Psychiatry

Question 1

Name 5 perceptual symptoms

Answer 1

illusion 
hallucination 
delusion 
delusional perception 
over valued idea

Question 2

PHENOMENOLOGY

What is a mental disorder

Answer 2

Any disorder or disability of the mind excluding substance abuse - drugs and alcohol

Question 3

PHENOMENOLOGY

Define psychosis

Answer 3

Severe mental disturbance charecterised by loss of contact with external reality

Question 4

PHENOMENOLOGY

Define neurosis

Answer 4

Relatively mild mental illness in which there is no loss of connection with reailty

Question 5

PHENOMENOLOGY

Define phenomenology

Answer 5

Study of signs and symptoms describing abnormal states of mind

Question 6

PHENOMENOLOGY

Define illusion

Answer 6

False perception of a real external stimulus

Question 7

PHENOMENOLOGY

Define hallucination

Answer 7

Perception in the absence of an external stimulus

Question 8

PHENOMENOLOGY

What are the different types of auditory hallucinations

Answer 8

2nd person - Voices speak directly to the patient
You are a bad person

3rd person - Runnin commentary
Voices discuss what the patient has been doing

Question 9

PHENOMENOLOGY

In terms of hallucinations what are the main sesnses

Answer 9

Visual 
auditrory 
tactile 
gustatory 
olfactory

Question 10

PHENOMENOLOGY
In terms of halluciantions what are.. 
i) Reflex 
ii)Extracampine 
iii) Hypnagoic 
iiii)Hypnopompic

Answer 10

i) Stimulus in one sensory modality produces a sensory experience in another

ii) Hallucination that is outside the limits of the sensory fields
Eg: Hears voices talking in paris when they are in Sydney

iii) Occur when subject is falling asleep
iiii) Occur when subject is waking up

Question 11

PHENOMENOLOGY

What are disorders reflex hallucinations commonly found in and give an example

Answer 11

Canabis and LSD poisoning

Eg: writing on a piece of paper but you can feel the scratching on the heart

Question 12

PHENOMENOLOGY

What is Charles bonnet syndrome and what conditions can it be seen in

Answer 12

Visual hallucinations caused by the brain’s adjustment to significant visual loss.
Patient understands that the hallucinations aren’t real

• Macular degeneration
• Diabetic retinopathy

Question 13

PHENOMENOLOGY

Define pseudo-hallucination

Answer 13

A perception in the absence of an external stimulus experienced in one’s subjective inner space of the mind rather than external sensory objects - Patients have insight

Question 14

PHENOMENOLOGY

Define over-valued idea

Answer 14

A false or exaggarated belief held with conviction but not with delsuional intensity
This idea although resonable dominates their life and causes distress

Question 15

PHENOMENOLOGY

Define delusion

Answer 15

False belief that is firmly maintained in spite of inconvertible evidence to the contrary.
It’s out of keeping with the patient’s social and cultural background

Question 16

PHENOMENOLOGY

What are primary and secondary delusions

Answer 16

Primary - Direct result of psychopathology

Secondary - Arise from some other morbid experience or in response to other primary psychiatric condition

Question 17

PHENOMENOLOGY
In terms of delusions what are...
i) Persecutory 
ii) Grandiose 
iii) Nihilisitc 
iv) Guilt

Answer 17

i) Belief that someone is trying to inflict harm on them
ii) Belief that the patient is powerful / crucially important beyond truth
iii) Belief involving intense feeling of emptiness, patient denies the existence of their body and mind
iv) Ungrounded feelings of remorse for situations

Question 18

PHENOMENOLOGY

Name 2 delusional misidentification syndromes

Answer 18

Capgras

Fregoli

Question 19

PHENOMENOLOGY

What are Cpagras delusions

Answer 19

Delusions that a close friend / relative has been replaced by an imposter

Question 20

PHENOMENOLOGY

What are fregoli delusions

Answer 20

Delusion that a stranger is someone they know is in disguise

Question 21

PHENOMENOLOGY

What are cotard delusions

Answer 21

Nihilisitic delsuions that body parts are misssing/person is dead / parts are rotting

Question 22

PHENOMENOLOGY

What is a delusional perception

Answer 22

A primary delusion of 2 componenets
Normal perception is sunject to delusional interpretation
Eg: Traffic light changed red so that means I am son of God

Question 23

PHENOMENOLOGY
What is thought alienation?
What are the 3 components of this?

Answer 23

Sx of psychosis in which a patient feels their thoughts are no longer in their control

Thought insertion

though withdrawal

Thought broadcast - Delusional belief that thoughts are accesible to others without expressing them

Question 24

PHENOMENOLOGY

What is concrete thinking

Answer 24

Loss of ability to understand abstract concepts and metaphorical ideas
Leads to a strictly literal form of speech

Question 25

``` PHENOMENOLOGY In terms of thought disorders, what is.... i) Flight of ideas ii) Pressured speech iii) Poverty of speech alogia ```

Answer 25

i) Thoughts follow eachother rapidly causing abrupt leaps between topics. Connection between successive thoughts due to chance factor ii) Rapid speech without pauses that is difficult to interrupt iii) Speech lacking i content or amount

Question 26

``` PHENOMENOLOGY In terms of thought disorders what is... i) circumstantiality ii) Preservation iii) thought block ```

Answer 26

i) Irrelevant wandering in a conversation - going around the point ii) Repetition of a word, theme or action beyond that point at which it was relevant iii) sudden interruption in the train of thought, leaving a blank

Question 27

PHENOMENOLOGY | What is loosening of associations

Answer 27

A lack of logical association between sequential thoughts often leading to incoherent speech, impossible to follow train of thought

Question 28

``` PHENOMENOLOGY In terms of thought disorders What is... i) neologisms ii )incoherence / word salad iii) povery of thought ```

Answer 28

i) making up new words ii) confused mixture of seemingly random words and phrases iii) Subjective expereince of being devoid of thoughts

Question 29

PHENOMENOLOGY | What is passivity phenomena

Answer 29

Feeling that ones actions / thoughts are not their own but are controlled by someone else

Question 30

PHENOMENOLOGY | What is somatic passivity

Answer 30

Delusional belief that one is a passive recipient of bodily sensations from an external agency e.g. the devil is making my arms itch

Question 31

PHENOMENOLOGY | What is psychomotor retardation and what conditions would you find it in?

Answer 31

Slowing of thoughts and movements with decreased spontaneous movements Parkinons disase depression

Question 32

PHENOMENOLOGY | Define anhedonia

Answer 32

Inability to experience pleasure form activities usually found enjoyable

Question 33

PHENOMENOLOGY | Define apathy

Answer 33

Lack of interest, enthusiasm or concern

Question 34

PHENOMENOLOGY | Define incongruity of affect

Answer 34

Emotional responses which don't match the situation | Eg: smiling even though they’re upset when someone dies

Question 35

PHENOMENOLOGY | Define blunting of affect

Answer 35

A limited range of normal emotional responsiveness

Question 36

PHENOMENOLOGY | Define depersonlisation

Answer 36

When a person feels detached from themselves

Question 37

PHENOMENOLOGY | Define derealisation

Answer 37

Person expereinces detachment from the world around them

Question 38

PHENOMENOLOGY | Define obsession

Answer 38

Repetitive irrationsl thoughts / impulses which are intrusive and persistent despite efforts to resist. Insight preserved - Recgonised as own thoughts

Question 39

PHENOMENOLOGY | Define compulsions

Answer 39

Repetitive purposeful behaviour performed in response to an obsession to reduce anxiety

Question 40

PHENOMENOLOGY | Define catatonia

Answer 40

Abnormality of movement and behaviour arising from a disturbed mental state Eg: Echolalia

Question 41

PHENOMENOLOGY | Define conversion

Answer 41

Development of features suggestive of physical illness without a physical cause

Question 42

PHENOMENOLOGY | Define belle indifference

Answer 42

A suprising lack of concern for / denial of apparently severe functional disability

Question 43

PHENOMENOLOGY | Define mannerism

Answer 43

Repeated involuntary movements

Question 44

PHENOMENOLOGY | Define confabulation

Answer 44

Giving a false account to fill in a gap of memory

Question 45

PHENOMENOLOGY | What is made, acts and feelings

Answer 45

Something is making you act something out, feel something, or drive you to do something

Question 46

MENTAL HEALTH ACT 1983 | What are the main principles of the MHA? (5)

Answer 46

``` Minimise impact of of mental illness on individual Maximise patient and others safety Minimise restrictions on liberty Effectiveness of treatment Respect for pateints wishes and feelings ```

Question 47

MENTAL HEALTH ACT 1983 | What is the MHA and where does it apply to?

