Psych Flashcards

Question

What are flight of ideas?

Answer 1

Leaps from one topic to another but with discernible links between them

Answer 2

Completely incoherent speech, where real words are strung together into nonsense sentences

Answer 3

Acute stress reaction that occurs in the first 4 weeks after a person has been exposed to a trauma event **Different to PTD which is diagnosed after 4 weeks

Answer 4

Intrusive thoughts e.g. flashbacks and nightmares Dissociation e.g. being in a daze Negative mood Avoidance Arousal e.g. hyper vigilance and sleep disturbance

Answer 5

FIRST LINE: Trauma focused CBT Benzodiazapines - Sometimes used for acute symptoms e.g. agitation and sleep disturbance

Answer 6

Enhances GABA mediated inhibition in CNS and inhibits NMDA glutamate receptors Alcohol withdrawal is opposite = decreased inhibitory GABA and increased NDMA glutamate transmission

Answer 7

Symptoms start at 6-12 hours: tremor, sweating, tachy, anxiety Peak incidence of seizures at 36 hours Peak incidence of delirium tremens is at 48-72 hours - coarse tremor, confusion, delusions, auditory and visual hallucinations, fever, tahycardic

Answer 8

First line: long acting benzodiazepines e.g. chlordiazepoxide or diazepam Lorazepam - may be preferable if hepatic failure

Answer 9

Excessive fear or anxiety Consistently occurs upon exposure or anticipation e.g. fear of cat or spider Persists usually for 6 months Impaired ability to function

Answer 10

Intermittent and without and obvious trigger Comes out of the blue Panic attacks - increased rate, chest pain, sweating, SOB, dizzy, anxious thoughts e.g. about to die.

Answer 11

Angina, stroke, phaechromocytoma- causes paroxysmal anxiety , intoxication , withdrawal

Answer 12

CBT or SSRIs If SSRIs are contraindicated or no response within 12 weeks then imipramine or clomipramine should be offered

Answer 13

Excessive fear - can't function in normal life Occurs in one or more social situations Concerned that they will act in a way, show anxiety symptoms or negatively evaluated by others e.g. seeking in front of people

Answer 14

Continuous and generalised anxiety Excessive and marked symptoms of anxiety Not restricted to anything in particular Struggle to concentrate, cant sleep, sympathetic overdrive

Answer 15

organic = hyperthyroidism causes anxiety symptoms Dementia - anxiety may be an early presentation Intoxication e.g. amphetamines, caffeine Withdrawal e.g. from benzodiazepines, alcohol and opiods Psychosis Depression Personality disorder

Answer 16

step 1: education about GAD + active monitoring step 2: low-intensity psychological interventions (individual non-facilitated self-help or individual guided self-help or psychoeducational groups) step 3: high-intensity psychological interventions (cognitive behavioural therapy or applied relaxation) or drug treatment. * step 4: highly specialist input e.g. Multi agency teams

Answer 17

Sertraline

Answer 18

Fluoxetine

Answer 19

Should be reviewed by a doctor after 2 weeks For patients under the age of 25 or at increased risk of suicide - reviewe after 1 weeks If a patient makes a good response to antidepressant therapy they should continue on treatment for at least 6 months after remission as this reduces the risk of relapse.

Answer 20

Dose should be gradually reduced over a 4 week period ( not necessary with fluoxetine) Paroxetine has higher incidence of discontinuation symtpoms

Answer 21

Citalopram and fluoxetine

Answer 22

QT interval lengthening and toursades de pointes

Answer 23

Use during the first trimester gives a small increased risk of congenital heart defects - Use during the third trimester can result in persistent pulmonary hypertension of the newborn - Paroxetine has an increased risk of congenital malformations, particularly in the first trimester

Answer 24

Sertraline is first line - if sertraline is ineffective, offer an alternative SSRI or a SNRI- examples of SNRIs include duloxetine and venlafaxine - If the person cannot tolerate SSRIs or SNRIs, consider offering pregabalin For patients under the age of 30 years NICE recommend you warn patients of the increased risk of suicidal thinking and self-harm. Weekly follow-up is recommended for the first month

