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The One Deck To Rule Them All > Psychiatry General > Flashcards

Psychiatry General Flashcards

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1
Q

Management for Seasonal Affective Disorder

A

SSRIs

Vit D

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2
Q

Risk factors of suicide

A 
Male
Hx of Self harm 
Substance abuse
Depression 
Schizophrenia (10%) 
Hx of chronic disease
Increases with age 
Social isolation 
Unemployment 
Living alone
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3
Q

Risk factors of future suicide attempt

A 
Efforts to avoid discovery 
Planning
Leaving a written note
Sorting out finances etc 
Violent method
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4
Q

Core 3 features of depression

A

Core 3 features

  • low mood
  • anhedonia (no enjoyment)
  • low energy

Other features

  • decreased concentration
  • decreased confidence
  • guilt
  • pessimism
  • ideas of self harm
  • disturbed sleep
  • agitation
  • decreased libido
  • global memory loss
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5
Q

Diagnostic criteria for mild depression

A

2/3 core features + 2 others
>2 weeks
Still able to function

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6
Q

Diagnostic criteria for moderate depression

A

2/3 core features + 3/4 others
>2 weeks
Difficult to function

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7
Q

Diagnostic criteria for severe depression

A

3/3 core features + 4 others
>2 weeks
Distressed
May have degree of psychosis

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8
Q

What is used to screen, diagnose and monitor the severity of depression

A

PHQ-9 (Patient Health Questionnaire 9)

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9
Q

What is used in screening anxiety and depression

A

HAD Score (Hospital Anxiety + Depression Score)

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10
Q

Management for mild depression

A

1st
CBT (cognitive behavioural therapy)

2nd
SSRI

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11
Q

Management for moderate depression

A

CBT + SSRI

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12
Q

Management for severe depression

  • catatonia
  • psychosis
  • debilitating depression
A

ECT (electroconvulsive therapy)

Decrease dose of drugs beforehand

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13
Q

Side effects of ECT

A

Headache
Retrograde amnesia
Short term memory impairment
Arrhythmia

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14
Q

Somatic symptoms

A 
Decreased emotions 
Diurnal mood variation 
Anhedonia 
Early morning wakening 
Agitation
Decreased appetite 
Decreased libido
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15
Q

1st rank features of Schizophrenia

A
  • Auditory hallucinations (3rd person, commentary, thought echo)
  • Thought disorders ( thought insertion/withdrawal/broadcasting)
  • Delusions (fixed false beliefs)
  • Passive phenomena (bodily sensations controlled by external influence)
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16
Q

2nd rank features of Schizophrenia

A
  • impaired insight
  • blunting affect
  • decreased speech
  • neologisms (made up words)
  • catatonia
  • knights move thinking
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17
Q

Risk factors for schizophrenia

A

Black
Urban life
Cannabis use
FHx (monozygotic twins = 50%, parents = 15%, sibling = 10%)

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18
Q

Poor prognostic indicators of schizophrenia

A 
FHx
Gradual onset
Low IQ
Prodromal phase of social withdrawal 
No precipitant
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19
Q

Hallmark features of mania and hypomania

A 
Mood
  - Irritable 
  - Elevated 
Speech + Thought 
  - Pressured 
  - Flight of ideas 
  - Poor attention 
Behaviour 
  - Insomnia 
  - Loss of inhibitions 
  - Increased appetite
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20
Q

Mania + Depression

A

Type 1 Bipolar Affective Disorder (BPAD)

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21
Q

Hypomania + Depression

A

Type 2 Bipolar Affective Disorder (BPAD)

