Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
160 Cards in this Set
- Front
- Back
|
Explain the depression symptom mnemonic SADAFACES
|
Sleep disorder
Anhedonia Dysphoria Appetitte gain/loss Fatigue Anxiety/agitation Concentration and memory problems Esteem issues Sexual dysfunction/suicidal behaviour (ideation, parasuicide, suicide) |
|
|
List the risk factors for suicide
|
1) MDD
2) family history of suicidal behaviour 3) past attempts 4) lack of social support 5) gender: males complete suicide 6) recent loss 7) alcohol or drug abuse |
|
|
Explain the SADPERSONS mnemonic for suicidal behaviour
|
Sex - male
Age - 25 to 35 Depression Past attempts Ethanol/Drugs Rational thinking (lack of) Social support (lack of) Organised plan to "do it" No spouse or partner Sickness: chronic, debilitating |
|
|
What are 3 strategies of poison antidotes
|
1) compeditive inhibitors: desferrioxamine
2) toxic metabolite scavengers: NAC 3) inhibitors: follinic acid |
|
|
Explain the mechanism of paraccetamol poisoning
|
1) Normal glucuronidation and sulfonation pathway saturated, allowing toxic metabolite (NAPBQI) to accumulate
2) If dosage is high (>15G) then glutathione is depleted increasing toxic metabolite level 3) Increased oxidative stress leads to hepatocyte necrosis, particularly in zone 3 |
|
|
What sort of injuries are doctors required to report
|
1) use of weapon
2) injury by asphyxiation, strangulation or heat 3) crimes: rape, child abuse |
|
|
What are the most common forms of suicide
|
1) hanging
2) drugs and poison 3) vehicle exhaust 4) firearms |
|
|
What are suicide risk factors
|
Sex (women attempt, men achieve)
Locations: rural more access to firearms. Isolation History of suicidal behaviour in the family Suicidal behaviours in the immediate peer group Hx mental illness, especially schitzophrenics (30% attempt) Sx of depression and hopelessness Aboriginality CALD Substance abuse Hx of childhood sexual abuse Stressful life events (bereavement, bankruptcy, unemployment) Diagnosis of serious illness Young people in custody |
|
|
A patient with major depression has stabilised as an inpatient. What is the main factor to consider on discharge. What about bipolar?
|
Depression: suicide motivation increases when depression improves. Requires close outpatient monitoring.
Bipolar: at beginning of mood downswing is greatest risk of suicidality. Monitor signs as outpatient |
|
|
What are suicide protective factors
|
Family patterns
Cognitive style, personality and health seeking behaviour Cultural (social involvement) and sociodemographic factors |
|
|
What are the assessment features to look for regarding suicidality
|
Ideation
Perterbation Intent v ambivalence Future orientation Plan Lethality Reversibility (how likely are they to be found by others) |
|
|
What controls the level of alertness
|
Reticular formation
|
|
|
What is the GCS
|
Eyes: 1, pain, sound, observant
Speech, 1, sounds, inappropriate, confused, normal speech Motor, 1, extension (decerebrate), flexion (decortate), pain withdrawal, localises pain, voluntary |
|
|
Which structure is primarily involved with depression and name 4 components of the anatomy
|
Limbic system:
fornix (connects limbic system to the cerebrum) amygdala (emotions, self-preservation) septum (pleasure) hippocampus (memory) |
|
|
What would a lesion to the hypocampus cause and how does this relate to its function
|
Extreme passivity (controls arousal)
Loss of drive (controls drives: sexual, agression) Excessive eating and drinking (control of pleasure, satiation) Rage (controls tranquility) |
|
|
What childhood factors contribute to depression
|
1) Deviant relationship with parents-> anxiety, fearfulness
2) Formation of core beliefs 3) Development of schema based on core beliefs of learned helplessness, self-defeating attitudes, belief in failure |
|
|
List social factors that contribute to depression
|
Unemployment
Life events (divorce, death) Domestic violemce Lack of social support Chronic medical condition |