Answer 25

Time consuming persistent obsessions and/or compulsions Take up an hour a day - Obsessions = intrusive, unwanted, repetitive thoughts - Compulsions = repetitive behaviours or mental acts that they are driven to perform to neutralise the obsession e.g. washing hands, repeating words or phrases

Answer 26

Conflict uncomfortably with the person's self image, and are in no way enjoyable E.g. contamination and illness, sex e.g. fear of being a paedophile( when this feels repungent), need for order or symmetry

Answer 27

Antidepressants - SSRIs e.g. sertraline SNRIs e.g. venlafaxine TCAs e.g. imipramine - avoid if suicidal, as toxic in overdose Anxiolytics - pregablin- GAD Benzodiazepines e.g. diazepam - short term anxiety.. But mustn't exceed 2-4 weeks. Beta blockers e.g. atenolol, propranolol CBT Psychoeducation

Answer 28

Continuous anxiety TFTs investigation

Answer 29

Hyperthyroidism Caffeine Alcohol

Answer 30

Caffeine Alcohol Recreational drugs Arrhythmia Hypoglycaemia Phaeochromocytoma

Answer 31

The thoughts CAN be shakeable

Answer 32

Family history Peak onset age is between 10-20 Pregnancy/postnatal History of abuse, bullying and neglect

Answer 33

Classifying to mild, moderate or severe Use of Y-BOCs scale Treat accordingly Mild - CBT, ERP ( exposure and response prevention) SSRI if doesnt wrok Moderate - SSRI or more intensive CBT with ERP If severe 0 SSRI and CBT and ERP, refer to secondary care. If the SSRI is effective continue it for at least 12 MONTHS! Note: SSRI is higher dose than for depression and must be continued for 12 months

Answer 34

Fluoxetine

Answer 35

Multiple physical symptoms present for at least 2 years Patient refuses to accept reassurance or negative test results

Answer 36

Persistent belief in the presence of an underlying serious disease e.g. cancer patient refuses to accept reassurance or negative test results

Answer 37

Typically involves loss of motor or sensory function Patient doesn't consciously feign the symptoms (factitious disorder) or seek material gain (malingering)

Answer 38

Separating off certain memories from normal consciousness Involves psychiatric symptoms e.g. amnesia

Answer 39

Münchausen's syndrome Intentional production of physical or psychological symptoms

Answer 40

Fraudulent stimulation or exaggeration of symptoms with the intention of financial or other gain

Answer 41

Symptoms must have been present for more than one month re-experiencing: flashbacks, nightmares, repetitive and distressing intrusive images avoidance: avoiding people, situations or circumstances resembling or associated with the event hyperarousal: hypervigilance for threat, exaggerated startle response, sleep problems, irritability and difficulty concentrating emotional numbing - lack of ability to experience feelings, feeling detached from other people depression drug or alcohol misuse anger unexplained physical symptoms

Answer 42

neuroticism, personal or family history of psychiatric problems, childhood abuse, poor early attachment

Answer 43

Trauma screening questionnaire is used Diagnosis based on criteria from DSM5 or ICD11

Answer 44

Watchful waiting may be used for mild symptoms lasting less than 4 weeks Military personnel have access to treatment provided by the armed forces CBT or EMDR ( eye movement desensitisation and reprocessing) therapy may be used in more severe cases Venlafaxine (SNRI) or sertraline ( SSRI) or risperidone ( antipsychotic)

Answer 45

Difficulty maintaining attention, excessive energy and activity and impulsivity More than twice as common in males ---> genetic, pregnancy related factors ( e.g. maternal smoking, premature birth and low birth weight), environmental factors Symptoms commonly start at childhood and should be consistent across settings!

Answer 46

- Short attention span - Easily distracted - Quickly moving from one activity to another - Quickly losing interest in task - Inability to persist with and complete tasks - Constantly moving or fidgeting - Impulsive behaviour - Disruptive behaviour - Difficulty managing time

Answer 47

Managing strategies for parents include: * A positive approach * Structured routines * Clear boundaries * Plenty of physical activity * A healthy diet (certain foods may exacerbate the symptoms) Self-management strategies for adults to help manage symptoms include organisation techniques, a healthy diet, exercise, and a sleep routine. Reasonable adjustments to the workplace may be helpful. Medication is an option after conservative management has failed, or in severe cases: Central nervous system stimulants e.g.: * Methylphenidate (Ritalin) * Lisdexamfetamine * Dexamfetamine * Atomoxetine Monitoring requirements whilst taking medications include heart rate, blood pressure, weight and mood changes.

