Psychiatry - conditions Flashcards
(273 cards)
1
Q
What is a mood disorder?
A
Marked disruptions in emotions - severe lows (depression)/ highs (mania)
2
Q
What two sets of diagnostic criteria are frequently used for psychiatric conditions?
A
- ICD-10/11
- DSM-5 (shitty American version)
3
Q
What are the three core symptoms of depression?
A
- Low mood
- Anhedonia (lack of interest)
- Anergia (lack of energy)
4
Q
What are some other symptoms of depression (7)?
A
- Weight change
- Sleep changes
- Reduced libido
- Worthlessness/ guilt
- Decreased concentration
- Thoughts of self harm
- Psychomotor sx (e.g. slow movements)
5
Q
What sleep change is typical of depression?
A
Early morning wakening (typically 2-3 hours early) - although sleeping more/ less overall are both common
6
Q
What 3 criteria should be fulfilled for a diagnosis of depression?
A
- Impair daily function + cause distress
- Symptoms most days for more than 2 weeks
- Not due to substance use or grief
7
Q
What are some risk factors for depression (8)?
A
- Chronic pain
- Post partum
- Hypothyroid
- Trauma + abuse
- Bereavement (although this itself is not depression)
- Divorce
- Stress
- Female
8
Q
What group of people are a higher suicide risk when depressed?
A
Male
9
Q
What are two theories that could lead to or worsen depression/ other psychiatric disorders?
A
- Stress-vulnerability model = positive outcome more likely if stress minimised
- Monoamine hypothesis = deficiency of catecholamines (e.g. norepinephrine) –> depression
10
Q
How is depression initially assessed (3)?
A
- Psychiatric: history, MSE, risk assessment
- Bloods: FBC, U&E, LFTs, TFTs, Ca2+, B12/folate, glucose, CRP/ESR
- Questionaries
11
Q
What questionnaire is commonly used for depression?
A
PHQ-9
12
Q
What scores are suggestive of different levels of depression in the PHQ-9?
A
Out of 27:
* <10 = mild
* 10-19 = moderate
* >19 = severe
13
Q
What symptom can occur alongside severe depression?
A
Psychosis
14
Q
What is psychosis?
A
Symptoms that occur when the mind has difficulty determining what is real and what is not
15
Q
What are some symptoms of psychosis (3)?
A
- Hallucinations
- Delusions
- Disorganised speech/thought
16
Q
What is a delusion?
A
A false belief based in incorrect inference about reality
17
Q
How is mild depression managed?
A
Psychotherapy - guided self help, CBT, group exercises/ mindfulness
Only give antidepressant if requested
18
Q
How is more severe depression treated?
A
- Offer antidepressant (SSRI/ SNRI)
- Psychotherapy (less group activities than mild depression)
19
Q
What PHQ-9 score should antidepressants be offered as first line?
A
16 or more
under 16 should only be given if requested
20
Q
When should initial follow up appointments be arranged for depression after starting antidepressants?
A
2 weeks
21
Q
Who should be seen 1 week after starting antidepressants?
A
- 18-25 year olds
- High risk of suicide
22
Q
How soon should antidepressants begin to have a clinical effect?
A
Within 4-6 weeks
23
Q
What should be done after 4-6 weeks of treatment if there has been no improvement in depression (3)?
A
- Re-evaluate + manage risk factors for depression
- Check compliance with medication
- Consider differential diagnoses
24
Q
How long after symptoms resolve should an antidepressant be taken for?
A
6 months
25
How frequently should those on long term antidepressants be seen?
Every 6 months
26
What treatment can be offered for extremely severe, life threatening depression?
ECT
27
What are the pharmacological options and order typically given for depression (6)?
1. SSRI
2. Another SSRI
3. SNRI/ mirtazapine
4. TCA
5. MAOIs
6. Treatment resistant depression --> lithium/ antipsychotics/ AEDs
28
When should a patient with depression be referred?
Treatment resistant depression/ very severe depression
29
Other than depression what are some other affective disorders (mood disorders) (6)?
* Bipolar disorder
* Dysthmia
* Postnatal depression
* Seasonal affective disorder
* Premenstrual dysphoric disorder (PMDD)
* Schizoaffective disorder
30
What is dysthymia?
Persistent (2-5 years) sub-threshold depressive symptoms
31
What is postnatal depression?
Depression within first year of giving birth, persisting beyond 2 weeks after birth
32
What severe symptoms can occur alongside postnatal depression?
Psychosis (postpartum psychosis)
33
What is the "baby blues"?
Depression that resolves within 2 weeks of giving birth
34
How is postnatal depression medically managed when mother is breastfeeding?
Sertraline/ paroxetine
*low levels pass into breast milk*
35
What is seasonal affective disorder (SAD)?
Depression usually during autumn/ winter with remission between
36
What is a specific treatment for SAD?
