1
Q
what is an illusion
A
a type of false perception of a real stimulus e.g. seeing trees as humans
2
Q
what is a hallucination
A
a perception in the absence of a stimulus e.g. hearing voices when there are none
3
Q
what is a pseudohallucination
A
an involuntary sensory experience vivid enough to be regarded as a hallucination, but which is recognised by the person experiencing it as being subjective and unreal
4
Q
what is an overvalued idea
A
a form of abnormal belief but that is not so FIRMLY held/can be convinced otherwise
5
Q
what is a delusion
A
an abnormal belief which is FALSE and FIXED (may be held in the face of contradictory evidence + has significant importance for person)
6
Q
what is a delusional perception
A
a primary delusion which is recalled as having arisen as a result of a perception (e.g. a patient who, on seeing two white
cars pull up in front of his house became convinced that he was therefore
about to be wrongly accused of being a paedophile)
7
Q
what is concrete thinking
A
the loss of ability to understand abstract concepts and metaphorical ideas = leads to strictly literal form of speech and inability to comprehend allusive language
- schizophrenia
- dementia
8
Q
what is loosening of association
A
symptom of formal thought disorder where there is lack of meaningful connection between sequential ideas
9
Q
what is circumstantiality/circumstantial thinking
A
disorder of thought form
= irrelevant details/digressions overwhelm the thought process but eventually get to the point
- mania
- anankastic personality
10
Q
what is perseveration
A
continuing verbal response/action past when it is reasonable e.g. continuing to say ‘in the hospital’ to every question
more indicative of organic brian disease
11
Q
what is confabulation
A
process of describing plausibly false memories for which the patient has amnesia
- korsakoff psychosis
- dementia
- alcoholic palimpsest
12
Q
what is somatic passivity
A
experience of bodily sensations (actions/thoughts/emotions) imposed by external agency e.g. voices commenting on one’s actions
13
Q
what is pressure of speech
A
speech pattern due to pattern of thought = rapid, difficult to interrupt
14
Q
what are the 3 main symptoms of depression
A
low mood
anhedonia = loss of pleasure in previously pleasurable activities
anergia = low energy
15
Q
what is incongruity of affect
A
displayed affect is not consistent with current thoughts or actions e.g. laughing while discussing trauma
- schizophrenia
16
Q
what is blunting of affect
A
loss of normal degree of emotional sensitivity/appropriate emotional response to events
= negative sympt schizophrenia
17
Q
what is belle indifference
A
surprising lack of concern for/denial of severe functional disability
18
Q
what is depersonalisation
A
unpleasant subjective experience where patient feels theyve become unreal
19
Q
what is thought alienation
A
patients feel their thoughts are no longer within their control e.g. removed or replaced by an outside agency
- psychosis
- schizophrenia
20
Q
what is thought insertion
A
delusional belief that thoughts are being placed in patients head from outside = FIRST RANK SYMPT
21
Q
what thought possession phenomena are first rank symptoms?
A
thought broadcasting
thought echo
thought insertion
thought blocking if due to delusion
22
Q
what is thought echo
A
auditory hallucination where patients think they can hear their own thoughts out loud
23
Q
what is thought blocking
A
sudden break in chain of thought
in absence of delusional elaboration = NOT a 1st rank symptom
24
Q
what is akathisia
A
a subjective sense of uncomfortable desire to move relieved by repeated movement of the affected part = SE of some antipsychotics
25
what is clouding of consciousness
conscious level between full consciousness and coma, covers a range of increasingly severe LoF w/ drowsiness and impairment of concentration and perception
26
what is catatonia
increased resting muscle tone which is not present on active or passive movement = motor symptom of schizophrenia
27
what is stupor
absence of movement and mutism where there is no impairment of consciousness (if organic cause = locked in syndrome)
28
what is psychomotor retardation
decreased spontaneous movement and slowness in instigating and completing voluntary movement
usually associated with subjective effort in depressive illnesses
29
what is flight of ideas
subjective experience of one's thoughts being more rapid than normal with each thought having a greater range of consequent thoughts than normal
*meaningful connections between thoughts ARE maintained
30
what is formal thought disorder
term used for 3 different groups of psychiatric sympt:
- all pathological disturbances in the form of thought
- synonym for schizophrenic thought disorder
- refers to the group of first rank symptoms which are delusions regarding thoughts (insertion/withdrawal/broadcasting)
31
what is dissociation and conversion
separation of unpleasant emotions and memories from consciousness awareness with subsequent disruption to the normal integrated function of consciousness and memory