Answer 48

Vary between individuals along the spectrum Deficits in social interaction, communication and behaviour Features usually observable before the age of 3

Answer 49

Impairments in social interaction, communication and behaviour Defined in the DSM-5 Asperges = difficulty in reading emotions and responding to others.

Answer 50

Lack of eye contact, delay in smiling, avoiding physical contact, unable to read non verbal cues, difficulty establishing friendships, not displaying a desire to share attention

Answer 51

Delay, absence or regression in language development, lack of appropriate non verbal communication, difficulty with imaginative or imitative behaviour, repetitive use of words or phrases

Answer 52

Greater interest in objects, numbers or patterns than people Stereotypical repetitive movements e.g. self stimulating- hand flapping, rocking Intense and deep interests that are persistent and rigid Repetitive behaviours and fixed routines Anxiety and distress with experiences outside their regular routine Extremely restricted food preferences

Answer 53

Depends on severity Non pharmacological therapy; - Early educational and behavioural interventions: applied behavioural analysis, ASD preschool programme, Pharmacologic interventions: no consistent evidence - SSRIS may be helpful to reduce symptoms like repetitive stereotypesd behaviour, anxiety and aggression Antipsychotics can be used to reduce aggression and self injury Methylphenidate for ADHD

Answer 54

Chronic mental health disorder characterised by periods of mania/hypomania alongside epodes of depression

Answer 55

Type 1: mania and depression - involves at least 1 episode of mania Type 2: hypomania and depression involves at least one episode of major depression and 1 of hypomania

Answer 56

Midler symptom of hypomania and low mood, symptoms not severe enough to impair function

Answer 57

Only episodes of depression without hypomania or mania

Answer 58

Abnormally elevated mood/irritability Severe functional impairment or psychotic symptoms for 7 days or more Psychotic symptoms e.g. delusions of grandeur/auditory hallucinations suggest mania

Answer 59

Abnormally elevated mood/irritability Decreased or increased function for 4 days or more Psychotic symptoms e.g. delusions of grandeur/auditory hallucinations suggest mania

Answer 60

- Antipsychotic medications (e.g., olanzapine, quetiapine, risperidone or haloperidol) are first-line - Other options are lithium and sodium valproate - Existing antidepressants are tapered and stopped

Answer 61

Psychological: lithium ( mood stabiliser). Serum lithium level - taken 12 hours after most recent dose- are closely monitored to ensure dose is correct. Usual initial target range = 0.6-0.8 mmol/L Alternative- sodium valproate (NOTE: THIS IS TERATOGENIC ) Consider stopping antidepressant if the patient takes one. Antipsychotic therapy e.g. olanzapine or haloperidol

Answer 62

Fine tremor, weight gain, CKD, hypothyroidism and goitre, hyperparathyroidism, hypercalcaemia, nephrogenic diabetes inspidius.

Answer 63

Talking therapies, fluoxetine is the antidepressant of choice Address co-morbidities there is a 2-3 times increased risk of diabetes, cardiovascular disease and COPD

Answer 64

Behavioural and psychological symptoms of dementia. Neuropsychiatric symptoms that accompany the syndrome of dementia such as delusions, hallucinations, apathy, anxiety, depression and inhibition

Answer 65

Cognitive/perceptual e.g. delusions and hallucinations Motor e.g. pacing, wandering, repetitive movements, physical aggression Verbal e.g. yelling, calling out, repetitive speech, verbal aggression Emotional e.g. euphoria, depression, apathy, anxiety, irritability Vegetative e.g. disturbances in sleep and appetite

Answer 66

Treating underlying causes (e.g., pain, constipation or urinary retention) Environmental factors (e.g., providing a calming setting and removing triggers) Appropriately trained carers Appropriate supervision (one-to-one observation may be required) Music therapy Medication options for managing BPSD are only used where necessary and cause significant side effects. Options include: * SSRI antidepressants for depressive symptoms * Antipsychotic drugs (typically risperidone first-line) * Benzodiazepines (only for crisis management)

