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Sheff 3a > Pych From Flash Cards > Flashcards

Pych From Flash Cards

1
Q

What is a hallucination

A

Perception experienced
In the absence of an external stimulus
Origination in the outside world

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2
Q

What is circumstantiality ? Seen in ?

A

Anxiety disorders

Lots of trivial detail when answering but will eventually get to the point

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3
Q

What is loosening of association

A

Breakdown in association between topics
-chain of thoughts random

“Knights move thinking”

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4
Q

5 points for OCD diagnosis

A

> 2 weeks of O and C

OWN thoughts / impulses

Intrusive / repetitive and unpleasant

Attempt to resist

Not pleasurable - Temporary relief of tension

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5
Q

3 parts of catatonia

A

Stupor - Fully conscious but unresponsive

Posturing - Strange postures held for substantial periods of time

Waxy flexibility - Limbs can be moulded into position (Could be increased muscle tone)

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6
Q

Define mood disorder

A

Persistent disturbance of mood that is severe enough to cause
-> impairment in ADLs

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7
Q

Negative sx of schitz?

A 
Poverty of speech 
Blunting of affect 
Social withdrawal / isolaition 
Lack of motivation 
Poor self care
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8
Q

Personality types associated with hebernephric schitz

A

Schitzoid / typal

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9
Q

Prominent features of hebernephric

A

Though disorder
Odd behaviour
Fleeting hallucinations / delusions
Mood changes - inappropriate affect

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10
Q

Sx in simple schiz

A

Mainly negative
Few positive sx
Poor functioning

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11
Q

What is schitzoaffective

A

Meets the criteria for schitz and bipolar in the same episode

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12
Q

Talk through the neruodevelopmental model for schitz

A

Genes

Early environmental
-Obstetric complications

Childhood
-impairments in Eg Intellect, motor, social

Adolescence

  • Stressors
  • psychoactive drugs

-> prodrome

Early adulthood
->schitz

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13
Q

2 Key features of phobic disorders

A

Situational - Anxiety caused by specific stimuli or objects

Avoidance - provides temporary relief but reinforces the fear

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14
Q

What is an adjustment disorder?

A

Reactions to stress that are more long than acute stress reactions

  • Usually begin within 1 month
  • Don’t last longer than 6 months
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15
Q

Features of adjustment disorders

A

Emotion - Depression, anxiety, poor concentration, irritable

Cognition - preoccupation with event

Behaviour - angry outbursts

Somatic - Moderate autonomic

Associations - Chronic stressor

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16
Q

Main DDx of OCD

A

Depressive disorder - obsessional Sx are common

Psychotic disorder - obsessions generally regarded as untrue

Obsessional personality disorder

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17
Q

Aetiology of OCD

A

Genetic vulnerability
Anakastic personality
Social stressors

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18
Q

What is PTSD ? Features? Associations

A

Delayed response to a severe traumatic event
-may be months -years after event

Emotion - anxiety, irritability, numbness
Cognition - Repeated reliving of events + nightmares
Behaviour - Avoidance of situations. With triggers
Somatic - Exaggerated startle response

Associations
Substance misuse
Depression

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19
Q

What are cluster A personality disorders? Egs and basic features?

A

Eccentric - suspicious or solitary

Paranoid

  • suspicious and distrusting
  • Bears grudges
  • Sensitive to criticism
  • Self-importance

Schitzoid

  • Emotionally cold
  • Social isolation
  • lack of joy of living

Schtizotypal
-Magical / odd beliefs

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20
Q

What are cluster B personality disorders? Egs and basic features?

A

Dramatic - emotionally liable and intense

Antisocial

  • unstable relationships
  • low frustration threshold
  • irritable and impulsive
  • Failure to learn from experience
  • Failure to accept responsibility
  • lack of guilt
  • Young men

Borderline (emotionally unstable)

  • Multiple turbulent relationships
  • impulsivity
  • recurrent emotional crisis
  • variable intense mood
  • stress related psychotic like sx
  • Young women

Histrionic

  • Exaggerated theatrical replays of emotion
  • Attention seeking
  • vain
  • Suggestable
  • Shallow liable mood

Narcissistic

  • Grandiose self importance
  • exaggerates achievements / abilities
  • exploits others
  • arrogant
  • expects special praise and respect
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21
Q

What are cluster C personality disorders? Egs and basic features?