Light therapy
37
What is adjustment disorder?
Negative reaction to stress involving negative thoughts, strong emotions and changes in behaviour.
*May occur with depressive symptoms*
38
How long does adjustment disorder last?
Less than 6 months
39
What are some key differential diagnoses for low mood (4)?
* Affective disorders (e.g. depression, bipolar, SAD...)
* Hypothyroidism
* Bereavement
* Cancer/ terminal illness
40
What is bipolar disorder?
The presence of both depressive and (hypo)manic episodes
41
What is mania?
Abnormally elevated mood lasting for more than **1 week** resulting in impairment in social and occupational functioning. Psychotic symptoms often present
42
What is hypomania?
Elevated mood lasting for more than **4 days** that does not significantly impact on the persons functioning
43
What are the types of bipolar disorder (3)?
* Type 1 = mania + depression
* Type 2 = hypomania + depression
* Cyclothymia = hypomania + subclinical depression
44
What criteria are needed for a diagnosis of each of the bipolar disorders?
* Type 1 = **manic episode**, don't need depressive episode
* Type 2 = **hypomanic AND depressive**
* Cyclothymia = **hypomania and subclinical depression** (much faster alternating) lasting 2 years
45
What are some symptoms of a manic episode (8)?
* **Elevated mood**
* **Increased activity**
* **Grandiose ideas**
* Decreased need for sleep
* Easily distracted
* Psychotic symptoms
* Pressure of speech, flight of ideas
* Changing appearance + overspending money
46
The lack of what features would point toward a **hypo**manic episode (3)?
* Grandiosity
* Psychosis
* Lack of insight (so would have some insight)
47
What can precipitate a manic episode (3)?
* Positive life events
* Getting up early
* Drugs/ alcohol
48
What are some risk factors for bipolar (4)?
* Family history (first degree)
* Trauma/ abuse
* Stress
* Substance abuse
49
What might be considered a typical person at risk of developing bipolar?
Female < 30 with family history of bipolar
50
What activities pose a risk to those in a manic episode (3)?
* Reckless behaviour/ aggression
* Sexual promiscuosity
* Lack of self care for physical illnesses
51
What are some organic causes of bipolar disorder (3)?
* Endocrine e.g. hyperthyroidism
* Neurological - MS, CVA, epilepsy, tumour
* Drugs - steroids, antidepressants
52
How is bipolar diagnosed (2)?
* Clinical diagnosis
* Bloods, imaging and other Ix used to rule out organic causes
53
How should bipolar be immediately managed (2)?
* Manic episode = urgent referral
* Hypomanic episode = routine referral
54
What is rapid cycling bipolar disorder?
Having 4 or more manic episodes in 1 year
55
What is the medication pathway to treat a manic episode (3)?
* Antipsychotic (haloperidol, risperidone, quetiapine, olanzapine)
* Offer second antipsychotic
* Add sodium valproate/ lithium
56
What should be stopped during a manic episode?
Antidepressants - tapered and stopped
57
How is a depressive episode in bipolar managed with medication (3)?
* Antipsychotics
* Olanzapine + fluoxetine
* Lamotrigine
58
What is the medication pathway for the long term management of bipolar?
* Lithium
* Sodium valproate
* Olanzapine
59
How should lithium be monitored when started for bipolar disorder?
Concentration measured 12 hours after dose weekly until stable, then every 3 months
60
What non pharmacological options are there for those with bipolar disorder?
* Education about bipolar and early warning signs (with involvement of family)
*CBT can be used - not particularly effective*
61
What are some differential diagnoses for bipolar disorder (3)?
* Unipolar depression
* Schizophrenia
* Emotionally unstable personality disorder (EUPD/BPD)
62
What is schizophrenia?
An acute mental health state resulting in psychosis (delusions and hallucinations) and dissociation from reality
63
What are 3 types of delusion?
* Grandeur = belief of inflated self importance (e.g. that they are the queen)
* Paranoid
* Somatic = believe they have a terrible illness
64
What are some risk factors for schizophrenia (6)?
* **Family history (1st degree)** = biggest factor
* 16-30 years
* Previous illicit drug user
* Trauma + abuse
* Traumatic birth
* Emigrating
65
What broad groups are the symptoms of schizophrenia divided into (3)?
* Positive symptoms
* Negative symptoms
* Cognitive impairment
66
What is a positive symptom in schizophrenia?
Those present in people during a psychotic episode
67
What is a negative symptom in schizophrenia?
Deficits of normal emotional responses
68
What are some examples of positive symptoms in schizophrenia?
* Delusions
* Hallucinations
* Thought disorders
* Disorganised speech/ behaviour
69
What types of hallucinations are common in schizophrenia?
Auditory (however talking to the voices is rare)
*visual and olfactory hallucinations are rarer in schizophrenia*
70
What types of disorganised speech sometimes occur in schizophrenia (6)?
