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

Psychiatry General Flashcards

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
Q

Management of mania in BPAD

A
  • Stop antidepressant

- Olanzapine / Haloperidol

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26
Q

Management of depression in BPAD

A

CBT + Fluoxetine

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27
Q

Moon stabilisers used in BPAD

A
  • Lithium

- Sodium Valproate

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28
Q

Excessive worry about a number of different events with heightened tension

A

Generalised Anxiety Disorder (GAD)

29
Q

Management for GAD

A
  1. Self-help + mindfulness
  2. CBT
  3. Drugs: - SSRI (Sertraline)
    - Alternative SSRI / SNRI
    - Pregabalin
  4. Specialist care
30
Q

When a person experiences things differently from those around them

A

Psychosis

31
Q

1st rank features of psychosis

A

Auditory hallucinations (Third person)
Delusions
Thought disorders

32
Q

2nd rank features of psychosis

A 
Agitation 
Aggression 
Cognitive impairment 
Depression 
Thoughts of self harm
33
Q

Differential Diagnoses for Psychosis

A 
Schizophrenia 
Schizoaffective disorder 
Delusional disorder 
Schizotypal disorder
Drug induced psychosis 
Depressive psychosis
BPAD 
Puerperal psychosis
34
Q

Drugs that cause psychosis

A

Cannabis
Methamphetamines
Phencyclidine (PCP)
Steroids

35
Q

Management for psychosis

A

Antipsychotics

36
Q

Management for acute psychotic episode

A

Benzodiazepines (Lorazepam)

37
Q

5 stages of Grief

A 
Denial 
Anger
Bargaining 
Depression 
Acceptance
38
Q

Length of grief

A

up to 12 months

39
Q

Takes 2 weeks before grief process begins

A

Delayed Atypical Grief

40
Q

Experience of grief for >12 months

A

Prolonged Atypical Grief

41
Q

1st rank symptoms of PTSD

A
  • Re-experiencing (flashbacks, nightmares)
  • Avoidance (people, places, situations)
  • Hyper-arousal (hyper vigilance, trouble sleeping, irritable, decreased concentration)
  • Emotional numbing
42
Q

2nd rank symptoms of PTSD

A
  • Depression
  • Alcohol abuse
  • Anger
43
Q

Time criteria for PTSD

A

to diagnose features present > 1 month since event

44
Q

PTSD symptoms for < 4 weeks since event

A

Acute stress disorder

45
Q

Management for PTSD

A

Watchful waiting
CBT
Eye-movement desensitisation + reprocessing (EMDR)
Drugs: - Venlafaxine (SNRI)
- Sertraline (SSRI)
- Risperidone (Atypical antipsychotic)

46
Q

Lasts 72 hours
Used for Assessment
Who: 1 x Fully registered doctor

A

Emergency Detention Certificate

Section 4

47
Q

Lasts 28 days
Used for assessment and treatment
Who: Doctor (Section 22 approved) and Mental Health Officer (MHO)

A

Short Term Detention Certificate

Section 2

48
Q

Lasts: 6 months (can be extended another 6 - 12 months)
Used for assessment and treatment
Who: Tribunal + 2 medical reports needed

A

Compulsory Treatment Order

Section 3

49
Q

Who gets Eating disorders

A

12-25 years old

90% Female

50
Q

5 types of eating disorders

A

Anorexia Nervosa
Bulimia Nervosa
Severe and enduring anorexia nervosa (SEAN)
Binge eating disorder
Avoidance-restrictive food intake disorder

51
Q

1st rank features of Anorexia nervosa

A

Restriction of energy intake
Intense fear of gaining weight (despite low BMI)
Body dysmorphia

52
Q

Other features of anorexia nervosa

A 
Lanugo hair (in response to low body fat)
Bradycardia
Cold-intolerance
Yellow-skin (hypercarotenaemia)
Amenorrhea
53
Q

Anorexia biochemistry

A 
Everything is low
- hypothyroidism is common
Gs and Cs are increased 
- Growth hormone 
- Glucose
- Glands (salivary)
- Cortisol 
- Cholesterol 
- Carotinaemia
54
Q

Management for anorexia nervosa

A

Family behavioural therapy
CBT
Maudsley Anorexia Nervosa Treatment for Adults (MANTRA)

55
Q

Binge eating followed by purging

A

Bulimia nervosa

56
Q

Features of bulimia nervosa

A 
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
Q

Management of bulimia nervosa

A

Family behavioural therapy
CBT
Monitor electrolytes

58
Q

Persistent inattention + hyperactivity/impulsivity

A

Attention deficit hyperactivity disorder (ADHD)

59
Q

ADHD is more common in

A

Males 4:1

3-7 year olds (first diagnosis)

60
Q

Criteria to diagnose ADHD

A

<16 years: 6 features present

>17 years: 5 features present

61
Q

Management for ADHD

A

Drugs are last resort (only available for >5 years olds)

  1. Methylphenidate
  2. Lisdexamfetamine
  3. Dexamphetamine
62
Q

Class of methylphenidate

A

Dopamine/noradrenaline re-uptake inhibitor

63
Q

Side effects of methylphenidate

A

Abdo pain
Nausea
Dyspepsia

64
Q

Monitoring for ADHD drugs

A

Weight and height every 6 months

ECG before starting as all ADHD drugs are cardiotoxic

65
Q

Persistent complex hallucinations
Preserved insight
Hx of Visual impairment

A

Charles Bonnet Syndrome

- occurs in 15% of visually impaired people

66
Q

Detain someone already in hospital for 72 hours

A

Section 5(2)

67
Q

Can break into someone’s home to detain them

A

Section 135

68
Q

Can detain someone in a public place

A

Section 136

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