A

Anxious

Anakastic - obsessional

  • Excessive orderness
  • Preoccupation with detail
  • Inflexible
  • Lack of humour

Anxious - Avoidant

  • Perstinet tense and apprehensive
  • Avoid personal contact
  • Fear of criticism / rejection
  • Feel inadequate

Dependant

  • Encourage others to make decisions
  • Excessive need to be taken care of
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22
Q

When you suspect delirium how could you duct impaired consciousness during history taking?

A

Problems establishing passage of time
-“How long has this interview been going on?”

Concentration tasks
-Count back from 20

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23
Q 
Cortical vs subcortical dementia’s 
Memory loss 
Personality 
Mood 
Co-ordination 
Motor speed
A 
Cortical - Eg alzheimers 
Memory loss - Severe 
Personality - Indifferent 
Mood - Normal
Co-ordination -Normal
Motor speed -Normal 
Subcortical Eg hungtintons 
Memory loss - Moderate 
Personality -apathy
Mood - Flat, depressed 
Co-ordination - Impaired
Motor speed - Slowed
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24
Q

RFs for Alzheimer’s

A

E4 variant of apoE gene
Low education
First degree relative with AD
Vascular RFs

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25
Q

Presentation of AD (4 areas of cognitive impairment and lobes ) ? What other features? Late sx?

A

Enduring, progressive global cognitive impairment

1- Visual spacial (parietal): Familliar routes become difficult, Can’t dress properly

2- Memory (Temporal)

3- Verbal: Receptive (temporal), expressive (frontal)

4- Executive functions

Lack of insight that problems are caused by disease
Agnosia - inability to interpret sensation

Later
-Irritability, behavioural Change, mood change, psychoses

26
Q

3 key features of Lewy body ? Seen on histology?

Mx? What drugs to avoid ?

A

Fluctuating cognitive impairment
Visual hallucinations
Later -> Parkinsonism

Lewy body’s in the brainstem and neocortex

  • Eosiniphilic intracytoplasmic neuronal inclusion bodies
  • Make of a-Synuclein

Cholinesterase inhibitors - Eg donepazil

AVOID ANTIPSYCHOTICS

27
Q

What is frontotemporal temporal dementia also called ? Features?

A

Picks disease

Early onset and loss of insight 
Personality change 
Expressive dysphasia 
Memory relatively preserved 
Family hx common
28
Q

What are pick bodies

A

Build up of tau proteins

-> spherical, silver staining aggregations

29
Q

Onset of Huntington’s

A

Early ~20-40

30
Q

What is prion disease also called? What happens? Cause?
Prognosis? Features?
Diagnosis?

A

Creutzfeldt-Jakob disease

Prions (abnormal proteins) can convert normal proteins into ones which fold into bizarre shapes (SPONGIFORM)

Most cases are sporadic but sometimes transmitted from meat products containing CNS tissue affected by
-bovine spongiform encephalopathy

Rapid onset and progression - death within 1year
Myoclonic jerks
Seizures
Cerebellar ataxia

Diagnosis
Brian biopsy
EEG - triphasic waves

31
Q

Pressure in normal pressure hydrocephalus ? Features? Usual age?

A

CSF pressure is raised

Features - Wet, wobbly and wacky

  • Urinary incontinence
  • Problems walking - ataxia
  • mental slowing - apathy / inattention

50-70

32
Q

Seen on CT/MRI of normal pressure hydrocephalus ?

A

Disproportionate ventricular enlargement

33
Q

Most prominent feature of alcoholic dementia ? Brain feature?

A

Visuospacial defects - Dressing, getting lost on familiar routes

Atrophy of white matter and frontal lobes

[True alcohol-induced dementia is rare - usually vascular / alzheimers]

34
Q

Main organs affected in Wilson’s ? Others? What are the neuopychiatric sx?

A

Brain and liver

Eyes
Kidneys
Heart
Parathyroid

Irritability, mild deterioration and clumsiness
Behaviour changes
Specific changes follow -> Parkinsonism, ataxia + migrane

35
Q

What opportunistic infection common in AIDS dementia

A

Crytococcus

36
Q

Levels of substance misuse

A

At risk consumption - Increased risk of harm but none yet

Harmful - associated with health consequences but not yet dependance

Dependance - physical and psychological - get withdrawal sx

37
Q

Aetiology of substance misuse

A

Genetic

  • Heritable component of vulnerability and personality
  • metabolism of substances

Neurological
-Abnormalities in Dopamine, GABA

Psychological

  • Personality
  • learnt behaviour

Socioeconomic

  • Cultural norms
  • price and availiblity
38
Q

Adverse health effects of cannabis?