conversion = emotional abnormality = physical symptoms
32
what is obsession
idea/image/impulse recognised by the patient as their own but experienced as repetitive, intrusive, distressing
33
what is stereotypy
repetitive and bizarre movement which is not goal-directed (unlike mannerism)
- schizophrenia
34
what is a compulsion
behaviour or action which is recognised by patient to be unnecessary and purposeless but which cannot be resisted
35
what are the risks of SSRIs in pregnancy
SERTRALINE =
first trimester = small increased risk in congenital heart defects
third trimester = persistent pulmonary hypertension of the newborn
PAROXETINE =
increase risk congenital malformations (particularly in 1st trimester)
36
what is the difference between acute stress disorder and PTSD
acute stress disorder is defined as an acute stress reaction that occurs in the 4 weeks after a traumatic event, as opposed to PTSD which is diagnosed after 4 weeks
37
what is somatisation disorder
multiple physical SYMPTOMS present for >2 years
patient refuses to accept reassurance or negative test results
38
what is hypochondria
persistent belief in the presence of an underlying serious disease e.g. CANCER
patient refuses to accept reassurance or negative test results
39
what side effect are SSRIs associated with
hyponatraemia
40
what are the symptoms of SSRI discontinuations symptoms
increased mood change
restlessness
difficulty sleeping
unsteadiness
sweating
GI sympts (pain, cramping, diarrhoea etc)
paraesthesia
**paroxetine particularly causes this**
41
what activity can cause a rise in blood clozapine blood levels
smoking cessation
42
which antidepressant characteristically causes increased appetite
mirtazepine
43
what drug can cause anterograde amnesia
lorazepam
44
what is the strongest risk factor for psychotic disorders
family history
45
which SSRI is most likely to lead to QT prolongation/toursades de pointes
citalopram
46
what are the symptoms of depression (dead swamp)
Depressed mood
Energy loss
Anhedonia
Death thoughts
Sleep distrubances
Worthlessness/guilt
Appetite or weight change
Mentation
Psychomotor retardation
47
what is cotard syndrome
characterised by pt believing they are dead or non-existant
48
what is capgras syndrome
irrational delusion of misidentification where pt believe a relative or friend has been replaced by an identical imposter
- schizophrenia
49
what is charles bonnet syndrome
psycho visual disorder patients with significant vision loss have vivid recurrent visual hallucinations
pt have insight and know theyre not real and suffer no other hallucinations
50
what is de clerambault syndrome
aka erotomania
rare delusional disorder pt believe another individual is in love with them
often person who is deceased/imaginary/doesnt know them
often involves 'secret messages'
51
what is binge drinking
drinking over twice the reccomended level of alcohol per day in one session
>8 units for men
>6 units for women
52
what is alcohol abuse
consumpton at a level to cause sufficient physical +psychiatric and/or social harm
53
what is harmful alcohol use
drinking above the safe levels with evidence of alcohol related problems
>50 per week for men
>35 per week for women
54
when might transient hallucinations and autonomic hyperactivity occur in alcohol wihtdrawal
6-12 hours after abstinence
55
when is peak incidence of seizures following alcohol withdrawal
36 hours
56
describe the questionnaires used in alcohol dependency
alcohol use disorders identification test AUDIT
severity of alcohol dependence questionnaire SADQ
FAST screening tool
57
what drugs can be used in long term alcohol dependence management and what do they do
disulfiram = build up acetaldehyde on consumption of alcohol which causes unpleasant symptoms
acamprostate = increase GABA = decrease cravings
naltrexone = blocks opioid receptors in the body = decreases the pleasurable effects of alcohol
58
what drug is given to help with parkinsonism effect of antipsychotics
procyclidine
59
what is frontal lobe syndrome and what can cause it
damage to prefrontal regions of frontal lobe characterised by deterioration in behaviour and personality in previously normal individual
head injury
cerebrovascular event
infection
neoplasm
60
how does frontal lobe syndrome present
usually family members reporting "theyre not the person i know"
decreased lack of spontaneous activity
loss of attention
memory retained but cba to remember
apathy
affect could be flat/childish/uninhinited
61
what signs indicate frontal lobe syndrome
echopraxia (hold up fingers, they copy you)
visual grasp (cant look away from wiggling fingers)
lack of letter fluency (cant name words beginning with a letter)
cannot follow 3 instructions
62
how is frontal lobe syndrome managed
check for organic cause
supportive
no pharmacological appropriate
63
what are the psychiatric features of hyperthyroidism
irritability
insomnia
anxiety
restlessness
fatigue
can develop into MANIA, depression and delirium
64
what are the baby blues
seen in 60-70% women
