
195
how is a violent patient treated?
haloperidol (or lorazepam)
196
for Section 3 of the mental health act, state the:
- duration
- reason
- who it needs to be approved by
- evidence required
- duration= 6 months (can be renewed)
- reason= treatment
- approved by= 2 doctors (one s12) and 1 AMHP
- evidence= mental disorder, safety and protection of themselves and others and appropriate treatment is available
197
for Section 2 of the mental health act, state the:
- duration
- reason
- who it needs to be approved by
- evidence required
- duration= 28 days (not renewed)
- reason= assessment (treatment can be given without consent)
- approved by= 2 doctors (one s12) and 1 AMHP
- evidence= patient suffering from a mental disorder, detained for safety of themselves and others
198
for Section 4 of the mental health act, state the:
- duration
- reason
- who it needs to be approved by
- evidence required
- duration= 72 hours
- reason=emergency order- used when waiting for 2nd doctor would cause undesirable delay
- approved by= 1 doctor, 1 AMHP
- evidence= mental disorder, safety of themselves and others, not enough time for 2nd doctor to attend
199
for Section 5 (4)of the mental health act, state the:
- duration
- reason
- who it needs to be approved by
- evidence required
- duration= 6 hours
- reason= pt admitted but wanted to leave
- approved by= nurse holding power
- evidence= cannot be coercively treated
200
for Section 5(2) of the mental health act, state the:
- duration
- reason
- who it needs to be approved by
- evidence required
- duration= 72 hours
- reason= allows time for section 2 or 3 to be completed
- approved by= doctor holding power
- evidence= cannot be coercively treated
201
what is a section 135?
police section; used to detain a patient when they are in their own home, detained in order to complete section 2 or 3
202
what is a section 136?
police section; used to detain a patient when they are in a public place, detained in order to complete section 2 or 3
203
what are the 5 principles of the mental capacity act and who does it apply to?
anyone over 16
5 principles:
- assume capacity
- individual supported to make own decision
- unwise decisions do not mean lack of capacity
- best interests
- least restrictive practice
204
what does the capacity assessment test?
- does the person have impairment or disturbance of mind or brain?
is the patient able to:
- understand
- retain
- weigh up
- communicate decision
205
what is an IMCA?
independent mental capacity advocate
206
what is an advanced statement?
written document stating the patients wishes should they lack capacity in the future
however this is not a legally binding document
207
what are advanced decisions/ directives?
LEGALLY BINDING
stipulates person's refusal of certain medical interventions/ must be signed when person has capacity
208
what is the court of protection?
makes decisions if no lasting power of attorney
209
what is a last power of attorney?
person to make decisions for the patient if they lack capacity in the future
210
what are DOLS?
Deprivation of Liberty Safeguards
allows deprivation of someones liberty who lacks capacity in a hospital environment if it is in the patients best interest
211
DD for dementia
- the 4 types
- Picks
- Creutzfeldt-Jacob disease
- Huntingtons
- HIV
- neurosyphillis
- Wilson's disease
- normal pressure hydrocephalus
- alcohol-induced dementia
212
DD for psychosis
- types of schizophrenia
- persistent delusional disorder
- schizoaffective disorder
- puerperal psychosis
213
DD for mood (affective) disorder
- hypomania
- mania
- bipolar
- persistent mood disorder
- cyclothymia
- baby blues
- post natal depression
214
What dietary restrictions are required for a pt taking a MOAI?
aged cheese
beer
red wine
smoked meat/ fish
215
what medication can cause a hypertensive crisis and how is this treated?
MOAI's
tx- phentolamine
216
what are the 'baby blues'?
- type of depression
- 3-7 days after birth
- tearful, anxious, irritable
- tx- reassurance and support
217
what is puerperal psychosis?
- occurs 2-3 weeks after giving birth
- severe mood swings and disordered perception
- requires hospital admission, antidepressants, and ECT
218
features of alzehimers dementia
- most common
- difficulty remebering things (names, conversations etc)
- apathy and depression
- impaired communication, poor judgement, disorientation, confusion
- aphasia, apraxia, agnosia
219
features of vascular dementia
- stepwise progression (due to multiple infarcts)
- impaired judgement, decision making, planning and organisation
- localising signs
220
features of lewy body dementia
Parkinsons+ dementia
- memory loss
- visual hallucinations
- parkinsonian movement features
- fast onset
221
features of frontotemporal dementia
- change in personality- disinhibition, pacing, etc
| - difficulty with language
222
cognitive screening tools used in dementia
- MMSE
- MOCA
- AMT
- 6-CIT
- Addenbrookes