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22
Q

Diagnostic criteria for mania

A

3+ features
Lasts >7 days
Psychotic symptoms
Marked impairment on life

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23
Q

Diagnostic criteria for hypomania

A

3+ features
Lasts <7 (~4) days
Doesn’t impair function

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24
Q

Most common type of BPAD

A

Type 1 BPAD

Mania + Depression

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25
Management of mania in BPAD
- Stop antidepressant | - Olanzapine / Haloperidol
26
Management of depression in BPAD
CBT + Fluoxetine
27
Moon stabilisers used in BPAD
- Lithium | - Sodium Valproate
28
Excessive worry about a number of different events with heightened tension
Generalised Anxiety Disorder (GAD)
29
Management for GAD
1. Self-help + mindfulness 2. CBT 3. Drugs: - SSRI (Sertraline) - Alternative SSRI / SNRI - Pregabalin 4. Specialist care
30
When a person experiences things differently from those around them
Psychosis
31
1st rank features of psychosis
Auditory hallucinations (Third person) Delusions Thought disorders
32
2nd rank features of psychosis
``` Agitation Aggression Cognitive impairment Depression Thoughts of self harm ```
33
Differential Diagnoses for Psychosis
``` Schizophrenia Schizoaffective disorder Delusional disorder Schizotypal disorder Drug induced psychosis Depressive psychosis BPAD Puerperal psychosis ```
34
Drugs that cause psychosis
Cannabis Methamphetamines Phencyclidine (PCP) Steroids
35
Management for psychosis
Antipsychotics
36
Management for acute psychotic episode
Benzodiazepines (Lorazepam)
37
5 stages of Grief
``` Denial Anger Bargaining Depression Acceptance ```
38
Length of grief
up to 12 months
39
Takes 2 weeks before grief process begins
Delayed Atypical Grief
40
Experience of grief for >12 months
Prolonged Atypical Grief
41
1st rank symptoms of PTSD
- Re-experiencing (flashbacks, nightmares) - Avoidance (people, places, situations) - Hyper-arousal (hyper vigilance, trouble sleeping, irritable, decreased concentration) - Emotional numbing
42
2nd rank symptoms of PTSD
- Depression - Alcohol abuse - Anger
43
Time criteria for PTSD
to diagnose features present > 1 month since event
44
PTSD symptoms for < 4 weeks since event
Acute stress disorder
45
Management for PTSD
Watchful waiting CBT Eye-movement desensitisation + reprocessing (EMDR) Drugs: - Venlafaxine (SNRI) - Sertraline (SSRI) - Risperidone (Atypical antipsychotic)
46
Lasts 72 hours Used for Assessment Who: 1 x Fully registered doctor
Emergency Detention Certificate | Section 4
47
Lasts 28 days Used for assessment and treatment Who: Doctor (Section 22 approved) and Mental Health Officer (MHO)
Short Term Detention Certificate | Section 2
48
Lasts: 6 months (can be extended another 6 - 12 months) Used for assessment and treatment Who: Tribunal + 2 medical reports needed
Compulsory Treatment Order | Section 3
49
Who gets Eating disorders
12-25 years old | 90% Female
50
5 types of eating disorders
Anorexia Nervosa Bulimia Nervosa Severe and enduring anorexia nervosa (SEAN) Binge eating disorder Avoidance-restrictive food intake disorder
51
1st rank features of Anorexia nervosa
Restriction of energy intake Intense fear of gaining weight (despite low BMI) Body dysmorphia
52
Other features of anorexia nervosa
``` Lanugo hair (in response to low body fat) Bradycardia Cold-intolerance Yellow-skin (hypercarotenaemia) Amenorrhea ```
53
Anorexia biochemistry
``` Everything is low - hypothyroidism is common Gs and Cs are increased - Growth hormone - Glucose - Glands (salivary) - Cortisol - Cholesterol - Carotinaemia ```
54
Management for anorexia nervosa
Family behavioural therapy CBT Maudsley Anorexia Nervosa Treatment for Adults (MANTRA)
55
Binge eating followed by purging
Bulimia nervosa
56
Features of bulimia nervosa
``` Recurrent binge eating Lack of control over eating Recurrent compensatory behaviour to prevent weight gain - vomiting - laxative use - excessive exercise - fasting Self-evaluation based on body weight/shape ```
57
Management of bulimia nervosa
Family behavioural therapy CBT Monitor electrolytes
58
Persistent inattention + hyperactivity/impulsivity
Attention deficit hyperactivity disorder (ADHD)
59
ADHD is more common in
Males 4:1 | 3-7 year olds (first diagnosis)
60
Criteria to diagnose ADHD
<16 years: 6 features present | >17 years: 5 features present
61
Management for ADHD
Drugs are last resort (only available for >5 years olds) 1. Methylphenidate 2. Lisdexamfetamine 3. Dexamphetamine
62
Class of methylphenidate
Dopamine/noradrenaline re-uptake inhibitor
63
Side effects of methylphenidate
Abdo pain Nausea Dyspepsia
64
Monitoring for ADHD drugs
Weight and height every 6 months | ECG before starting as all ADHD drugs are cardiotoxic
65
Persistent complex hallucinations Preserved insight Hx of Visual impairment
Charles Bonnet Syndrome | - occurs in 15% of visually impaired people
66
Detain someone already in hospital for 72 hours
Section 5(2)
67
Can break into someone's home to detain them
Section 135
68
Can detain someone in a public place
Section 136

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