Answer 67

Disturbance in the neurotransmitter activity in the CNS- particularly serotonin low mood and anhedonia - lack of pleasure or interest in activities. emotional, cognitive and physical symptoms

Answer 68

Emotional symptoms: - Anxiety - Irritability - Low self esteem - Guilt - Hopelessness about the future Cognitive symptoms: - Poor concentration - Slow thoughts - Poor memory Physical symptoms: - Low energy - TATT - Abnormal sleep - early morning waking - Poor appetite or overeating - Slow movements

Answer 69

PHQ-9 score 9 questions about how often the patient is experiencing symptoms in the past 2 weeks Higher score = more severe depression 5-9 = mild 10-14 = moderate 15-19 = moderately severe 20-27 = severe depression <16 = less severe, >16 = more severe

Answer 70

Treatment options, listed in order of preference by NICE: * guided self-help * group cognitive behavioural therapy (CBT) * group behavioural activation (BA) * individual CBT * individual BA * group exercise * group mindfulness and meditation * interpersonal psychotherapy (IPT) * selective serotonin reuptake inhibitors (SSRIs) * counselling * short-term psychodynamic psychotherapy (STPP)

Answer 71

Treatment options, listed in order of preference by NICE: * a combination of individual cognitive behavioural therapy (CBT) and an antidepressant * individual CBT * individual behavioural activation (BA) * antidepressant medication ○ selective serotonin reuptake inhibitor (SSRI), or ○ serotonin-norepinephrine reuptake inhibitor (SNRI), or ○ another antidepressant if indicated based on previous clinical and treatment history * individual problem-solving * counselling * short-term psychodynamic psychotherapy (STPP) * interpersonal psychotherapy (IPT) * guided self-help * group exercise

Answer 72

Direct switch is possible

Answer 73

Withdrawal then leave a gap of 4-7 days ( as it has a long half life), before starting a low dose of the alternative SSRI

Answer 74

Cross tapering recommended - current drug dose is reduced slowly and new drug dose is increased slowly.

Answer 75

Withdraw and then start venlafaxine at low dose 4-7 days later

Answer 76

Depersonalisation- derealisation = feeling of being separated or outside their body Dissociative amnesia - forgetting autobiographical information, typically following traumatic experience and leading to gaps in memory Dissociative identity disorder - previously called multiple personality, lack of clear individual identity -multiple separate identities, with unique names, personalities and memories. Often associated with severe stress and trauma in childhood

Answer 77

Abnormal movement, communication and behaviour Awake but abnormal behaviour May hold unusual postures, perform odd actions etc Most common causes = severe depression, bipolar

Answer 78

Results from severe neglect and trauma in early childhood. Results in emotional withdrawal and inhibition, sadness, fearfulness, irritability

Answer 79

Conscious effort to fake illness and seek medical attention for personal gain SYmptoms are invented, exaggerated or induced- may induce harm. Repeated presentations with inconsistent and dramatic symptoms that don’t fit with examination findings

Answer 80

Excessive accumulation of possessions and emotional difficulty getting rid of items Lack of insight

Answer 81

Functional neurological disorder Sensory and motor symptoms, not explained by any neurological disease, and may be caused by underlying psychosocial factors Symptoms include weakness, gait disturbance, seizures, sensory loss and visual disturbances

Answer 82

Seen in 50% of women in first week or so after birth Mood swings, low mood, anxiety, irratibility, tearfulness Symptoms mild, no treatment

Answer 83

Seen in 50% of women in first week or so after birth Mood swings, low mood, anxiety, irratibility, tearfulness Symptoms mild, no treatment

Answer 84

Seen in 1 in 10 women, with a peak around 3 months after birth Similar to depression - low mood, anhedonia, low energy Symptoms should last at least 2 weeks before postnatal depression is diagnosed Treatment similar to depression

Answer 85

Seen in 1 in 1000 women Starts a few weeks after birth Psychosis symptoms - delusions, hallucinations, depression, mania, confusion and thought disorder URGENT assessment needed.?ECT, medications and admission

Answer 86

Assessing how mother has felt for the past week 10 questions, 30 points and more than 10 indicates postnatal depression

Answer 87

Treatment option for patients with severe depression refractory to medication e.g. catatonia or those with psychotic symptoms

Answer 88

Raised ICP.