Answer 47

Provides legal framework for assessment and treatment of people with a mental disorder England Wales

Question 48

MENTAL HEALTH ACT 1983 | What does an individual have to show in order to be sectioned

Answer 48

- Evidence of MH disorder - Evidence they're a risk to themselves or others and treatment is in the interests of safety - Appropriate treatment must be available

Question 49

MENTAL HEALTH ACT 1983 i) What is a S12 approved Dr ii) What is an AMPH

Answer 49

i) Doctor with expertiese in treatment and assessment of mental health disorders ii) Health proffesional with specialist non medical skills in mental health assessment and law

Question 50

MENTAL HEALTH ACT 1983 | Who can remove a section?

Answer 50

Consultant psychiatrust MH review tribunal if patient disagrees with section Nearest relative can make an order to discharge patient from hospital with 72hr written notice

Question 51

MENTAL HEALTH ACT 1983 | What is the: Purpose, duration, location and proffesionals involved in a Section 2?

Answer 51

P - Admission for assesment but treatment can be given without consent D - 28d (Non-renewable) L - Anywhere in community P - 2Drs (1x S12), 1 AMHP

Question 52

MENTAL HEALTH ACT 1983 | What is the: Purpose, duration, location and proffesionals involved in a Section 3?

Answer 52

P - Admission for treatment D - 6 months (Renewable) L - Anywhere in community P - 2 doctors (1 x S12) + AMHP

Question 53

MENTAL HEALTH ACT 1983 | What is the: Purpose, duration, location and proffesionals involved in a Section 4?

Answer 53

P - Emergency order Waiting for second doctor would lead to undesirable delay D - 72hrs L - Anywhere in community P - 1 S12 doctor and AMHP

Question 54

MENTAL HEALTH ACT 1983 | Where can you apply a section 5 and what cannot be done to a patient on a section 5?

Answer 54

Voluntary patient in hospital that wants to leave - Not A+E Cannot co-ervively treat a patient but provides legal framework to restrain

Question 55

MENTAL HEALTH ACT 1983 | What is the: Purpose, duration, location and proffesionals involved in a Section 5 (2)?

Answer 55

P - Drs holding power allowing for S2/3 assesment D - 72hrs Proffesionals - 1 Dr Usually the one in charge of their care

Question 56

MENTAL HEALTH ACT 1983 | What is the: Purpose, duration, location and proffesionals involved in a Section 5(4)?

Answer 56

P - Nurses holding power until Dr can attend to assess D - 6hrs Proffesionals - 1 registered nurse

Question 57

MENTAL HEALTH ACT 1983 What are the 2 police sections and what are their differences? what is the duration and purpose of these?

Answer 57

S135 - Court order to access patient's home and move to place of safety for MHA Assesment. Applied through magistrates court by social worker - Required to accompany police S136 - D - >72hrs Allows police to arrest a person suspecte dof having a mental disorder in a public space and moved to a place of safety

Question 58

SOMATISATION DISORDER What is somatisation disorder? How many years do symptoms have to be present for a diagnsis?

Answer 58

Psychiatric disorder in which patients experience psychological distress in the form of multiple and incosistent MUS

Question 59

SOMATISATION DISORDER | What is a patient with somatisation disorder reluctant to do?

Answer 59

Accept reassurance despite negative test results

Question 60

SOMATISATION DISORDER | How does a patient with a somatisation disorder present?

Answer 60

- No specific and atypical sx - Patient refuses to accept -ve results - discrepancy between subjective and objective findings - Results in multiple needless Ix and operations - Sx move from one system to another once diangostic possibilities have been exhausted

Question 61

SOMATISATION DISORDER | What is the management of a patient with somatisation disorder

Answer 61

Rule out organic illness Communicate dx and reassure patient of continuing care - 1 regular doctor Psychotherpay - CBT / Group therapy

Question 62

PUBLIC HEALTH APPROACH TO MH | What is the primary prevention for MH issues?

Answer 62

Preventing problems from occuring Education of MH issues Encouraging conversations

Question 63

PUBLIC HEALTH APPROACH TO MH | What is the secondary prevention for MH issues?

Answer 63

Early interventions before the problem starts to emerge to resolve it - IAPTT

Question 64

PUBLIC HEALTH APPROACH TO MH | What is the tertiary prevention for MH issues?

Answer 64

Making sure an ongoing problem is well managed to avoid crises and reduce its harmful consequences - Monitoring medications - Making sure physical health problems are addressed / checked

Question 65

PSYCHIATRIC TREATMENTS | What is ECT and what is the puropse of it?

Answer 65

Treatment that involves sending an electric current through the brain under GA - Stimulate development of new neurones - Increases serotonin and dopamine

Question 66

PSYCHIATRIC TREATMENTS | Name some inidcations for ECT therapy?

Answer 66

``` Severe life threatening depression psychotic depression treatement resisitant schizophrenia catatonia severe long lasting mania ```

Question 67

PSYCHIATRIC TREATMENTS | What are the short term effects of ECT?

Answer 67

Drowsy / confused headache retrograde amnesia muscle ache

Question 68

PSYCHIATRIC TREATMENTS | what are the logn term effects of ECT?

Answer 68

Apathy Imapired memory difficulty concetrating

Question 69

PSYCHIATRIC MANAGEMENT | What is the biopsychosocial formulation and what are the 5P's

Answer 69

An approach to understanding a patient and describing their sx Presenting Predisposing factors (what increases a pts risk of developing a mental illness) - Precipitating factors (potential trigger to the onset of current problem) - Perpetuating factors (what maintains the problem once it's been established) - Protective factors (strengths that reduce the severity of problems)

Question 70

PSYCHIATRIC MANAGEMENT | Give examples of what might come under the 5Ps (excluding presenting).

Answer 70

Predisposing = genetics, life events, temperament Precipitating = abuse, drug misuse, loss of family Perpetuating = drug abuse, lack of social support, financial difficulties Protective = family support, children, marriage

Question 71

ORGANIC DISORDERS | What is an organic disorder

Answer 71

Describes reduced brain function due to illnesses that are not psychoatric in nature Aetiology is in CNS

Question 72

ORGANIC DISORDERS | What is delirium?

Answer 72

Transient acute metal confusional state | characterised by disturbance of consciousness, perception, sleep-wake cycle, emotion + cognition

Question 73

ORGANIC DISORDERS | What are the 2 states of delirium?

Answer 73

Hyperactive Hypoactive

Question 74

ORGANIC DISORDERS | What is the aetiology of delirium?

Answer 74

DELIRIUM D - Drugs (Anti-Ach/BDZs) E - Environment / electrolytes Uraemia / LF / Gluocse L - Lack of drug (withdrawal) Opiates /levodopa/alcohol I - Infection R - Retention (stool/urine) Reduced sensory input -blind / deaf I - Intracranial isses Stroke / post-ictal / Meningitis U - Underhydration / Undernutrition M - Myocardical S - Subdural / sleep deprived / Surgery

Question 75

ORGANIC DISORDERS | What are some metabolic causes of delirium?

Answer 75

- Hypo/hyperthyroid - Hypo / hyperglycaemia - Hypercortisolaemia - Substance misuse - Withdrawal (incl. delirium tremens) - Opioids, anticholinergics, Parkinson's meds, steroids, BDZs, interactions

Question 76

ORGANIC DISORDERS | What are some high risk factors for delirium?

Answer 76

- >65y, men, previous delirium - Pre-existing cognitive deficit (dementia, PD, stroke) - Sensory impairment (hearing/visual) - Significant illness (hip #, cancer) - Poor nutrition - Hx of alcohol excess

Question 77

ORGANIC DISORDERS | Describe the 2 sub-types of delirium?

Answer 77

- Hyperactive = agitated/aggressive, hallucinations, delusions, wandering + restless - Hypoactive = withdrawn, quiet, lethargic, lacks concentration, slow

Question 78

ORGANIC DISORDERS | What is a suitable screening tool for delirium?

Answer 78

4AT (≥4 = likely) – - Alertness - AMT4 (age, DOB, hospital name, year) - Attention (list months backwards) - Acute change or fluctuating course

Question 79

ORGANIC DISORDERS | What other cognitive tools can be used in the assessment of delirium/dementia?

Answer 79

- GP-COG (GP assessment of cognition) - 6-CIT (6-item cognitive impairment test) - AMT (abbreviated mental test) - MOCA (Montreal Cognitive Assessment, <26/30) - MMSE - ACE-III

Question 80

ORGANIC DISORDERS | What bedside assesments can you do on a confused patient?

Answer 80

``` Hydration status O2 stats BP Temp Blood glucose ABG VBG ```

Question 81

ORGANIC DISORDERS | What is involved in a confusion screen?