A

Panic / anxiety
Gateway drug
Paranoid ideation
Heavy use -> risk of schitz

39
Q

Effects of opioids

A 
Euphoria 
Analgesia 
Constipation 
Drowsiness 
Respiratory depression 
N+V
Pupil constriction
40
Q

Adverse health and social effects of opioids

A

Risk of blood borne viruses
High rates of morbidity / mortality
Psych - increased risk of suicide
Major negative social effects

41
Q

Withdrawal from opioids begins? Features?

A

8-12hrs after last dose
Peaks at 24-48 hours

Craving 
Restlessness 
Sweating 
Abdo pain, Vomiting 
Dilated pupils 
Goose bumps
42
Q

Signs of opioid OD

A 
Unconscious
  pinpoint pupils 
Bradycardia 
Hypotension 
Shallow breathing -> may resp arrest

IM Naloxone

43
Q

Which benzo commonly used for alcohol / substance withdrawal?

A

Chlodiazepoxide

44
Q

Harmful effects of alcohol

A

Medical

  • liver damage: hepatitis, cirrhosis, fatty
  • CV: cardiomyopathy, hypertension
  • GI: pancreatitis, peptic ulcer, oesophageal varsities
  • Neoplasms: Liver, oesophagus
  • Blood: Anaemia
Neurological 
Epilepsy 
Blackout 
Neuropathy 
Korsakoffs / wernikies 
Cerebellar degeneration 
Head injury 
Delirium Tremens 
Psychiatric 
Hallucinations 
Morbid jealousy 
Sexual dysfunction 
Dementia 
Depression 
Social 
Accidents 
Relationship problems 
Violence 
Employment 
Crime
45
Q

Mx of alcohol withdrawal

A

Obs ever 4 hours
Chlordiazepoxide
Oral thiamine
Pabrinex - Vit B/C

46
Q

Methadone half life? What does it do?

Subutex?

A

Long - 5/7
Blocks opiate receptors completely
-> heroin will have no effect

Partial blocker -> Herron will have effect - used for more low risk

47
Q

What premorbid experiences / characteristics contribute to eating disorders?

A

Adverse parenting - Low contact, arguments, high expectations
Sexual abuse
Family dieting / pressure to be slim

Premorbid characteristics 
Low self esteem 
Perfectionism 
Anxiety 
Early menarche
48
Q

Ix in anorexia

A 
FBC - normocytic, normochromic anaemia, thrombocytopenia, mild leukopenia 
U+E 
TFT - low T3, normal TSH/ T4 
Increased cortisol / growth hormone 
Low FSH, LH and oestroadol 
ECG - prolonged QT
49
Q

2 Types of bulimia

A

Purging - compensatory behaviour Eg vomiting, laxatives, diuretics

Non-purging - Fasting and exercise

50
Q

What characterises bulimia ?

A

Binge eating
Recurrent compensatory behaviour

At least twice/week for 3 months

51
Q

Management of insomnia

A

Treat underlying disorder - Anx / depression …
Stimulus control - bed when sleepy / routines
Sleep hygiene - avoid caffeine / noises / light
Relaxation therapy
Hypnotics Eg benzos

52
Q

Typical antipsychotics work on D2 receptors, what additional receptor do atypical work on?

A

5 HT2a

53
Q

What side effect is more common with atypical ?

A

Metabolic syndrome

54
Q

Mx of akathisia ?

A

Benzos and b blockers

55
Q

Mx of acute dystonia / Parkinsonism ?

A

Procyclidine

Procyclidine / change antipsychotic

56
Q

Side effects of antipsychotics

A

ESPEs

Anticholinergic
Dry mouth, urinary retention, postural hypotension, constipation, blurred vision

Metabolic syndrome - Olanzapine is worst for weight gain

Hyperprolactinaemia
Women -> abnormal menses / galactorrhea
Men -> decreased libido, sexual dysfunction, gynacomastia
-haloperidol, risperdone and chlorpromazine

Prolonged QT - haloperidol

57
Q

What is the sign of muscle damage in neuroleptic malignant syndrome ?

A

Raised creatine kinase

58
Q

What are MAOIs good for

A

Less effective than SSRIS / TCA but good for atypical depression

59
Q

Main indication for SNRIs

A

Lack of response to SSRIs

60
Q

What is transference ? Counter transference?

A

Set of expectations, beliefs and emotional responses that a patient brings to a doctor-patient relationship

The therapists own reaction to the patient

Sheff 3a (30 decks)

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