Answer 89

SHORT TERM Headache, nausea, short term memory impairment, memory loss of events prior to ECT, cardiac arrhythmia LONG TERM - impaired memory

Answer 90

SHORT TERM Headache, nausea, short term memory impairment, memory loss of events prior to ECT, cardiac arrhythmia LONG TERM - impaired memory

Answer 91

Anaemia, leukopenia (low WBC) , thrombocytopenia (low platelets), hypokalaemia - low potassium due to vomiting or excessive laxatives Reduced bone marrow activity NORMOCYTIC NORMOCHROMIC anaemia

Answer 92

Hypokalaemia Low FSH, LH, oestrogen and testosterone Raised cortisol and GH Impaired glucose toleranc e Hypercholesterolaemia Hypeorcarotenaemia Low T3

Answer 93

Reduced body mass index Bradycardia Hypotension Enlarged salivary glands Amenorrhea- absent periods, due to disruption of HPG axis. Lack of gonadotrophins (LH and FSH) from the pituitary, = reduced activity of the ovaries ( hypogonadism) Cardiac complications Low bone mineral density Hypotension Languago hair - fine, soft hair across most of the body

Answer 94

3 things: 1. restriction of energy intake relative to requirements leading to SIGNIFICANTLY low body weight in the context of age, sex, developmental trajectory and physical health. 2. intense fear of gaining weight or becoming fat, even though underweight 3. Disturbance in the way in which one's body weight or shape is experiences, undue influence of body weight or shape on self evaluation or denial of the seriousness of current low body weight

Answer 95

Adults - individual eating disorder focused CBT ( CBT-ED) Children and young people - Anorexia focused family therapy is first line - CBT is second line

Answer 96

Recurrent episodes of binge eating followed by intentional vomiting, or other purgative behaviours e.g. laxatives/diuretics/exercising

Answer 97

Recurrent episodes of binge eating Sense of lack of control over eating during binge eating Recurrent inappropriate compensatory behaviour in order to prevent weight gain Recurrent vomiting may lead to erosion of the teeth and Russels sign = calluses on the knuckles or back of hand due to repeated self induced vomiting Binge eating and compensatory behaviours occur at least once a week for 3 MONTHS

Answer 98

Swollen salivary glands Mouth ulcers GORD Often normal weight though

Answer 99

Referral for specialist care Bulimia nervosa focused guided self help If ineffective after 4 weeks - CBT-ED Children - bulimia nervosa focused family therapy

Answer 100

AUDIT C for identification SAD Q for severity CEWA for severity of alcohol withdrawal

Answer 101

Methadone Buprenorphine

Answer 102

When someone with an extended severe nutritional deficit resumes eating. Hypomagnesaemia Hypokalaemia Hypophosphataemia Fluid overload (due to water following the extra sodium into the extracellular space) RISK OF ARRHYTHMIA AND HF

Answer 103

During prolonged starvation, intracellular potassium, phosphate and magnesium are depleted. Electrolytes move from inside to outside the cells (into the blood), to maintain normal serum levels in the absence of dietary intake. Cell metabolism reduces to conserve energy = loss of intracellular electrolytes ( Sodium potassium ATP slows- usually pumps potassium into the cell and sodium out) During re-feeding - various mechanisms shift magnesium, potassium and phosphate out of the blood and sodium into the blood. Carbohydrate intake causes an increase in insulin, which drives glucose, potassium and phosphate into cells. Sodium/potassium ATP pump actively pumps potassium into the cells and sodium out of the cells. Insulin causes extra sodium reabsorption into the kidney.