Answer 81

``` FBC B12 + FOlate U+E Ca2+ TFT LFT Gluocse INR + Clotting CRP / ESR Toxicology ```

Question 82

ORGANIC DISORDERS What non invasive tests can also be used in a patient with suspected delirium? What referrals could be considered?

Answer 82

CXR CT head ECG Referral to memory clinic or old age psychiatrist

Question 83

ORGNAIC DISORDERS | What is required for a delirium diagnosis?

Answer 83

Acute mental change from baseline - fluctuating - Impaired attention - Disorientation in time, place and person - Cognitive imapirement - Sleep wake abnormality - Disorganised thinking - Medical cause

Question 84

ORGANIC DISORDERS | What is the mainstay of treatement for delirium?

Answer 84

Treat underlying vause Capacity assessment Maximise orientation Make environment safe and comforting

Question 85

ORGANIC DISORDERS | How long can a recovery from delirium take?

Answer 85

3-6 months

Question 86

ORGANIC DISORDERS | What is the management for a patient with delirium?

Answer 86

``` Reorientate: Clocks and calendars Continuity of care - Frequent reassurance Consistency of staff members Avoid multiple rooms/ward moves Sleep hygiene Discourage napping Bright light exposure during daytime Good lighting environment Encourage visits from family Mobilize and encourage exercise Tx sesnory imapirements - glasses / hearing aids ```

Question 87

ORGANIC DISORDERS Sometimes conservative de-escalation is inadequate and medications may be required. What is the pharmacological management and what are the CI to this?

Answer 87

Oral Haloperidol Extremely agitated patients – small doses CI: Lewy body dementia / Parkinsonism / Prolonged QT interval

Question 88

ORGANIC DISORDERS | What are the differential dx for a patient with suspected delirium diagnosis

Answer 88

dementia anxiety thyroid disease temporal lobe epilepsy

Question 89

DEMENTIA What is dementia? What time frame is required in order to make a diagnosis?

Answer 89

Clinical neurodegenerative syndrome defined by progressive loss of higher mental function, affecting multiple cognitive domains with an impact on the general functioning of the patient >6m for diagnosis

Question 90

DEMENTIA What is mild cognitive impairement? What is the timeline required for a review of a patient presenting with mild cognitive impairement?

Answer 90

Cognitive impairement without fucntional impairement Review in 6m to 1 year

Question 91

DEMENTIA Where does subcortical dementia affect? Name some examples

Answer 91

Basal ganglia Thalamus PD Huntingtons Alcohol related

Question 92

``` DEMENTIA What are the differences between delirium and dementia? i) onset + deterioration ii)course iii) consciousness iv) sleep wake cycle v) other presentations ```

Answer 92

``` Delirium acute onset - reversible flucutating course altered level of consciousness altered sleep-wake cycle delusions/ illusions/ hallucinations ``` ``` Dementia chronic lllness - irreversible progressive course consciousness preserved normal sleep wake cycle ```

Question 93

DEMENTIA | What are some risk factors for dementia development?

Answer 93

``` Age > 65 family hx Gentics downs syndrome smoking diabetes obesity Head trauma - Repetitive injury (boxing) CVD ```

Question 94

DEMENTIA | What is the gene associated with dementia?

Answer 94

Apoliprotein E-E4

Question 95

DEMENTIA | Name some factors for dementia prevention

Answer 95

Healthy behaviours - excericse - diet - low alcohol - no smoking Engaging in lesiure activities Socially active Cognitive active

Question 96

DEMENTIA | What are some diangostic features of dementia?

Answer 96

Multiple cognitive deficits resulting in ADL impairement - memory - orientation - language - reasoning Clear cosnisousness BPSD - insominia - daytime drowsiness - nocturnal restlesness - depression / anxiety

Question 97

DEMENTIA | What are some general investigations for dementia?

Answer 97

- Full Hx + collateral with full physical exam + MSE | - Check for reversible causes with confusion screen ± CXR ± CT head

Question 98

DEMENTIA | Describe the ranges for no, moderate and severe cognitve imapirement scores in an MMSE

Answer 98

none = 24 - 30 Mod = 18 - 23 Severe < 17

Question 99

DEMENTIA | What score on a ACE-III indicates dementia

Answer 99

<82 with abnormla scores in more than 2 domains - attention - orientation - memory - language - visuospatial - fluency

Question 100

DEMENTIA | What investigations are invovled in a dementia screen?

Answer 100

``` FBC / U+E / LFT / CRP / TFT Thaimine B12 / Folate Syphillis serology Cortisol Glucose MRI - SDH / NPH ```

Question 101

DEMENTIA | Name some potentially treatable causes of dementia?

Answer 101

``` Substance misuse Hypothyroid Hyperparathyroid Cushings Addisons Depression NPH Vit B12/Foalte def ```

Question 102

DEMENTIA | What biological and psychological treatment can be used in dementia?

Answer 102

Bio - Risperidone (agitation) - Memantine (Aggression) Psycho - CBT (Depression) - Art therapy - Counselling - mental stimulation eg: puzzles

Question 103

DEMENTIA | Why is the use of risperidone not encouraged?

Answer 103

Increased risk of stroke

Question 104

DEMENTIA | What social treatements can be used in dementia?

Answer 104

- OT assessment to remain independent (pendent, labels on cupboards, key safe, carers, handrails) - Carers assesment - Physio assessment - Encourage family visits + photos - Animal/pet therapy, music, arts + crafts - Care plans + advanced directives before worsens - Lasting power of attorney - Need to iform DVLA

Question 105

ALZHEIMERS | What is the pathophysiology of alzheimers?

Answer 105

Accumulation of - Extracellular beta amyloid plaques - Intracellular Tau containing neurofibrillary tangles Leads to degeneration of cerebral cortex with cortical atrophy + loss of Ach

Question 106

ALZHEIMERS | What condition has increased rates of alzheimers

Answer 106

Down's syndrome - develop at 50

Question 107

ALZHEIMER'S What genes have been implicated to... i) familial early-onset Alzheimer's? ii) late onset Alzheimer's?

Answer 107

i) APP gene, presenilin 1 + 2 (autosomal dominant) | ii) Apolipoprotein E (ApoE)

Question 108

ALZHEIMERS | Name some risk factors for alzheimers development?

Answer 108

``` Family hx Age - >65 Genetics - ApoE Low intelligence / education Depression CVD - HTN Diabetes Hypercholeterolaemia Smoking ```

Question 109

ALZHEIMERS | Name a protective factor for alzheimers

Answer 109

High intelligence

Question 110

ALZHEIMERS | What is the clinical presentation of alzheimers

Answer 110

4 A's Amnesia - loss of STM - poor disorientation about time Aphasia / Dysphasia - word finding problems - speech muddles / disjointed Apraxia Inability to carry out skilled tasks despite normal motor function - button clothes - pick up pen Agnosia Failure to recognise people / items Executive fucntion imapired - planning - visuospatial impairment

Question 111

ALZHEIMERS | Name some non-cognitive presentations of alzheimers

Answer 111

Psychosis - delsuions - hallucinations Mood - depression - anxiety Behavioural - apathy - agitation - wanderign - aggression

Question 112

ALZHEIMER'S DISEASE On CT/MRI head in Alzheimer's disease, what are the... i) macroscopic pathological changes? ii) microscopic or histological pathological changes?