* **Word salad** - completely mixed up sentence
* **Neologism** - made up word
* **Flight of thought** - jumps from one idea to another with associations
* **Knights move thinking** - jump from ideas with no associations
* **Pressure of speech** - fast talking
* **Circumstantiality** - take ages to get to the point
71
What type of thought disorders occur in schizophrenia (3)?
* Insertion - thoughts put in mind
* Withdrawal - thoughts taken from mind
* Broadcasting - thoughts told against will
* Passivity - lack of control over them
72
What negative symptoms can be present in those with schizophrenia (5)?
* **A**logia - impoverished level of thinking (poverty of speech)
* **A**nhedonia - loss of pleasure
* **A**pathy - lack of enthusiasm
* **B**lunting of affect (emotionless)
* **S**lowness of thought and movement
*AAABS*
73
What other symptoms can be present in those with schizophrenia (5)?
* Depression
* Anxiety
* Agitation
* Withdrawal
* Self harm
74
What are Schniders first rank symptoms for schizophrenia (more historical criteria) (4)?
* **A**uditory hallucinations
* **B**roadcasting, insertion, withdrawal of thoughts
* **C**ontrol (passivity) - others controlling actions + thoughts
* **D**elusional perceptions
75
What are some differential diagnoses for psychosis (4)?
* Psychological disorders
* Delirium tremens
* Drugs e.g. cannabis
* Organic disorder e.g. epilepsy
76
What psychological disorders cause psychosis (5)?
* Schizophrenia
* Bipolar disorder
* Brief psychotic disorder
* Delusional disorder
* Major depressive disorder
77
How long should a brief psychotic disorder last?
less than 1 month, often with a precipitating factor
78
What is delusional disorder?
Similar to schizophrenia but without significant hallucinations, though disorders or mood disorders
79
How is schizophrenia investigated (4)?
* FBC + LFTs
* Drug screening
* EEG - for epilepsy
* CT/ MRI - enlarged lateral ventricles
80
How long should symptoms of schizophrenia be going on for before a diagnosis is made?
28 days
81
What is important to tell people with a diagnosis of schizophrenia?
Can't drive until well for 3 months
82
What is indicative of a poor prognosis for schizophrenia (4)?
* Slower onset
* Family history
* Abuse history
* Negative symptoms
83
What is late onset schizophrenia?
After age 45
84
What is the prognosis for later onset schizophrenia?
Better prognosis
85
What risks are associated with those with schizophrenia (3)?
* Self neglect - exacerbate physical health conditions
* Risk to others
* Suicide - thoughts/ auditory hallucinations
86
How is schizophrenia managed pharmacologically?
* Trial 2 atypical antipsychotics (risperidone, olanzapine, aripiprazole, quetiapine)
* if no effect ... clozapine
87
What non pharmacological treatments are offered to those with schizophrenia (3)?
* CBT
* Early warning signs education
* Family therapy (they can recognise the signs)
88
What is schizoaffective disorder?
Schizophrenia + mood disorder (e.g. depression/ bipolar)
89
What "state" do some people with schizophrenia sometimes end up in?
Catatonia
90
What is catatonia?
Ceases in movements/ speech, sometimes with abnormal movements
91
Other than schizophrenia what is catatonia associated with (2)?
* Major depressive disorder
* Mania/ bipolar disorder
92
What is the most common anxiety disorder affecting 15% of people?
Specific phobias
93
How could a specific phobia be defined?
Irrational fear of particular thing/ situation
94
What is a symptom of specific phobias (2)?
* Avoidance behaviours
* Catastrophising
95
What are some examples of specific phobias (1)?
* Agoraphobia = fear of public places/ unknown environment
96
How is a specific phobia treated (2)?
* **Exposure responce prevention**
* Consider SSRIs
97
What is the second most common anxiety disorder?
PTSD
98
What is PTSD?
Onset of symptoms such as flashbacks for more than 1 month after a particularly traumatic event
99
What is 'PTSD' that does not continue 1 month past the traumatic event known as?
Acute stress reaction
100
What are the 3 main symptoms of PTSD?
* Flashbacks/ nightmares to event
* Avoidance behaviour of things that remind them of the event
* Hypervigilance - exaggerated responce to stimuli
101
What is the first line treatment for more mild PTSD?
Trauma focused CBT + exposure therapy
102
What is the gold standard treatment for chronic PTSD?
Eye movement desensitisation and reprocessing (EMDR)
103
What is a pharmacological treatment for PTSD?
SSRI *or* venlafaxine
104
Other than PTSD and phobias, what are some other anxiety disorders (3)?
* Panic disorder
* GAD
* OCD
105
What 3 features are suggested in models that result in the development of panic/ anxiety disorders?
* Stress
* Loss of control
* Genetics
106
What are some risk factors for the development of anxiety/ panic disorders (6)?