3-7 days post birth
more common in first births
mothers are anxious/tearful/irritable
reassurance and support from health visitor is needed
65
what is postnatal depression
affects ~10% women
start w/n month, peaks ~3 month
features similar to depression
reassurance and support
CBT may be beneficial
sertraline/paroxetine in severe cases
66
what is puerperal psychosis
affects ~0.2% women
onset within 2-3 weeks following birth
features = mood swings, mania/depressive
disordered perception
auditory hallucinations
admission to hospital required (mother and baby unit)
25-50% risk in future pregnancies
67
name the different types of psychotherapies
cognitive behavioural therapy
behavioural therapies:
relaxation training
desensitisation
exposure and prevention
psychodynamic therapies (intense, freud)
psychoeducation
counselling
supportive psychotherapy
problem solving therapy
interpersonal therapy
eye movement desensitisation and reprocessing
dialectical behaviour therapy
cognitive analytic therapy
68
describe harmful use of substances
recurrent misuse associated with physical, psychological and social consequences WITHOUT dependence
69
describe dependence syndrome
3 or more over 1 month:
strong desire to consume substance
preoccupation with substance use
withdrawal state when substance is reduced/stopped
impaired ability to control taking behaviour
tolerance to substance
persistent use despite evidence of harmful effects
70
when is a substance deemed the cause of a psychotic disorder
onset within 2 weeks of substance use
must persist for more than 48 hours
71
what is amnesic syndrome
memory impairment in recent memory and ability to recall past experiences
defect in recall
clouding of consciousness
global intellectual decline
72
what is residual disorder
specific features subsequent to substance misuse
- flashbacks
- PD
- affective disorder
- dementia
- persistant cognitive impairment
73
what population is substance misuse more common in
males
74
describe the physical complications of substance misuse
death
infection (HIV, Hep A/B/C, Staph A, group A strep, TB)
endocardidtis
superficial thrombosis
DVT
PE
75
describe the psychological complications of substance misuse
craving
anxiety
cognitive disturbance
drug-induced psychosis
76
what is detoxification
process in which effects of drug are eliminated in a safe manner (replacement drug then weaning)
= withdrawal symptoms are avoided
= aim of abstinence
77
what is maintenance therapy
abstinence is not the priority
aim is to minimise harm (e.g. needle exchange programmes)
78
what drugs are used in opioid dependence
methadone or buprenorphine for detox AND mainenance
naltrexone for formerly opioid dependent but now stopped
IV nalaxone in opioid overdose
79
what is schizoaffective disorder
symptoms of schizophrenia + mood disorder (depression/mania) in same episode of illness
mood sympt need to meet criteria for depressive/manic episode + 1/2 typical sympts of schizophrenia
80
how long do symptoms have to be present for to diagnose paranoid schizophrenia
at least 1 month
<1 month = acute/transient psychotic disorder
81
what is a persistent delusional disorder
development of single/set of delusions for at least 3 months in which the delusion is the ONLY/the most prominent symptoms
thinking/functioning maintained
delusions often persecutary/grnadiose/hypochondriacal
respond well to antipsychotics
82
what is induced delusional disorder/folie a deaux
= shared paranoid disorder
uncommon
similar delusions in one or more individuals
83
what is schizotypal disorder
aka latent schizophrenia
eccentric behaviour
suspiciousness
unusual speech
deviation of thinking/affect
NO hallucinations/delusions
increased risk in those with 1 degree relative with schizophrenia
84
what conditions can present with cognitive impairment
depression
anxiety
sleep disorders
neuro pathology = stroke/normal pressure hydrocephalus
B12 deficiency
eye/hearing problems
infection
side effects of anticholinergics
alcohol related illnesses/disease
85
what is a phobia
intense irrational fear of object/situation/place/person that is recognised as excessive or unreasonable
86
what is agoraphobia
fear of public spaces or fear of entering a public space from which immediate escape would be difficult
affects up to 1/3rd those with panic disorders
87
describe the clinical features of phobia disorder
tachycardia
bradycardia especially in blood/needle = syncope
unpleasant anticipatory anxiety/inability to relax
fear of dying/urge to avoid feared situation
88
how are phobia disorders different from GAD
phobia:
specific situations
anticipatory anxiety when prospect of encountering situation
attempted avoidance of circumstance
89
how is agoraphobia managed
1) CBT + graduated exposure
2) SSRIs
90
how is social phobia managed
CBT specific for social phobia
graduated exposure
SSRIs
psychodynamic psychotherapy
91
how is specific phobia managed
mainstay = exposure using CBT
benzodiazepines in short term e.g. in specific situations
92
what is hyperkinetic disorder and what is the aetiology