Answer 112

i) Diffuse cerebral atrophy (shrunken brain), increased sulcal widening, enlarged ventricles ii) Neuronal loss, neurofibrillary tangles, beta-amyloid plaques

Question 113

ALZHEIMER'S DISEASE | What is the pharmacological management of Alzheimer's?

Answer 113

slow rate of decline + allow functioning at higher level - AChEi (donepezil, rivastigmine) for mild–mod - NMDA antagonist (memantine) for mod–severe

Question 114

VASCULAR DEMENTIA What is vascualr dementia and what is it charecterised by? What are the risk factors?

Answer 114

Subcortical dementia - cumilative effect of small multiple infarcts charecterised by a stepwise deterioration ``` CVA / TIA HTN DM Hypercholeterolaemia Smoking Hx of PVD IHD ```

Question 115

VASCULAR DEMENTIA | What is the clinical presentation of vascular dementia?

Answer 115

Stepwise deterioration with short periods of stability then sudden decline Specific sx - depends on location of focal brai damage memory issues focal neurologicla signs if caused by stroke eg:UMN signs

Question 116

VASCULAR DEMENTIA | What is the management of vascualr dementia?

Answer 116

``` Prevent further decline Lifestyle changes - weight loss - healthy diet - smoking cessation - alcohol consumption decrease ``` Pharmacological - atorvastatin Optimise co-morbidities - DM - HTN

Question 117

LEWY BODY DEMENTIA | What is lewy body dementia and what might it be confused with?

Answer 117

Presence of lewy bodies in basal ganglia and cerebral cortex presents between 50-80y/o Delirium - fluctuating consciousness - hallucinations

Question 118

LEWY BODY DEMENTIA | How do differentiate between parkinsons disease and lewy body dementia?

Answer 118

dementia before movement signs - LBD Movement before dementia signs = PD

Question 119

LEWY BODY DEMENTIA | What is the clinical presentation of lewy body dementia?

Answer 119

``` fluctuating cognition visual hallucinations Parkinsonsism REM sleep disorder narrow based gait autonomic dysfunction - fluctuating BP - falls ```

Question 120

LEWY BODY DEMENTIA | What is the management of LBD?

Answer 120

Conservative management 1st line - Rivastigme last line - Memantine Sleep disturbance - clonazepam

Question 121

LEWY BODY DEMENTIA | Why should antipsychotics be avoided in LBD pateints?

Answer 121

Irreversible parkinsoism Impaired consciousness NMS

Question 122

LEWY BODY DEMENTIA | Name 1 effect of levodopa usage

Answer 122

Psychosis

Question 123

FRONTOTEMPORAL DEMENTIA | What is the clinical presentation of FTD?

Answer 123

Behavioural chnages - Disinhibition - Withdrawal - Emotional unconcern - Behavioural stereotypies (humming) executive imapirement poor insight

Question 124

FRONTOTEMPORAL DEMENTIA What is the inheritence pattern for FTD? What condition is FTD linked to?

Answer 124

AD MND

Question 125

FRONTOTEMPORAL DEMENTIA | What are the investigations and the results of the Ix of a patient suspected of having FTD?

Answer 125

MRI - Frontal atrophy SPEC scan - lack of perfusion in fronto-temporal lobes

Question 126

PSEUDO-DEMENTIA | What conditions can present with pseudo-depression

Answer 126

Depression Anxiety Bipolar

Question 127

PSEUDO-DEMENTIA | What leads to pseudo-dementia presentation

Answer 127

Conditions cause an impairement in concentration cognitive imapirement occurs secondary to mental illness Patients tend to give "I don't know answers"

Question 128

ENDOCRINE - PSYCHIATRY | Name 5 endocrine causes of psychosis

Answer 128

``` Hyper/hypothyroidism cushings hyperparathyroidism addison's disease Metabolis - Uraemia / Na+ imbalance ```

Question 129

ENDOCRINE - PSYCHIATRY | Name 5 causes of depression

Answer 129

``` Hypothyroidism Cushing's disease Addison's disease Parathyroid disease Vit deficiency - B12/Folate ```

Question 130

ENDOCRINE - PSYCHIATRY | Name 1 endocrine cause of mania

Answer 130

Hyperthyroidism

Question 131

ENDOCRINE - PSYCHIATRY | Name 1 endocrine cause of anxiety

Answer 131

Hyperthyroidism

Question 132

ADDICTIVE BEHAVIOURS | Name the 5 stages of the behavioural model of change

Answer 132

``` Pre-contemplation Contemplation Determination Action Relapse Maintenance ```

Question 133

ADDICTIVE BEHAVIOURS | Define addiction

Answer 133

Compulsive substance taking behaviour with psychological withdrawal state

Question 134

ADDICTIVE BEHAVIOURS | Define addictive behaviour

Answer 134

Behaviour which is both rewarding and reinforcing

Question 135

ADDICTIVE BEHAVIOURS | Define dependence

Answer 135

Inability to control the intake of substance one is addicted to

Question 136

ADDICTIVE BEHAVIOURS | Define withdrawal

Answer 136

Psychological state when substance is stopped with negative symptoms

Question 137

ADDICTIVE BEHAVIOURS | Define tolerance

Answer 137

Pharmacological cocnept describing requiring larger doses to gain the same effect

Question 138

ADDICTIVE BEHAVIOURS | Name some features of dependence

Answer 138

Withdrawal Cravings Continued use despite harm Tolerance Primary / Salience Loss of control Narrowed repitoire Rapid reinstatement

Question 139

ADDICTIVE BEHAVIOURS What is Primary / salience? Give an example?

Answer 139

Obtaining / using substance becomes so important other interests are neglected Not eating to save money for drugs

Question 140

ADDICTIVE BEHAVIOURS | Give an example of continued use despite harm

Answer 140

Injecting heroin despite abscess formation

Question 141

ADDICTIVE BEHAVIOURS What is narrowed repitoire? Give an example

Answer 141

Less variation in types of substances used Drinking at the pub to drinking cheapest alcohol at home

Question 142

ADDICTIVE BEHAVIOURS | What is rapid reinstatement

Answer 142

User relapses after period of abstenience | Risk of returning to previous dependence pattern quicker

Question 143

ADDICTIVE BEHAVIOURS | Name the 4 questions involved in the CAGE questionnaire

Answer 143

C - Have you ever felt you need to CUT down A - Have people ANNOYED you by critscising your drinking G - Have you ever felt bad or GUILTY about your drinking E - Do you have an EYE-OPENER first thing in the morning to steady the nerves of a hangover

Question 144

ADDICTIVE BEHAVIOURS | What does AUDIT stand for

Answer 144

Alcohol use disorders identification test

Question 145

ADDICTIVE BEHAVIOURS | How do you calculate the units of an alcoholic drink

Answer 145

Strength(ABV) x volume (L) = units

Question 146

ADDICTIVE BEHAVIOURS | How many ml of alcohol is in 1 unit

Answer 146

10ml

Question 147

ADDICTIVE BEHAVIOURS | Name some causes of alcohol misuse

Answer 147

``` Genetic factors chronic illness occupation social reinforcement anxiety traumatic life event ```

Question 148

ADDICTIVE BEHAVIOURS | Name a protective factor for alcohol misuse

Answer 148

Acetaldehyde dehdrogenase deficiency

Question 149

ADDICTIVE BEHAVIOURS What drugs can interact with a patient with an alcohol disorder What is their MOA What are the effects

Answer 149

Metronidazole Chlorporpamide They inhibit acetaldehyde dehydrogenase Headache / sweating / nausea