* Genetics
* Stimulant drugs
* Palpitations
* Hyperthyroid
* Trauma/ abuse
* Stress
107
How many panic attacks are required for a diagnosis of panic disorder?
4 or more within 1 month
*usually last 10-30 min*
108
Who is typically affected by panic disorder?
Female (20-30 years old)
109
What are 8 symptoms of a panic attack?
* SoB
* Chest pain
* Lightheaded/ dizzy
* Palpitations
* Shaking
* Sweating
* Parasthesia
* Fear of dying
110
What phobia do people with panic disorder often develop?
Agoraphobia - fear of unknown surroundings
111
What questionnaire is used to diagnose panic disorder?
PHQ-PD
112
How is panic disorder treated (4)?
* Psychoeducation
* CBT/ ERP = gold
* SSRI
* Beta blockers (propanolol)
113
What is OCD?
Obsessive thoughts and recurrent ritualistic behaviour (for relief)
114
What are the 2 symptoms/ features of OCD?
* Recurrent unwanted intrusive thoughts
* Behaviours that result from the obsessive thoughts believed to prevent a bad outcome
115
How long should OCD be going on for to get a diagnosis?
More than 4 days per week for more than 2 weeks
116
What are some common OCD behaviours (3)?
* Handwashing
* Checking lights/ locks
* Cleaning
117
Do patients with OCD have insight into their behaviours?
Yes they know it is unnecessary
118
What is the cycle of emotions in OCD?
Obsession --> anxiety --> compulsion --> temporary relief
119
What questionnaire can be used to help diagnose OCD?
Y-BOCS (Yale-brown OCD scale)
120
How is OCD managed (3)?
* Exposure and response prevention (+CBT)
* 1st = SSRIs (for at least 12 weeks)
* 2nd = clomipramine (TCA)
121
What is generalised anxiety disorder?
Numerous worries cause anxiety throughout the day and in various situations
122
How long should symptoms go on for a diagnosis of GAD?
6 months
123
What are 3 key features of the anxiety in GAD?
* Pervasive
* Persistent
* Non-specific
124
What are some physiological reactions to anxiety (6)?
* Decreased blood flow to gut
* Smooth muscle contraction in gut
* Increased blood flow to skeletal muscle
* Dilation of pupils
* Nausea
* Increased HR/BP
125
What are the 6 key signs/ symptoms of GAD?
* Restlessness
* Fatigue
* Irritability
* Poor concentration
* Sleep disturbance
* Muscle tension
126
How is GAD investigated (2)?
* Bloods
* GAD-7 questionnaire
127
How is GAD treated (4)?
* Psychoeducation - explain the diagnosis
* Guided self help + **breathing techniques**
* CBT
* Pharmacological Tx
128
What drug treatments are offered to those with GAD in primary care (3)?
* Sertraline = 1st
* SSRI/SNRI (particularly duloxetine and venlafaxine)
* Pregabalin
129
What drug treatments are offered for GAD in secondary care?
Antipsychotics (e.g. quetiapine)
130
What medications can be offered for symptom relief in those with GAD?
Beta blockers (e.g. propanolol)
131
What medication is used for short term symptomatic relief of GAD?
Benzodiazapines e.g. diazepam
132
Why should long term use of benzodiazepines be avoided (4)?
* Addiction risk
* Adverse effects on mood
* Reduced motivation
* Oversedation
133
What percent of men and women have GAD?
* Men = 2-4%
* Women = 3-5%
134
What is it known as when there is a focus/ exaggeration of physical symptoms?
**S**omatisation = **s**ymptoms
135
What is concern of a serious illness known as?
Hypo**c**hondriasis = **c**ancer
136
What is a personality disorder?
A longterm, persistent pattern of inner experiences and behaviour that differs markedly from cultural expectations leading to distress/ impairment
137
When do personality disorders typically develop in life?
Early adulthood/ adolescence
138
What are some risk factors for personality disorders (2)?
* Traumatic childhood without any strong connections with other people
* Family member with personality disorder
139
What theory has been suggested to contribute to the development of personality disorders?
Attachment theory - idea that children need one relationship with primary caregivers for their survival
140
What areas of functioning do personality disorders affect (5)?
* Interpersonal functioning
* Affectivity
* Cognition
* Impulse control
* Occupational/ social performance
141
What questionnaire can be used to diagnose and distinguish different PDs?
Personality diagnostic questionnaire 4 (PDQ-4)
142
Are behaviours/ emotions exhibited due to personality disorders easy to change?
No, they are deeply ingrained + enduring
143
What are the 3 broad categories of personality disorders?
* A = Suspicious/ odd
* B = Emotional/ impulsive
* C = Anxious
144
What personality disorders are within group A - odd/ eccentric (3)?