Answer 104

* Slowly reintroducing food with limited calories * Magnesium, potassium, phosphate and glucose monitoring * Fluid balance monitoring * ECG monitoring in severe cases Supplementation with electrolytes and vitamins, particularly B vitamins and thiamine

Answer 105

Maladaptive personality traits that cause significant psychosocial distress and interfere with functioning Characterised by patterns of thought, behaviour and emotion that differ from what is normally expected. Genetic and environmental factors

Answer 106

- Strong and intense emotions (e.g., anger) - Emotional instability (rapidly changing emotions) - Difficulty managing emotions - Difficulty maintaining relationships - Poor sense of identity - Feelings of emptiness - Fear of abandonment - Impulsive and risky behaviour - Recurrent self-harm - Recurrent suicidal behaviours

Answer 107

Cluster A: Suspicious, odd, eccentric - paranoid, schizoid, schizotypal Cluster B: Emotional or impulsive - antisocial, borderline, histrionic, narcissistic Cluster C: Anxious and fearful - obsessive-compulsive, avoidant, dependent

Answer 108

Paranoid - Hypersensitivity and unforgiving attitude when insulted - Unwarranted tendency to questions the loyalty of friends - Reluctance to confide in others - Preoccupation with conspirational beliefs and hidden meaning Schizoid - Indifference to praise and criticism - Preference for solitary activities - Lack of interest in sexual interactions - Lack of desire for companionship - Emotional coldness - Few interests Schizotypal - Ideas of reference - Odd beliefs and magical thinking - Unusual perceptual disturbances - Paranoid ideation and suspiciousness - Odd, eccentric behaviour - Lack of close friends other than family members

Answer 109

Antisocial - Failure to conform to social norms e.g. repeatedly performing acts that are ground for arrest - More common in men - Deception, lying - Impulsiveness or failure to plan ahead - Irritability and aggressiveness - Lack of remorse Borderline - emotionally unstable - Efforts to avoid real or imagined abandonment - Unstable interpersonal relationships which alternate between idealisation and devaluation - Unstable self image - Chronic feelings of emptiness - Difficulty controlling temper - Impulsivity in potentially self damaging areas e.g. spending, sex, substance abuse Histrionic - Inappropriate sexual seductiveness - Need to be centre of attention - Rapidly shifting and shallow expression of emotions - Suggestibility - Physical appearance used for attention seeking Narcissistic - Grandiose sense of self importance - Preoccupation with fantasies of unlimited success, power or beauty - Sense of entitlement - Lack of empathy - Excessive need for admiration - Chronic envy - Arrogant and haughty attitude

Answer 110

Obsessive compulsive - Occupied with details, rules, lists, order, organisation - Demonstrates perfectionism that hampers with completing tasks - Dedicated to work and efficiency to the elimination of spare time activities - Meticulous, scrupulous and rigid about etiquettes of mortality, ethics or values - Not capable of disposing worn out or insignifican thtings - Stingy, stiffness, stubborness Avoidant - Avoidance of occupational activities which involve significant interpersonal contact due to fears of criticism or rejection - Unwillingness to be involved unless certain of being like d - Preoccupied with ideas they are being criticised or rejected in social situations - Restraint in intimate relationships due to fear of being ridiculed Dependent - Difficulty making everyday decisions without excessive reassurance from others - Need for others to assume responsibility for major areas of their life - Lack of initiative Difficulty in expressing disagreement with others due to fears of loosing support

Answer 111

- Psychological treatment - DBT - Risk management Sometimes sedative medications are used in short term in crisis.

Answer 112

- Hallucinations - visual, auditory- voices talking about/to .. External to own thoughts , olfactory , tacticle hallucinations - bugs crawling on you etc - Delusions - unshakeable, out of context with culture/ religion etc - Thought disorganisation ○ Alogia - little info conveyed by speech ○ Tangentiality - answers diverge from topic ○ Clanging ○ Word salad - linking real words incoherently

Answer 113

- Schizophrenia - Depression - Bipolar disorder - Puerperal psychosis - Brief psychotic disorder: where symptoms last less than a month - Neurological conditions e.g. Parkinson's disease, Huntington's disease, stroke, brain tumours - Hyperthyroidism - Psychotic depression - Prescribed drugs e.g. corticosteroids - Certain illicit drugs e.g. cannabis, phencyclidine - Cushing's syndrome - and taking systemic steroids

Answer 114

15-30 years

Answer 115

Admission for assessment for up to 28 days, not renewable Approved mental health professional + 2 doctors. Treatment can be given against a patients wishes

Answer 116

Admission for treatment for up to 6 months, can be renewed. Approved mental health professional + 2 doctors Treatment can be given against a patients wishes

Answer 117

72 hour assessment Used as an emergency, when a section 2 would involve an unacceptable delay. GP and a AMHP. Often changed to section 2 upon arrival to hospital

Answer 118

A patient who is a voluntary patient in hospital can be legally detained by a doctor for 72 hours.