Question 150

ADDICTIVE BEHAVIOURS | How is alcohol intake cardioprotective

Answer 150

Increases HDL level | Reduces platelet aggregation

Question 151

ADDICTIVE BEHAVIOURS | Name some negative cardiac effects of alcohol

Answer 151

``` Increased BP Arrhythmias --> AF Alcohol related cariomyopathy IHD CVA Stroke ```

Question 152

ADDICTIVE BEHAVIOURS | Name some negative heaptic effects of alcohol

Answer 152

Hypoglycaemia fatty liver cirrhosis induction of drug metabolising enzymes

Question 153

ADDICTIVE BEHAVIOURS | Name some negative GI effects of alcohol

Answer 153

Gastritis Pancreatitis Mallory-weiss tear reflux oesophagitis

Question 154

ADDICTIVE BEHAVIOURS | Name some negative GU effects of alcohol

Answer 154

Sexual desire increased - ST Erectile dysfunction - LT (Due to vasodialtion) Damage to leydig cells - loss of libido - infertility - loss of male body hair

Question 155

ADDICTIVE BEHAVIOURS | Name some negative Neuropsychiatric effects of alcohol

Answer 155

``` Painful peripheral neuropathy Imapired memory depression SDH Korsakoff sundrome Alcoholic dementia ```

Question 156

ADDICTIVE BEHAVIOURS | Name some negative endocrine effects of alcohol

Answer 156

Diabetes - due to cirrhosis Issues with metabolisation of oestrogen --> testosterone leads to femininisation of patients - loss of body hair testicualr atrophy

Question 157

ADDICTIVE BEHAVIOURS | Outline the general approach to alcohol misuse management

Answer 157

Manage co-morbidities Psychological support Location for withdrawal Medication to maintain abstenince

Question 158

ADDICTIVE BEHAVIOURS | What factors are invovled in the psychologicla support of a patient with alcohol misuse disorder

Answer 158

- Support groups - AA - Motivational interviewing - FRAMES principle

Question 159

ADDICTIVE BEHAVIOURS | What factors indicate that a hospital admission for a detox

Answer 159

``` previous withdrawal seizure suicidal ideation co-existing drug addiction history of DT No social support ```

Question 160

ADDICTIVE BEHAVIOURS | What are the indications for a home detox

Answer 160

- No hx of DT - Good family support - No psychological complications (depression) - No physical complications

Question 161

ADDICTIVE BEHAVIOURS | What tests are used to screen for drug or alcohol abuse

Answer 161

breath test - Blood alcohol content Blood test - Elevated MCV or GGT Urinary tests Hair testing

Question 162

ADDICTIVE BEHAVIOURS What is disulifram What is its MOA Why is it useful

Answer 162

Antebuse - aversive drugs Inhibits acetaldehyde dehydrogenase - prevents acetaldehyde breakdown leading to adverse effects if alcohol is ingested. Acetaldehyde reaction and histamine release

Question 163

ADDICTIVE BEHAVIOURS Name some adverse effects of disulfiram Which patients should not be given disulfiram

Answer 163

Hangover S/E ``` Flushing nausea headache Increased temp Increased pulse reduced BP ``` Do not give to impulse patients or pateits with LD - Fatal if mixed with alcohol

Question 164

ADDICTIVE BEHAVIOURS Name 2 anti-craving medications for patients with alcohol abuse What increases the effects of these medications working

Answer 164

Acamprosate Naltrexone Counselling

Question 165

ADDICTIVE BEHAVIOURS What is acamprosate's MOA How long can it be prescribed for

Answer 165

Inhibits glutamate helping to reduce cravings Helps patients seekign to maintain abstenence Up to 6m or longer if there is a benefit

Question 166

ADDICTIVE BEHAVIOURS | What are the adverse effects and contra-indications of acramposate

Answer 166

Adverse effects - GI disturbance - Sexual impotence - Flucutations in libido - Rash Contra-indications - Pregnant - Breast feeding - Severe heaptic/renal impairement

Question 167

ADDICTIVE BEHAVIOURS | What is naltrexone and who is it recommended for

Answer 167

Opiod antagonist Recommended for patients wishing to reduce alcohol intake - reduces positive reward of alcohol

Question 168

ADDICTIVE BEHAVIOURS Describe a pateints presentation: - 6/12 hrs after last drink - 24 hrs after last drink - 72 hrs after last drink

Answer 168

``` Insomnia fine tremor anxiety N+V Sweating palpitations raised BP Fatigue ``` Hallucinations coarse tremor seizures Delirium tremens

Question 169

ADDICTIVE BEHAVIOURS | What is the management of alcohol withdrawal

Answer 169

Chlordiazepoxide - reducing regime over 7-10 days IV Pabrinex Prophylactic oral thiamine

Question 170

ADDICTIVE BEHAVIOURS | What are the risks of frequent detoxing

Answer 170

Epilepsy

Question 171

ADDICTIVE BEHAVIOURS | Name some public health strategies to help prevent alcohol abuse

Answer 171

``` Increasing tax on alcohol restricting alcohol advertisement Drinkaware Know your limits campaign Keep alcohol out of site - behind counter School alcohol education ```

Question 172

ADDICTIVE BEHAVIOURS | What are the features of opiate withdrawal

Answer 172

Everything runs - sweaty - rhinorrhoea - diarrhoea - cold - high BP - dialted pupils

Question 173

ADDICTIVE BEHAVIOURS | What are some harm reduction strategies for opiate users

Answer 173

- needle injection | - screening for HBV / HNV / HIV

Question 174

ADDICTIVE BEHAVIOURS | What are some detoxification methods for opiate users

Answer 174

- Methadone Long acting - 24hr half life - Bupronorpheine Parial opiate

Question 175

ADDICTIVE BEHAVIOURS | What are the short term complications of opiate usage

Answer 175

``` VTE PE Bacterial infection secondary to injection - IE Overdose - Respiratory depression - Resp acidosis ```

Question 176

ADDICTIVE BEHAVIOURS | What are the long term complications of opiate usage

Answer 176

``` dependence craving crime constipation - chronic usage Infections - sepsis/HIV Abscess ```

Question 177

ADDICTIVE BEHAVIOURS | What are the common injection sites for opiate usage

Answer 177

``` Antecubital fossa groin neck feet fingers ```

Question 178

PERSONALITY DISORDERS | What is the only personality disorder that can be diagnosed at 18

Answer 178

EUPD - As long as there is evidence that the patient has fully undergone puberty

Question 179

PERSONALITY DISORDERS | What are cluster A,B and C disorders

Answer 179

A = Abnormal / angry Odd/eccentric B = Bad dramtic/erratic C = Critical / Criers Anxious/fearful

Question 180

PERSONALITY DISORDERS | What is a schizoid personality

Answer 180

SchizoiD - Distant | Detached in emotions and relationships

Question 181

PERSONALITY DISORDERS | What is a paranoid perosnality

Answer 181

distrustful and suspicious Hypersensitive to critcism Pre-occupied with percieved conspiricies against them

Question 182

PERSONALITY DISORDERS | What is a schizo-T-ypal personality

Answer 182

T - Tries to make friends Magical / odd beliefs Inappropriate behaviour and strange speech causes others to see them as strange Similar to schizo - but better grasp on reality

Question 183

PERSONALITY DISORDERS | Describe an EUPD personlity

Answer 183

unstable relationships unstable emotions - mood swings Instability in self image Impulsive

Question 184

PERSONALITY DISORDERS | Describe a historonic personality disorder

Answer 184

H - Hungry for attention attention seeking display a lot of emotions

Question 185

PERSONALITY DISORDERS | Describe a narscissistic perosnality disorder

Answer 185

big egos lack of emapthy need admiration can't handle criticism

Question 186

PERSONALITY DISORDERS | Describe a dissocial personality disorder

Answer 186

Little to no regard for others legal issues - aggresive inability to obey social norms

Question 187

PERSONALITY DISORDERS | Describe an obsessive - compulsive personality (Anankastic)

Answer 187

Order + control Hyper focused Perfectionist Unlike OCD these actions are pleasurable and desirable as opposed to anxiety inducing

Question 188

PERSONALITY DISORDER | Describe a dependant personality disorder

Answer 188

submissive - strong psychological need to be cared for clingy lack initiatvie

Question 189

PERSONALITY DISORDER | Describe an avoidant perosnality disorder

Answer 189

Strong feeling of inadequacy and fear of social situation Avoid situations where they can be criticised Self impose isolation whilst craving acceptance