* **Paranoid** - suspicious, sensitive, unforgiving
* **Schizoid** - emotionally cold, lack of interest, detached
* **Schizotypal** - magical thinking, unusual perceptions, inappropriate affect
145
What personality disorders are within group B - emotional/ erratic (4)?
* **Antisocial** - lack of concern, disregard for rules, aggression
* **Borderline/ EUPD** - impulsive, fear of abandonment, poor self image
* **Histrionic** - dramatic, crave attention, manipulative
* **Narcissistic** - grandiosity, lack of empathy, need for admiration
146
What personality disorders are within group C - anxious/ fearful (3)?
* **Avoidant** - fear of criticism, self-conscious, tense
* **Dependant** - doesn't like to take control, doesn't disagree, needs reassurance
* **Obsessive - compulsive** - perfectionist, indecisive, likes orderliness + control
147
What are common signs and symptoms for all personality disorders (7)?
* Strong emotions
* Low self esteem
* Impulsive
* Self harm
* Substance abuse
* Violence/ agression
* Difficulties maintaining relationships
148
What questionnaire is useful for diagnosis of personality disorders?
Minnesota multiphase personality inventory (MMPI)
149
How are personality disorders managed?
* Psychoeducation
* Dialectical behaviour therapy (+other CBT)
150
What is a particularly effective management of BPD/ EUPD?
Dialectical behaviour therapy
151
Which personality disorder is suicide/ self harm particularly common?
EUPD/BPD
*antisocial as well*
152
What are 6 psychiatric emergencies?
* Neuropleptic malignant syndrome
* Serotonin syndrome
* Acute dystonic syndrome
* Wernicke-korsakoff syndrome
* Delirium tremens
* Lithium toxicity
153
What causes neuroleptic malignant syndrome?
Reduced dopaminergic activity due to adverse reaction to **antipsychotics** (dopamine receptor antagonists) or **abrupt dopaminergic withdrawal** (levodopa)
154
What are the symptoms of neuroleptic malignant syndrome (5)?
* Fever
* Altered mental state/ confused
* Rigidity
* Fluctuating BP
* Tachycardia
155
How is NMS investigated (3)?
* Bloods
* CT/MRI
* Infection screen
156
What blood result is often raised in NMS?
Creatinine kinase
157
How is NMS managed (4)?
* Treat **hyperthermia** (e.g. with ice packs)
* Stop drug
* Dantrolene (muscle relaxant)
* Bromocriptine
158
What are some complications of NMS (2)?
* Rhabdomyolysis
* AKI
159
What causes serotonin syndrome?
High synaptic concentration of serotonin
160
What drugs cause serotonin syndrome (4)?
* Antidepressants
* Opioids e.g. tramadol
* St johns worts
* Stimulants e.g. ecstacy/ cocaine
161
How do opioids sometimes cause serotonin syndrome?
Unknown although metabolites may be SSRIs
*Tramadol acts as an SNRI*
162
What antidepressant is a particular risk for causes serotonin syndrome?
MAOIs
163
What are the symptoms of serotonin syndrome (7)?
* Agitation/ confusion/ hallucinations
* Tremor
* Rigidity
* Hyperreflexia
* Hypertension
* Tachycardia
* Hyperthermia
164
How soon after starting medications does serotonin syndrome usually occur?
Within 2 weeks
165
How is serotonin syndrome treated?
**Chlorpromazine**
Mainly supportive treatments e.g. ice packs, intubation
166
What medication can be given to those with serotonin syndrome?
Cyproheptadine or chlorpromazine - blocks dopamine
167
What is a differential diagnosis for serotonin syndrome?
Neuroleptic malignant syndrome
168
What can help differentiate between NMS and SS in terms of signs/ symptoms?
* NMS = (lead pipe) muscle rigidity
* SS = hyperreflexia/ clonus
169
How can NMS and SS be differentiated between from blood results?
NMS usually has raised WBC and CK more than SS
170
How is self harm often carried out (5)?
* Cutting
* Headbanging
* Burning
* Alcohol
* Overdoses
171
What are some risk factors for self harm (6)?
* LGBTQ+
* Female
* EUPD
* Depression
* Bereavement
* Trauma/ abuse
172
How is suicide often carried out (4)?
* Overdose
* Jumping from height
* Cutting
* Ligatures
173
What are some risk factors for suicide (10)?
* **S**ex = male
* **A**ge = old/ teenager
* **D**epressed
* **P**ast history of suicide attempt
* **E**mployment = unemployed
* **R**ational loss (psychotic)
* **S**elf harm
* **O**rganised plan
* **N**on married/ divorced
* **S**ick/ chronic disease
174
What factors suggest a higher likelihood of a completed suicide attempt (5)?
* Makes effort not to be found
* Leaves note
* Plans death
* No regret
* Violent method
175
What pathway is thought to be the cause of addictive behaviours?