Answer 119

Similar to a section 5(2), allows a nurse to detain a patient who is voluntarily in hospital for 6 hours

Answer 120

Supervised community treatment. Can be used to recall a patient to hospital for treatment if they do not comply with conditions of the order in the community, such as complying with medication

Answer 121

Court order to allow the police to break into property to remove a person to a place of safety

Answer 122

Someone found in a public place who appears to have a mental disorder can be taken by the police to a place of safety Can only be used for up to 24 hours, whilst a MHA assessment is arranged.

Answer 123

Long term, severe mental health disorder characterised by psychosis. Often presents between the ages of 15-30 and earlier in men than women Symptoms must be present for at least 6 months before schizophrenia is diagnosed Strongest risk factor is family history.

Answer 124

Combines the symptoms of schizophrenia with bipolar disorder Psychosis + depression and mania.

Answer 125

Presents with the same features of schizophrenia but lasts less than 6 months.

Answer 126

Strong family history Gradual onset Low IQ Prodromal phase of social withdrawal Lack of obvious precipitant

Answer 127

Prodrome phase often precedes the full symptoms of psychosis Delusions, hallucinations, thought disorder lack of insight - lacking of awareness that delusions and hallucinations are not based in reality.

Answer 128

Subtle symptoms e.g. poor memory, reduced concentration, mood swings, suspicion of others, loss of appetite, difficulty sleeping, social withdrawal and decreased motivation

Answer 129

- Auditory hallucinations - Somatic passivity - believing that an external entity is controlling their sensations and actions - Thought insertion or withdrawal or broadcasting - Thought broadcasting - believing others are overhearing their thoughts - Persecutory delusions - false belief that a person or group is going to harm them - Ideas of reference - false belief that unconnected events or details in the world directly relate to them - Delusional perceptions - Occurs when patient experiences an ordinary and unremarkable perception e.g. cat crossing the road that triggers a sudden, often self related delusion e.g. the traffic light is green therefore I am the king - Passivity phenomena- bodily sensations being controlled by an external influence, actions/impulses/feelings imposed on the individual - Neologisms - made up words - Catatonia

Answer 130

Affective flattening - minimal emotional reaction to emotive subjects or events Alogia - poverty of speech - reduced speech Anhedonia - lack of interest in activities Avolition - lack of motivation in working towards goals or completing tasks

Answer 131

The active phase symptoms may be: Continuous, episodic (relapsing and remitting) , a single episode only

Answer 132

ABCD A- Auditory hallucinations, hearing own thoughts spoken aloud hearing voices talking about you in 3rd person, hearing voices talking about you B- Broadcast C- Control D- Delusional perception

Answer 133

Based on the DSM5 criteria Symptoms including prodrome phase must have been present for at least 6 months, with symptoms of the active phase (delusions, hallucinations and thought disorder) present for at least 1 month (or less if treatment is successful).

Answer 134

- Early intervention in psychosis services are available for the first episodes of psychosis - Crisis resolution and home treatment teams - urgent support in crisis - Second generation antipsychotic +long acting benzodiazepine in hospital - Acute hospital admission when required - Community mental health team for ongoing management and monitoring - Oral ATYPICAL ANTIPSYCHOTICS second gen are first line CBT offered to all

Answer 135

Depot antipsychotics given as an IM injection every 2 weeks- 3 months

Answer 136

Potentially life threatening complication of antipsychotics Muscle rigidity, hyperthermia, altered consciousness, autonomic dysfunction - fluctuating BP and tachycardia

Answer 137

Raised CK Raised WBC- leucocytosis

Answer 138

Stopping the causative medications and supportive care e.g. IV fluids and sedation with benzodiazepines. Severe cases may require treatment with bromocriptine or dantrolene

Answer 139

When other treatment doesn't control symptoms Often taken by mouth

Answer 140

Smoking changes can destabilise clozapine levels SIDE EFFECTS !!! - close monitoring is required. Agranulocytosis - severely low neutrophil count - predisposing to severe infection. Myocarditis or cardiomyopathy Constipation Seizures Excessive salivation