aka ADHD
inattention, hyperactivity and impulsivity more severe than normal individuals
genetic predisposition
dopaminergic pathways linked
social deprivation/family conflict/parental cannabis/alcohol exposure
93
what is the epidemiology and risk factors for ADHD
males 3x more likely affected
FHx is a strong determinant
social deprivation and family conflict
parental alcohol/cannabis exposure
94
what are the 3 core features of ADHD
1. abnormality of attention, activity and impulsivity at HOME
2. abnormality of attention and activity at SCHOOL/NURSERY
3. directly observed abnormality of attention or activity
4. does not meet criteria for alternative psych disorder
5. onset before 7 y/o
6. duraciton >6 months
7. IQ above 50
95
what are some of the ADHD comorbid conditions
70% have comorbidity:
learning difficulties (ASD/dyslexia)
dyspraxia
tourettes
mood/anxiety disorder
50% have conduct disorder co-oexisting = antisocial and rekcless behaviour that violates law and physcially abusive
oppositional defiant disorder = defiant and disrutive behaviour but less serious and severe
96
what drug treatment is available for ADHD
**should be last resort + only for >5y/o**
methylphenidate = 1st line in children (monitor height/weight)
trial for 6 weeks
lisdexamfetamine if inadequate response
ADULTS
methylphenidate/lisdexamfetamine = 1st line
all drugs potentially cardiotoxic = baseline ECG
97
what are the risk factors for self-harm (dsh largely comes via self-poinsoning)
Divorced/single/alone
Severe life stressors
Harmful drug/alcohol
Less than 35
Chronic physical health problem
Violence
Socioeconomic disadvatage
Psychiatric illness
98
what is the most common form of self-harm in the UK
drug overdose (90%):
analgesics (paracetamol)
benzodiazepines
antidepressants
large proportion drink alcohol in hours leading up to act
99
what questions should be asked about motives for self-harm
Death wish = intention to die?
Relief
Influencing others = did it to change behaviour of another person
Punishment
Seeking attention = expression of emotional distress
100
how is self harm managed
BIO
treat overdoses/suturing
PSYCHO
counselling/CBT
treatment for personality disorder
SOCIAL
social services/voluntary organisation
**RISK ASSESSMENT**
101
describe the antidotes to common overdosed medications
paracetamol = N-acetylcysteine NAC
opiates = nalaxone
benzos = flumazenil
warfarin = vitamin K
beta blockers = glucagon
TCAs = sodium bicarbonate
organophospates = atropine
102
describe the risk factors for suicide
self harm = 50-100x greater risk of suicide
psychiatric illness
childhood physical or sexual abuse
FHx of suicide or suicide attempt in 1st degree relative
physically disabling/painful/terminal illness
103
describe the socioeconomic risk factors for suicide
men x3
40-44 males
unemployed/low SE status
vets/doctors/nurses/farmers
access to lethal means (men often have violent attempts)
living alone/institutionalised
single/widowed/divorced
recent life crisis
104
what features increase the risk of suicide following self harm
note left behind
planned attempt
attempts to avoid discovery
afterwards no help sought
violent method
final acts - will etc
105
describe some individual suicide prevention strategies
detect and treat psychiatric disorders
urgent hospitalisation under MHA
involvement of crisis resolution and home treatment team
106
what are some reversible causes of dementia
Drugs
Eyes/ears
Metabolic (cushings, hypothyroidism)
Emotional
Nutritional deficiencies (b12)
Trauma/tumours
Infections (encephalitis)
Alcoholism/atherosclerosis
107
what are the requirements for capacity
**must assume capacity**
1. understand information
2. keep information in mind long enough to make decision
3. weigh up information to make a decision
4. communicate decision
108
what is a section 2
admission for assessment
up to 28 days
cannot be renewed
signed by 2 doctors or 1 doctor and AMHP
can treat at time if needed also
109
what is a section 3
admission for treatment
6 months
can be renewed
2 doctors or 1 dr + 1 amhp
can give treatment/investigations etc
110
what is a section 4
emergency treatment only
only 1 dr/amhp needed
can hold in hospital until another dr (72 hours) /amhp (6 hours) shows up and section 2/3 can be used
cannot treat you can only keep you there
111
what is a section 5
detention of patient already in hospital by doctor 5(2) or nurse 5(4)
can only stop you physically leaving until you can be reviewed/sectioned under 2 or 3
112
what is a section 135 and 136
135 = police can enter and take you from your private property to a place of safety - can be held there for 72 hours
136 = same but can take you from a public space
113
what are the side effects of SSRIs
GI dysfunction - nausea/flatulence/diarrhoea
STRESS:
Sweating
Tremor
Rashes
Extrapyramidal SE (uncommon)
Sexual dysfunction
Somnolence
citalopram = dose dependent QT prolonging
114
what are the symptoms of discontinuation syndrome
increased mood change
restlessness
somnolence
unsteadiness
GI symptoms
sweating
paraesthesia
*paroxetine = higher incidence!