Mesolimbic reward dopaminergic pathway
176
What terms are used to describe substance dependance (8)?
* Withdrawal Sx
* Tolerance
* Narrow repertoire
* Craving
* Loss of control
* Rapid reinforcement
* Primacy
* Continued use despite harm
177
What does a narrow repertoire refer to in the context of substance dependence?
Exhibit same behaviour - e.g. drinking around the same times each day to maintain high BAC
178
What does rapid reinforcement refer to in substance dependence?
Quick return to old level after stopping
179
What does primacy refer to in substance dependence?
Takes precedence over physiological need
180
What is the mechanism of action of alcohol in the brain?
Alcohol up-regulates GABA (inhibitory) receptors and down-regulates glutamate (excitatory) receptors
181
What is the pathophysiology of long term alcohol use?
GABA system down-regulated and glutamate system up-regulated, therefore when alcohol is not taken this results in an imbalance in the body
182
What is the recommended alcohol consumption each weak?
14 units
183
What are some symptoms of alcohol intoxication (7)?
* Ataxia
* Slurred speech
* Increased confidence
* Irritable
* Decreased GCS
* Vomiting
* Sexual arousal
184
What are some signs/ symptoms of excess chronic alcohol use (6)?
* Smelling of alcohol
* Slurred speech
* Bloodshot eyes
* Telangiectasia
* Tremor + other withdrawal Sx
* Decreased cognitive functioning/ memory
185
What are the symptoms of alcohol withdraw and what time period do they appear (3)?
* 6-12 hours = anxiety + (fine) tremor
* 24-48 hours = seizures (peak at 36 hours)
* 48 -72 hours = delirium tremens
186
What are the signs/ symptoms of delirium tremens (6)?
* Corse tremor
* Confusion
* Delusions
* Auditory + visual hallucinations
* Fever
* Tachycardia
187
How is alcohol use investigated (3)?
* **Bloods**
* **CAGE** questionnaire = screening
* **AUDIT** questionnaire = diagnosis
188
What score on AUDIT questionnaire indicates harmful alcohol use?
8/10 or more
189
What are the blood findings of those with alcohol use (3)?
* Raised MCV
* Raised **GGT** + AST>ALT
* Raised CDT
190
What questions are asked in the CAGE questionnaire?
* **C**ut down? (think about it)
* **A**nnoyed (when people ask about alcohol)
* **G**uilty
* **E**ye opener (drink when wake up)
191
What is the treatment for acute alcohol withdrawal (2)?
* **Chlordiazepoxide**
* IM/IV pabrinex (vitamin Bs e.g. thiamine)
192
How is alcohol use managed in the long term (5)?
* Naltrexone = reduces pleasure
* Acamprosate = reduces cravings
* Disulfiram = induces hangover Sx with alcohol
* Oral thiamine
* Psychological therapy
193
What is the BAC limit for driving?
0.08%
194
What are some complications of alcohol consumption (5)?
* Liver cirrhosis
* Wernicke-korsakoff
* Pancreatitis
* Cancer
* Alcohol dependance + withdrawal
195
What is the cause of Wernicke-Korsakoff syndrome?
Poor thiamine (B1) absorption --> thiamine deficiency
196
What are the symptoms of wernickes encephalopathy (4)?
* Confusion
* Oculomotor disturbance/ nystagmus
* Ataxia
* AMS
197
What are the signs/ symptoms of korakoff (3)?
Memory impairment/ confabulation
198
What are some MRI findings in Wernicke-Korsakoff syndrome (2)?
* Wernicke = reversible cytotoxic oedema
* Korsakoff = mammillary body + thalamic atrophy
199
How is Wernicke-Korsakoff treated?
IV pabrinex (vitamin Bs/ thiamine)
200
What are the symptoms of opioid overuse/ toxicity (5)?
* **Pinpoint pupils**
* **Resp depression**
* Reduced GCS + confusion
* Euphoric
* Constipated
201
How is opioid overdose treated?
Naloxone
202
How is opioid use treated in the long term?
Methadone
203
What are some withdrawal symptoms of opioid use (6)?
* Yawning
* Anxiety
* Dilated pupils
* N+V
* Lacrimation (increased tears)
* Rinorrhoea
204
What is the mechanism of MDMA, cocaine, amphetamines and LSD (4)?
* MDMA (ectasy) = stimulates serotonin release + blocks reuptake
* Cocaine = blocks dopamine reuptake
* Meth = stimulates Da release + blocks reuptake
* LSD = stimulates 5-HT2A receptors (serotonin receptors) in prefrontal cortex
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What are the general signs/ symptoms of MDMA, cocaine, amphetamines and LSD use (4)?
* Agitation
* Hypertension
* Hyperthermia
* Tachycardia
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What are two specific features of cocaine use?