Answer 141

- Social support - Religious belief - Children at home Regretting an attempt

Answer 142

- Male - History of deliberate self harm - Alcohol or drug misuse - History of mental illness ○ Depression ○ Schizophrenia - History of chronic disease - Advancing age - Unemployment or social isolation/living alone - Being unmarried, divorced or widowed

Answer 143

1. Emotional suffering 2. Emotional overload 3. Panic 4. Self harming 5. Temporary relief 6. Shame and guilt

Answer 144

- Previous suicidal attempts - Escalating self harm - Impulsiveness - Hopelessness - Feelings of being a burden - Making plans - Writing a suicide note

Answer 145

Volume(ml) x alcohol content (%) /1000

Answer 146

No more than 14 units per week Spread evenly over 3 or more days Not more than 5 units in a single day

Answer 147

Single session involving 6/8 or more units

Answer 148

Smelling of alcohol Slurred speech Bloodshot eyes Dilated capillaries on the face ( telangiectasia) Tremor

Answer 149

* Raised mean corpuscular volume (MCV) * Raised alanine transaminase (ALT) and aspartate transferase (AST) * AST:ALT ratio above 1.5 particularly suggests alcohol-related liver disease *Raised gamma-glutamyl transferase (gamma-GT) (particularly notable with alcohol-related liver disease)

Answer 150

* 6-12 hours: tremor, sweating, headache, craving and anxiety * 12-24 hours: hallucinations * 24-48 hours: seizures * 24-72 hours: delirium tremens

Answer 151

Medical emergency associated with alcohol withdrawal Under functioning of GABA and over functioning of glutamate system = extreme excitability and excessive adrenergic activity

Answer 152

* Acute confusion * Severe agitation * Delusions and hallucinations * Tremor * Tachycardia * Hypertension * Hyperthermia * Ataxia (difficulties with coordinated movements) Arrhythmias

Answer 153

Chlodiazepozide Pabrinex (high dose B vitamins) and then long term thiamine

Answer 154

* Specialist alcohol service involvement * Alcohol detoxification programme * Oral thiamine to prevent Wernicke-Korsakoff syndrome * Psychological therapy (e.g., cognitive behavioural therapy) * Acamprosate, naltrexone or disulfiram are medications used to help maintain abstinence * Informing the DVLA (their driving licence will be revoked until an extended period of abstinence)

Answer 155

Confusion Ocuomotor distrubances Ataxia ( difficulties with coordinated movements)

Answer 156

Memory impairment Behavioural change

Answer 157

* decreased red cell transketolase * MRI

Answer 158

metabolic alkalosis. The low chloride suggests the cause of this metabolic alkalosis is loss of hydrochloric acid from the stomach (through vomiting). Severe vomiting would also account for the hypokalaemia shown on ECG( Tall P and flatterned T) The lack of acute nausea and vomiting suggests that the vomiting may be a long standing issue and therefore bulimia nervosa is a likely diagnosis unless she has a past medical history of another condition which could account for persistent vomiting.

Answer 159

Increased risk of falls in elderly

Answer 160

TCA drowsiness dry mouth blurred vision constipation urinary retention antagonism of adrenergic receptors postural hypotension lengthening of QT interval

Answer 161

Antisocial = criminal schizotypal = odd beliefs and magical thinking, ideas of reference with retained insight and odd behaviour schizoid = solitary behaviour, indifference or lack of interest towards others and being affectively detacheD. WANTS TO BE ALONE avoidant = Alone but doesnt want to be - feels inferior

Answer 162

Mirtazapine may be prescribed due to useful side effects (sedation and increased appetite) SSRI

Answer 163

Conversion disorder is loss of function with no cause. Dissociative disorder is similar, but is when the loss of function is non-physical, for example loss of memory.

Answer 164

Malingering is faking symptoms in order for personal, usually financial, gain. There is no sign that this woman is looking for financial compensation.

Answer 165

Delusional parasitosis is a rare condition in which patients present with a fixed, false belief that they are infected by bugs. Although it may present in conjunction with other psychiatric disorders, it may present in isolation, and leave patients relatively functionally unimpaired, as in this case.

Answer 166

sustained muscle contraction (e.g. torticollis, oculogyric crisis) may be managed with procyclidine

Psych Flashcards

(192 cards)