Question 190

PERSONALITY DISORDER | What is EUPD

Answer 190

Personality disorder affecting mood regualation and interpersonal relationships

Question 191

PERSONALITY DISORDER | Name some risk factors for EUPD

Answer 191

``` women trauma insecure attachement domestic violence neglect family hx ```

Question 192

PERSONALITY DISORDER | How would a patient with EUPD present

Answer 192

``` Intense usntable relationships low self esteem emotional dysregualtion fear of abandonment chronic feeling of emptiness impulsive behaviour thoughts of self harm ```

Question 193

PERSONALITY DISORDER | What is the gold standard treatement for EUPD and what does it involve

Answer 193

DBT Learn individualised techniques for managing their emotional state as an Alternative self harm - Self soothing techniques - Distraction techniques

Question 194

PERSONALITY DISORDER | Name reasosns that an EUPD patient would self harm

Answer 194

``` releive psychic pain feel concrete pain decrease anxiety feel in control express anger ```

Question 195

PERSONALITY DISORDER | What are the differential diagnoses for EUPD

Answer 195

``` Bipolar Autism ADHD Psychosis PTSD ```

Question 196

PSYCHOSIS | Name some presentations of psychosis

Answer 196

``` schizophrenia manic depression bipolar schizoaffective disorder substance induced post partum brief psychotic disorder ```

Question 197

PSYCHOSIS | what is psychosis

Answer 197

A break from reality charecterised by delsuions, hallucinations and disorganised speech

Question 198

PSYCHOSIS | How is psychosis different from neuroses

Answer 198

``` Whole of personality is affected Patient lacks insight loss of control with reality hallucinations delusions Managed with physical methods ```

Question 199

PERSONALITY DISORDER | Which personalities are classified as cluster A

Answer 199

Schzoid paranoid schizotypal

Question 200

PERSONALITY DISORDER | Which personalities are classified as cluster B

Answer 200

EUPD Historonic Narcisstic Dissocial

Question 201

PERSONALITY DISORDER | Which personalities are classified as cluster C

Answer 201

Obsessive complusive - Anankastic dependent avoidant

Question 202

PSYCHOSIS | What are some indicators of an impending psychotic break

Answer 202

social isolation worsening self care paranoia gradual shifts in thinking and perceptions

Question 203

PSYCHOSIS | What is schizophrenia

Answer 203

syndrome charecterised by disturbances in thinking, perception, affect and behaviour. Preserved consciouness and cognitive skills

Question 204

PSYCHOSIS | Name 5 risk factors for schizophrenia

Answer 204

``` family hx cannabis usage Inner city living Intrauterine infection - CMV Illicit substanes - cocaine maternal poor health / malnutrition Pregnancy/birth complications - hypoxia traumatic childhood ```

Question 205

PSYCHOSIS | What are the first rank symptoms of schizophrenia

Answer 205

hallucination - 3rd person auditory delusional perception passivity phenomena thought alienation

Question 206

PSYCHOSIS | What are some secondary symptoms of schizophrenia

Answer 206

``` delusions thought disorders - loosening of associations - thought blocking catatnoic behaviour negative symptoms ```

Question 207

PSYCHOSIS | What are the negative symptoms of schizophrenia

Answer 207

``` blunting of affect anhedonia flat affect alogia - poverty of speech avoilition - poor motivation ```

Question 208

PSYCHOSIS | Name 4 poor prognostic factors for schizophrenia

Answer 208

``` family hx gradual onset Low IQ Prodromal phase of social withdrawal lack of precipitating factor ```

Question 209

PSYCHOSIS | How is schizophrenia diagnosed

Answer 209

one 1st rank symptom for 1 month or longer OR two 2nd rank symptoms acutely for 1 month, with evidence of disturbance of functioning for 6 months.

Question 210

PSYCHOSIS | What is the rule of 1/4s for schizophrenia

Answer 210

``` Prognosis for treatment 25% - have another episode - improve a lot - little improvement - resistant ```

Question 211

PSYCHOSIS | What is the non-pharmacologicla treatment of schizophrenia

Answer 211

``` CBT Family interventions Offer support for carers Offer support with: - finances - accommodation - employement ```

Question 212

PSYCHOSIS | What is schizoaffective disorder

Answer 212

disorder with features of schizophrenia and mood disorders

Question 213

PSYCHOSIS | What are the diagnostic features for schizoaffective disorders

Answer 213

Presence of schizophrenia symptoms concurrent with the mood symptoms (depression or mania), and lasting for a considerable part of a 1-month period.

Question 214

PSYCHOSIS | What are some features of psychosis

Answer 214

``` hallucinations delusions disorganised thinking and speech - flight of ideas Alogia tangeatality word salad ```

Question 215

PSYCHOSIS | What is a delusional disorder

Answer 215

Delusional disorder is distinguished from schizophrenia by the presence of delusions without any other symptoms of psychosis (eg, hallucinations, disorganized speech or behaviour, negative symptoms). No psychosocial impairement

Question 216

PSYCHOSIS | What is a erotomanic delusional disorder

Answer 216

patients believe that another person is in love with them | - stalking is common

Question 217

PSYCHOSIS | What is a jealous delusional disorder

Answer 217

Patients believe that their spouse or lover is unfaithful. This belief is based on incorrect inferences supported by dubious evidence

Question 218

NEUROSES | What is GAD

Answer 218

Persistent uncontrolled worry about a number of different events with no identifiable cause present for 6m Associated with an impairement in normal daiy function, somatic, cognitive and behavioural sx

Question 219

NEUROSES | Name 6 risk factors for GAD

Answer 219

``` Female family hx child abuse and neglect emotional trauma substance abuse physcial health problems environmental stress - reduncency - divorce ```

Question 220

NEUROSES | What investigations are required in an individual suspected of having GAD?

Answer 220

``` History + MSE + Risk assesment GAD - 7 Hospital anxiety and depression scale questionnaire Exclude organic causes - FBC / U+E / LFT ```

Question 221

NEUROSES | How would a patient with GAD present

Answer 221

Generalised persisitent free floating worry for 6m - present for more days than not Worry not due to other mental disorder or substane abuse 4 other sx must be present with 1 being from the autonomic range of sx

Question 222

NEUROSES | Descibe autonomic sx for GAD

Answer 222

Sweating palpitations trembling dry mouth

Question 223

NEUROSES | describe physical sx for GAD

Answer 223

Difficulty breathing chest pain nausea

Question 224

NEUROSES | Descibe Brain/mind sx for GAD

Answer 224

``` dizzy poor concentration fear of loosing control derealsation depersonalisation ```

Question 225

NEUROSES | Describe tension sx for GAD

Answer 225

Muscle tension aches restesness

Question 226

NEUROSES | Describe general sx for GAD

Answer 226

Tingling hot flushes Easily startled

Question 227

NEUROSES | What are the psychiatric differential diagnoses for a patient with GAD

Answer 227

``` Depression mixed anxiety and depression Normal worries excess caffiene drug and alcohol problems ```

Question 228

NEUROSES | What is the clinical presentation of hypoglycaemia

Answer 228

``` HE IS TIRED He - Headache IS - Irritability / Sweating T - Tachycardia I - Irritability R - Restlesness E - Excessive hunger D - Dizziness ```

Question 229

NEUROSES | What are the medical differential diagnoses for a patient wth GAD

Answer 229

``` Arrhthmias COPD Asthma Hyperthyroidism Hypoparathyroidism Hypoglycaemia Anaemia ```

Question 230

``` NEUROSES What medications are associated with inducing anxiety like sx - CVS - Resp - CNS - Endo ```

Answer 230

CVS - Anti-hypertensves - Anti - arrhythmics Resp - Bronchodilators (Salbutamol) - Theophylline - corticosteroids CNS - Anti - Ach - Antipsychotics Endo - Levothyroxine

Question 231

NEUROSES | Describe the stepwise management of GAD

Answer 231

1. Patient education + active monitoring - manage co-morbidites - excercise - environmental stressors 2. Low intesity psychological intervetions - individual / guided self help - psychoeducation groups 3. High intensity psychologicla interventions - CBT - Applied relaxation OR/AND - Pharmacological 4. Specialist referral