* Vasospasm
* QRS prolongation + arrhythmias
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What are the two specific features of amphetamine use?
* Hallucinations
* Dilated pupils
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What are two specific features of LSD use?
* Hallucinations
* Hyperreflexia
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What are the general principles of management of drug overdoses (6)?
* A-E approach
* Intubate
* Reduce temperature
* Monitor BP
* Benzodiazapines (for seizure prevention)
* Psychological support
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What is drug misuse vs drug abuse (2)?
* Abuse = use in a way that causes considerable harm
* Misuse = use in a way different to prescription/ unsafe setting
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What are 3 common eating disorders?
* Anorexia nervosa
* Bulimia nervosa
* Binge eating disorder
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Which eating disorder is the least common but has the highest mortality?
Anorexia nervosa
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What is anorexia nervosa?
Believing they are overweight and need to loose weight despite evidence of low/ normal BMI
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What are some risk factors for anorexia nervosa (7)?
* Family history
* Female
* Younger age (20-40)
* Trauma/ abuse
* Social media
* History of overweight
* Depression
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What are the signs/ symptoms of anorexia nervosa (8)?
* Low BMI < 17.5/ 15% below expected
* Purging (laxatives + vomiting)
* Weight loss
* Amenorrhoea
* Lanugo hair
* Osteopenia + muscle waisting
* Hypotension
* Hypothermia
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What are some common cardiac complications in those with anorexia nervosa (3)?
* Arrhythmias
* Cardiac atrophy
* Sudden cardiac death
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How is anorexia nervosa investigated (4)?
* SCOFF screening questions
* SUSS test (sit-up-squat-stand)
* Bloods
* ECG
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What are the SCOFF screening questions for AN (5)?
* Make yourself **S**ick
* Lost **C**ontrol of how much you eat
* **O**ne stone in 3 months
* **F**ood dominates life
* **F**at perception
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What are the blood results of someone with anorexia nervosa (4)?
* **Anaemia**
* **Leucopenia**
* **Thrombocytopenia**
*reduced bone marrow activity*
* **Hypokalaemia**
*everything low except growth hormone + cortisol*
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How is anorexia nervosa managed (5)?
* Structured eating plan + supplements
* Anorexia focused family therapy
* CBT
* Inpatient management
* Fluoxetine
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What are some complications of anorexia nervosa (4)?
* **Refeeding syndrome**
* Osteoporosis
* Amenorrhoea
* Infertility
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What is the pathophysiology of refeeding syndrome?
Low food intake = low electrolytes, when begin eating --> insulin spike --> glucose + electrolytes move into cells --> further depletes electrolytes + glucose
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What are the important effects of referring syndrome (4)?
* Hypokalaemia
* Hypomagnesaemia
* Hypophosphataemia
* Fluid overload
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What is bulimia nervosa?
Episodes of binge eating followed by purging (typically making oneself vomit)
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Who is typically affected by bulimia nervosa?
Young female (20-30) athletes/ models
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What are the signs/ symptoms of bulimia nervosa (9)?
* Preoccupation with body image
* Often normal BMI
* Binge eating then purging
* Erosion of teeth
* Russels sign (callouses on knuckles)
* Gord/ reflux
* Parotitis
* Halitosis (bad breath)
* Dental carries
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What is the typical episode of a binge eating then purge like in BN?
Eating alone until uncomfortably full, feel guilty, then making themselves vomit
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What are some examples of ways people with BN purge (3)?
* Vomit
* Exercise
* Laxatives/ diuretics
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How is bulimia nervosa investigated (3)?
* SCOFF screening
* SUSS -ve
* Bloods
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How long should bulimia nervosa typically have gone on for?
3 months with 2 episodes per week
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What are the blood findings in those with bulimia nervosa?
Hypokalaemic hypochloraemia metabolic alkalosis
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How is bulimia nervosa managed (4)?
* Self help + education
* CBT (eating disorder focused)
* Bulimia nervosa focused family therapy
* Fluoxetine
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What are the signs/ symptoms of binge eating disorder (5)?
* Higher BMI
* Planned episodes of eating lots very quickly in private
* Loss of control
* Guilt/ disgust
* Underlying psychological distress
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How long should binge eating disorder typically have been going on for for a diagnosis?
More than 3 months
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How is binge eating disorder treated?
CBT
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What are some common reasons children may be referred to CAMS (4)?
* Learning disabilities
* ADHA
* ASD
* Tics
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What is a learning disability vs learning difficulty?
* Disability = general intelligence resulting in a lower IQ
* Difficulty = difference in the way someone learns making it harder to learn certain things
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How are learning disabilities categorised (4)?
* 50-70 = mild
* 35-49 = moderate
* 20-34 = severe
* <20 = profound
*measured in IQ*
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What are some causes of learning disabilities (5)?
* ASD
* ADHD
* Genetic (e.g. downs)
* TORCH
* PANDAS
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What is PANDAS?