= dose should be reduced over 4 week period
115
what are the first line SSRIs and why
citalopram and fluoxetine
sertraline post MI as safer
fluoexetine 1st line in children
116
what drugs should be avoided with SSRIs
NSAIDs = if have to, prescribe PPI at same time
warfarin/heparin = use mirtazepine instead
apirin
triptan/MAOis = serotonin syndrome risk
117
when should SSRIs be reviewed
2 week after start
<30 or high risk = 1 week after start
continue at least 6 months after remission of symptoms
118
what group of antidepressant is mirtazepine
noradrenaline-seratonin specific antidepressant NASSAs
119
what are the side effects of SNRIs (venlafaxine/duloxetine) and NARIs (reboxetine)
nausea
dry mouth
headache
sexual dysfunction
hypertension
**do NOT use SNRI in cardiac disease/uncontrolled HTN
120
what are the side effects of NASSAs (mirtazepine)
increased appetite
weight gain
dry mouth
postural hypertension
oedema
121
what is the benefit of a seratonin antagonist and reuptake inhibitor (SARIs)
minimal anticholinergic side effects
low cardiotoxicity
similar to TCA = careful serotonin syndrome
122
what are the side effects of tricyclic antidepressants (amitriptyline)
anticholinergic SE
cardiovascular arrthymias/postural hypotension
mania/confusion/delirium
endocrine effects
neurological - movement disorders
**dont use in pregnancy or cardiac disorders**
123
what are anxiolytics/hypnotics and what is an example
= minor tranquilisers
hypnotics if used to treat sleep
e.g. benzodiazepines, barbiturates, buspirone, beta blockers
hypnotics:
benzos
low dose amitriptyline
zopiclone/zolpidem/zaleplon
124
what are some examples of bezodiazepines and what are their side effects and contraindications
long acting >24 hours = diazepam
short acting <12 hours = lorazepam
drowsy/light headed
confusion/ataxia
muscle weakness/respiratory depression
paradoxical increase in aggression
!!dont use in hepatic impairment
!!withdrawal syndrome can occur
125
what is the danger with benzodiazepines and how does this present
OVERDOSE
ataxia
dysarthria
nystagmus
coma
respiratory depression
**give IV flumazenil
126
give some examples of anxiolytics other than BZD
antidepressants
propranolol
buspirone
barbituates
pregabalin
Z drugs
antipsychotics
127
what is electroconvulsive therapy
passage of small electrical current through the brain inducing modified epileptic seizure
used with general anaesthetic and muscle relaxant
128
what are the indications for ECT
1. prolonged or severe mania
2. catatonia
3. severe depression (tx resistant/life threatening)
129
what are the side effects of ECT
peripheral nerve palsies
cardiac arrhythmias/confusion
dental/oral trauma
anaesthetic risks
muscular aches/headaches
short term memory impairments/status epilepticus
130
when should ECT NOT be used
MARS
major unstable fracture/MI
aneurysms
raised ICP **v important**
stroke/status epilepticus/severe anaesthetic risk
131
what drug is used to treat ADHD
methylphenidate (ritalin)
Phase 3a/4
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