Question 232

NEUROSES | What is the pharmacological treatment of GAD

Answer 232

1st - SSRI - Sertraline 2nd - alternative SSRI or SNRI 3rd line - Pregabalin

Question 233

NEUROSES | What is a good progonostic factor for GAD

Answer 233

Stable pre-morbid personality

Question 234

NEUROSES | What is a panic attack

Answer 234

period of intense fear charecterised by a group of sx that develop rapidly - peak is reached in 10 mins - Attacks can be spontaneous or situational

Question 235

NEUROSES | What is a panic disorder

Answer 235

Recurrent panic attacks not secondary to substance abuse, medical conditions or another psychiatric disorder

Question 236

NEUROSES | What are the physical sx of a panic attack

Answer 236

``` papitations chest pain choking tachypnoea dry mouth urgency of urination dizziness blurred vision sweating chills hot flushes ```

Question 237

NEUROSES | Why does paraesthesia occur durign a panic attack

Answer 237

Hypocalcaemia due to hyperventialtion

Question 238

NEUROSES | What is agraphobia

Answer 238

Anxiety like sx associated with palcrs or situations where escape may be difficult / embarassing leading to avoidance

Question 239

NEUROSES | What is the management of panic disorder

Answer 239

Acute - Reasurrance +/- BDZs Chronic 1st line - recognise and diagnose ``` 2nd line: - CBT Pharmacotherapy - 1st line: SSRI --> Sertraline -2nd line: Clomipramidine ```

Question 240

NEUROSES | What is a simple phobia

Answer 240

Recurring excessive and unreasoanble psychological / autonomic sx on anxiety in anticipated presence of feared object or situation leading to avoidance

Question 241

NEUROSES | What is the management of simple phobia

Answer 241

Beahvioural: - Exposure therapy - graded exposure Cognitive - Education - Anxiety management - coping strategies Pharmacological - Not used generally - BDZs in severe cases

Question 242

NEUROSES | What is social phobia

Answer 242

Sx of anxiety - psychological and physical restricted to certain social situations leading to avoidance

Question 243

NEUROSES | What is the presentation of a social phobia

Answer 243

Soamtic sx - Blushing - trembling - dry mouth - sweating - fear of humiliation Avoidance of situation - difficulty developing relationships - educational and vocational problems

Question 244

NEUROSES | What is the mangement of social phobia

Answer 244

Psychological 1st line - CBT - Graded exposure therapy Pharmacological 1st line - SSRI / SNRI - sertraline / escitalopram - Venelafaxine Other sx - Beta blockers

Question 245

NEUROSES | What is PTSD

Answer 245

Severe psychological disturbance following trauamtic event | Sx arise within 6m of truamatic event and be present for 1m imapring fucntioning

Question 246

NEUROSES | What can be seen on neuroimaging of a PTSD patient

Answer 246

Reduced hippocampal volume

Question 247

NEUROSES | What are the risk factors for PTSD

Answer 247

``` Low education Afro-carribean female sex low self esteem previous traumatic event Percieved life threat ```

Question 248

NEUROSES | Name 5 protectiva factors for PTSD

Answer 248

``` High IQ Higher social class Caucasian Male gener Good fmaily support ```

Question 249

NEUROSES | What is the presentation of PTSD

Answer 249

Re-experiencing - flashback - nightmares Avoidance - avoiding people - sitaution connected to event Hyperarousal - Hypervigilent - sleep issues - exaggarated stratle - Irritability - difficulty concentrating Emotional numbing - feeling detached Inability to recall

Question 250

NEUROSES | What is the management of PTSD

Answer 250

1st line - Trauma focused CBT - EMDR 2nd line - SSRI --> Sertraline - SNRI - Venelafaxine

Question 251

``` NEUROSES What is the management for these other factors in a patient with PTSD - Sleep issues - Anxiety - Intrusive thoughts ```

Answer 251

- Mitarzapine - BDZs - Antidepressants - Propanolol - Lithium - Valporate

Question 252

NEUROSES | What is OCD

Answer 252

Chronic condition charecterised by obsessions and compulsions which imapct functional imapirement

Question 253

NEUROSES | What are obsessions

Answer 253

Intrusive distressing thoughts and urges that cause anxiety | Patient can recognise thoughts are their own

Question 254

NEUROSES | What are compulsions

Answer 254

Repetitive actions or behaviours which patient feels compelled to perform to reduce anxiety

Question 255

NEUROSES | Name 4 risk factors for OCD

Answer 255

``` Family hx substance misuse anxiety / depression Age : 10 - 21 childhood abuse and neglect ```

Question 256

NEUROSES | What is the management of OCD

Answer 256

1st line - CBT 2nd line - High intensity CBT + ERP OR SSRI / Clomipiramine - If patient does not engage with therapy 3rd line - High intensity CBT AND - SSRIq

Question 257

AFFECTIVE DISORDERS | What are the 3 core sx of depression ad how long must sx be present for to diagnose

Answer 257

Low mood Low energy Anhedonia Nearly everyday for 2 weeks

Question 258

AFFECTIVE DISORDERS | Name 5 other sx of depression

Answer 258

``` DEAD SWAMP D - Depressed mood E - Energy low / Early morning wakening A - Anhedonia D - Dead thoughts Suicidal ``` ``` S - Sleep disturbance W - Worthlesness A - Appetite chnage M - Mentation decreased P - Psychomotor agitation / retardation ```

Question 259

AFFECTIVE DISORDERS | What is the criteria for different severities of depression

Answer 259

Mild - 2 core and 2 other Moderate - 2 core and 4 others Severe - 3 core and 5 others

Question 260

AFFECTIVE DISORDERS | What are the risk factors for depression

Answer 260

BIOPSYCHOSOCIAL Bio - Genetics - Monamine theory Psychosocial - Childhood experiences (Abuse / loss of parent ) - Social circumstances (Marital status / adverse life events) - Physicla illness Peronality traits - Anxiety / Impulsivity

Question 261

AFFECTIVE DISORDERS | Name 2 Investigations used for a depression diangosis

Answer 261

PHQ-9 HADs Rule out organic cause

Question 262

AFFECTIVE DISORDERS | What is the management of mild depression

Answer 262

NO MEDICATION Low intensity psychological intervention - IAPT Group based CBT Lifestyle interventions - Sleep hygeine - Physical activity

Question 263

AFFECTIVE DISORDERS | What is the management of moderate depression

Answer 263

Lifestyle changes Anti-depressants High intensity psychological therapies - CBT

Question 264

AFFECTIVE DISORDERS | What is the pharmacological management of depression

Answer 264

1st line - SSRI 2nd line - Alternative SSRI 3rd line - SNRI

Question 265

``` POSTPARTUM DISORDERS What are baby blues - risk factors - duration - presentation - Management ```

Answer 265

First baby Occurs 3 - 7 days after primiparous birth Tearful Anxious about baby Irritable Poor conentration Reasurrance and support

Question 266

``` POSTPARTUM DISORDERS What is postnantal depression - risk factors - screening tool - duration - presentation - Management ```

Answer 266

N/A Occurs within 1m of delivery and peaks at 3m Edinburugh postnantal depression scale Usual features of depression including - Marital tension - Fears about babys health - Maternal deficinecies Reasurance and support - Most resolve in <6m CBT SSRI - Sertraline and Paroxitine