**P**aediatric **a**utoimmune **n**europsychiatric **d**isorders **a**ssociated with **s**treptococcal infections - it is a controversial diagnosis where children develop tic disorders or OCD after streptococcal infection
241
What is autism spectrum disorder?
Spectrum of severity of impaired communication and social interaction
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What age do symptoms of ASD typically appear?
< 3 years
243
What 3 general categories can symptoms of ASD be placed in (3)?
* Social interaction
* Communication difficulties
* Behavioural deficits
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What are some signs/ symptoms of ASD (11)?
* Lack of eye contact
* Delay in smiling
* Avoiding physical contact
* Difficulty reading non-verbal cues/ emotions
* Delay in language/ minimal language
* Difficulty with imaginative behaviour
* Repetitive use of words/ phrases
* Lack of interest in people
* Repetitive movements/ behaviours
* Fixed routine
* Deep + intense interests
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In what situations should symptoms of ASD be present?
Across more than 1 setting e.g. home and school
246
What questionnaire can help diagnose autism?
M-CHAT
247
How is ASD managed?
Supportive - SENCO, psychologists, etc
248
What are the key features of ADHD (3)?
* Difficulty maintaining attention
* Excessive energy + activity
* Impulsivity
249
What are some risk factors/ causes of ADHD (3)?
* Genetics/ family history
* Pregnancy related (e.g. low birth weight, smoking, premature)
* Environmental factors
250
In what situations should symptoms of ADHD be present?
Consistent across all settings
251
What are some symptoms of ADHD (7)?
* Short attention span
* Easily distracted
* Quickly moving between activities
* Inability to complete tasks
* Constantly moving/ fidgeting
* Impulsive behaviour
* Disruptive behaviour
252
What assessment can help diagnose ADHD?
DIVA-5
253
How is ADHD managed (3)?
1. Watch + wait/ conservative management
2. Methylphenidate
3. Lisdexamfetamine
254
What are some conservative management strategies for ADHD (4)?
* Structured routines
* Clear boundary
* Healthy diet
* Plenty of exercise
255
What type of medications are used for ADHD?
Amphetamines (CNS stimulants)
256
What should be monitored in people on methylphenidate + other ADHD drugs (2)?
* Baseline ECG needed as risk of RBBB
* **Monitor height + weight** on growth charts as meds can decrease appetite
257
What conditions are tics associated with (3)?
* ASD
* ADHD
* PANDAS
258
What are the classification of tics (2)?
* Simple (non goal orientated movements)
* Complex
259
What are some examples of complex tics (3)?
* Echolalie (repeating phrases others have said
* Involuntary swearing
* Involuntary obscene gestures
260
What is Tourettes (2)?
* More than 1 year simple tics
* Multiple complex tics
261
How should tics be managed?
Don't try to suppress them
262
What is a Neurodevelopmental disorder?
Group of mental disorders affecting the development of the nervous system
263
What are some examples of Neurodevelopmental disorders (4)?
* ASD
* ADHD
* Learning disability
* Tics
264
What are some disorders affecting sleep (4)?
* Insomnia
* Narcolepsy
* Restless leg syndrome
* Sleep apnoea
265
How can insomnia be treated (2)?
* Zopiclone
* Benzos
*should only be prescribed for a short period*
266
What is narcolepsy?
Condition impairing the ability to regulate sleep-wake cycle
267
What are some signs/ symptoms of narcolepsy (5)?
* **C**ataplexy (collapse after emotional high)
* **H**allucinations (visual)
* **E**xcessive daytime sleepiness
* **S**leep paralysis
* **S**leep difficulty
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How is narcolepsy treated?
Modafinil (CNS stimulant)
269
What are some criteria for gender dysphoria (6)?
* Difference between assigned gender and expressed/ experienced gender
* Desire to be rid of ones sexual characteristics
* Desire for characteristics of another gender
* Desire to be a gender other than ones assigned gender
* Belief that one has the typical reactions/ feelings of another gender
* Desire to be treated as a different gender
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How long should these symptoms of gender dysphoria be going on for to have a diagnosis?
2 or more symptoms for more than 6 months
271
What are some causes of cognitive impairment (7)?
* Dementias + parkinsons
* Strokes
* Traumatic brain injuries
* Meningitis/ encephalitis
* Depression/ schizophrenia/ bipolar
* Substance use
* Genetics (e.g. downs)
272
What disorders under the scope of psychiatry are common in older people (6)?
* Depression
* Dementia
* Anxiety disorders
* Bereavement
* Delirium
* Insomnia
273
What factors might suggest a diagnosis of depression rather than dementia?
* Rapid onset
* Weight loss/ sleep disturbance
* Patients worried about poor memory
* Variable mini-mental test scores
* Global memory loss (dementia tends to affect recent memories)