Question 267

POSTNATAL DISORDERS | Which SSRI should be avoided in pregnancy

Answer 267

Fluoxetine

Question 268

``` POSTPARTUM DISORDERS What is peurperal psychosis - duration - presentation - Management ```

Answer 268

Sx develop within 2-3 weeks post birth Manic depression or psychosis - severe mood swings - disordered perception (auditory hallucinations) ``` Hspital admission Medication - Mood stabaliser - Antidepressants - Antipsychotics if psychotic sx are present ```

Question 269

AFFECTIVE DISORDERS | What is bipolar disorder and how is it charecterised

Answer 269

Cyclical mood disorder that flucutated between epsidoes of acute mania and depression Charecterised by at least 2 epsidoes - one of which muct be mania/ hypomania

Question 270

AFFECTIVE DISORDERS | Describe Bipolar 1

Answer 270

Mania + Depression | PSYCHOTIC SYMPTOMS

Question 271

AFFECTIVE DISORDERS | Describe Bupolar 2

Answer 271

Hypomania + Depression | NO PSYCHOSIS

Question 272

AFFECTIVE DISORDERS | What is cyclothymia

Answer 272

Cyclical mood swings with subclinical features of depression or mania

Question 273

AFFECTIVE DISORDERS | Describe a manic episode

Answer 273

Lasts > 7 days - Functional impairement - psychotic features DIG FAST Distractability Irritability Grandiosity Fast speech Activity - Increased goal directed activity Sleep / Sexual desire Talkability

Question 274

AFFECTIVE DISORDERS | Descibe a hypomanic episode

Answer 274

lasts > 4 days No functional impairement No psychotic features

Question 275

AFFECTIVE DISORDERS What is the management of an acute manic episode - with agitation - without agitation

Answer 275

IM Benzodiazepine Oral monotherapy with antipsychotic

Question 276

AFFECTIVE DISORDERS | What is the management of a depressive episode is a bipolar patient

Answer 276

SSRI - Fluoxetine | Lithium

Question 277

AFFECTIVE DISORDERS | What is the long term management of bipolar

Answer 277

1st line - Lithium 2nd line - Valporate

Question 278

AFFECTIVE DISORDERS | What is the driving regulations for a newly diangosed bipolar patient

Answer 278

No driving for 3m until DVLA assesment

Question 279

AFFECTIVE DISORDERS | Describe the diagnostic criteria for anorexia

Answer 279

Weight <85% predicted BMI < 17.5kg/m2 Intense fear of gaining weight Body image distorsion - Feeling fat when underweight

Question 280

AFFECTIVE DISORDERS | Describe the 5 componenets of the SCOFF questionnaire

Answer 280

S – Do you make yourself SICK because you feel uncomfortably full? C – Do you worry you have lost CONTROL over how much you eat O – Have you recently lost more than ONE STONE (6kgs) in a three month period F – Do you believe yourself to be FAT when other say you are thin? F – Would you say FOOD dominates your life? 2 or more --> High sensitivity

Question 281

AFFECTIVE DISORDERS | Describe the CVS effects of anorexia

Answer 281

``` Hypotension Bradycardia Hypothermia QT prolongation Arrhythmias ```

Question 282

AFFECTIVE DISORDERS | Descibe the endocrine effects of anorexia

Answer 282

Hypoglycaemia Hypo - K+ / Na+ / PO43- Swelling of parotid and submandibular glands Low T3/T4 ``` High - Gs and Cs Cortisol Beta-carotene Cholesterol GH ```

Question 283

AFFECTIVE DISORDERS | Descibe the dermatological effects of anorexia

Answer 283

Lanugo hair Brittle hair Yellow ting to skin

Question 284

AFFECTIVE DISORDERS | Descibe the GU effects of anorexia

Answer 284

Amenorrhoea Infertility Breast atrophy

Question 285

AFFECTIVE DISORDERS | What are the red flags for anorexia

Answer 285

``` BMI < 13 Weight loss > 1 kg/week Temperature < 35.5 BP < 80/50 Long QT Flat T waves weakness in muscles ```

Question 286

AFFECTIVE DISORDERS | What are the investigations required for an anorexic patient

Answer 286

``` Bloods - FBC -U+E - TFTs Calcualte BMI ECG - bradycardia and prolonged QT BP DEXA scan - after 1 year of being underweight Temp ```

Question 287

AFFECTIVE DISORDERS What is the management of anorexia - child - adult

Answer 287

Child 1st line - Anorexia based family therapy 2nd line - CBT Adult ED - CBT Maudsley Anorexia Nervosa Treatment for Adults (MANTRA)

Question 288

ANOREXIA | What is re-feeding syndrome

Answer 288

Drop in phosphate due to rapid initiation of food after > 10 days of undernutition

Question 289

ANOREXIA | What is the management of re-feeding syndrome

Answer 289

``` Slowly re-feed Thiamine and Vitamin B complex Monitor U+E's - Low phosphate - Low potassium - high glucose - high Mg Regualr ECGs ```

Question 290

ANOREXIA | What is the presentation of re-feeding syndrome

Answer 290

``` Rhabdomylysis respiratory failure cardiac failure Low BP Arrhythmias Seizures ```

Question 291

BULIMIA | What is bulimia

Answer 291

Repeated episodes of over eating followed by compensatroy behaviour

Question 292

BULIMIA | Name 4 methods of compensatory behaviour

Answer 292

vomiting starvation laxatives excessive excercise

Question 293

BULIMIA | What is the diagnostic criteria for bulimia

Answer 293

Periodsof binging | Lack of control

Question 294

BULIMIA | Name the metabolic disorders caused by bulimia and the compensatory behaviours associated

Answer 294

Metabolic: Acidosis - Laxatives Alkalosis - Vomiting

Question 295

BULIMIA | What can continued use of laxatives lead to

Answer 295

Cardiomyopathy

Question 296

BULIMIA | What is the management of bulimia in adults and children

Answer 296

Adults 1st line - Bulimia nervosa guided self help 2nd line - Individual CBT - ED Children 1st line - Bulimia nervosa focused fmaily therapy

Question 297

BULIMIA | What is thr pharmacological management of Bulimia

Answer 297

High dose fluoxetine | - reduced binging and purges

Question 298

LEARNING DISABILITY | What is a learning disability

Answer 298

Global impairement in intellectual function in development period leading to an impairement of adaptive function

Question 299

LEARNING DISABILITY | What is a learning difficulty

Answer 299

Localsied impairement of intellectual fucntioning during developementla period leading to impairement of specific adaptive function

Question 300

LEARNING DISABILITY | Describe the categorisation of IQ and it's relevance to learning disability

Answer 300

IQ: < 70 --> Mild 35 - 50 --> Moderate 34 - 21 --> Significant <20 --> Profound

Question 301

SUICIDE | What are the risk factors for suicide

Answer 301

``` male sex Hx of self harm or suicide Substance misuse Hx of mental illness Hx of chronic illness older age divorced low self esteem ```

Question 302

SUICIDE | Name 5 protective factors for suicide

Answer 302

``` married active religious beliefs social support good employement Children ```

Question 303

LITHIUM TOXICITY | What shoudl a patient takin lithium avoid

Answer 303

NSAIDs ACEi Diuretics

Question 304

WERNICKE'S KORSAKOFF SYNDROME | What is the cause and presentation of wernicke's

Answer 304

cause: Thiamine deficiency - B1 ``` presentation: ataxia encephalopathy ocular abnormalities - opthalmoplegia - gaze paresis - ptosis ```

Question 305

WERNICKE'S KORSAKOFF SYNDROME | What is the management of wernicke's

Answer 305

IV Thiamine - Pabrinex IV Glucose - After thiamine has stabalised if not can lead to metabolic acidosis due to lactic acid build up

Question 306

WERNICKE'S KORSAKOFF SYNDROME | What is the presentation of Korsakoff syndrome

Answer 306

Retrograde amnesia Anterograde amnesia confondibulation

Question 307

WERNICKE'S KORSAKOFF SYNDROME | Describe the pathophysiology of Korsakoff's

Answer 307

Affects limbic system Affects Mamillary bodies to cause irreversible deficits in anterograde and retrograde memory Mamillary bodies are part of limbic system – Memory / emotion / behaviour

Question 308

NEUROLEPTIC MALIGNANT SYNDROME | What are the causes of NMS

Answer 308

Antipsychotics | Withdrawal of dopaminergic drugs

Question 309

NEUROLEPTIC MALIGNANT SYNDROME | Hownlogn does it take for NMS to set in

Answer 309

10 days

Question 310

NEUROLEPTIC MALIGNANT SYNDROME | What is the presentation of NMS

Answer 310

REDUCED ACTIVITY Hyperthermia - > 38 BP fluctuation Muscular ridgidity

Question 311

DELIRIUM TREMENS | What is the presentation of delirium tremens

Answer 311

occurs 72 hours after last drink - altered consciousness - liluptian hallucinations - Formication - paranoid delusios - marked tremor - heavy sweating - raised pulse / BP - fever