|
|
What personality factors contribute to depression
|
Neuroticism
Dependency Self criticism Introversion |
|
|
Define affect
|
The external manifestation of mood (emotional state)
|
|
|
Briefly describe the aetiologies of depression
|
1) Genetics: serotonin transporter polymorphisms
2) Stressors: bereavement, illness, lack of social or family support, adverse life events 3) Neuroendoctine: low levels of cortisol, testosterone, menopause, PMS, OCs 4) Child-parent relations: low parental involvement, overprotectiveness, abuse, neglect 5) Vascular lesions: CAD, stroke, vascular dementia 6) Neurodegenerative diseases: Parkinson's, Altzheimer's, alcoholism |
|
|
What is the diagnostic scale commonly used for depression and list 5 of the 17 diagnostic criteria
|
Hamilton Depression Rating Scale
Depressive mood Sleep disorder Suicidality Fatigue disturbing work and activities Agitation |
|
|
What is the reason for the relatively high prevalence of depression
|
It is generally a lifelong illness with a recurring relapse rate
|
|
|
Based on the severity of depression obtained from the Hamilton Depression Rating Scale, what is the likely course of treatment
|
Mild: either psychotherapy (CBT) alone or combined with an SSRI
Moderate: pharmacological therapy based on the type of depression Severe: pharmacotherapy (including antipsychotics) or ECT |
|
|
What is alcohol tolerance
|
Need for marked increases in amounts over time with diminishing effects
|
|
|
What is alcohol abuse
|
Socially inappropriate alcohol consumption causing:
1) obligations: failure to fulfil family or societal role obligations 2) risk taking: engaging in hazardous activities eg driving, piloting 3) personal problems: health, financial or social problems (familial dysfunction, abuse of loved ones) 4) legal problems: arrested for intoxication or related crimes |
|
|
How does DSM-IV classify alcohol dependence
|
3 or more of the following over 12 months
1) tolerance 2) withdrawal 3) taken in larger amounts and over a longer period than intended 3) repeated unsuccessful attempts at cutting down or quitting 4) excesive time spent obtaining, consuming and recovering from alcohol intoxication 5) withdrawal from important social, recreational and occupational activities because of intoxication 6) Continued use despite warnings of health effects, family breakdown or warnings of poor work performance |
|
|
What are the CAGE criteria and when is alcohol consumption a concern
|
1) Cut down attempts
2) Annoyance at others commenting on your drinking 3) Guilty feelings about drinking 4) Eye opener Score of 2 or more is significant |
|
|
What are the risk factors for alcoholism
|
1) Genetic: alcoholism runs in families. Possibilities include fast acting Aldehyde dehydrogenase, GAGA-A and dopamine receptor, serotonin transporter promoter variants
2) Psychiatric comorbidity (depression, bipolar, personality disorder) 3) Cultural factors (cultural acceptance of alcohol use) |
|
|
Discuss DT's
|
5% of withdrawal cases with 5% mortality rate.
Occurs 48-96 hors post witdrawal: autonomic activation including diaphoresis, fever, tremor, tachycardia, hypertensive crisis, delerium with loss of consciousness |
|
|
How does DSM-IV classify alcohol dependence
|
3 or more of the following over 12 months
1) tolerance 2) withdrawal 3) taken in larger amounts and over a longer period than intended 3) repeated unsuccessful attempts at cutting down or quitting 4) excesive time spent obtaining, consuming and recovering from alcohol intoxication 5) withdrawal from important social, recreational and occupational activities because of intoxication 6) Continued use despite warnings of health effects, family breakdown or warnings of poor work performance |
|
|
What are the CAGE criteria and when is alcohol consumption a concern
|
1) Cut down attempts
2) Annoyance at others commenting on your drinking 3) Guilty feelings about drinking 4) Eye opener Score of 2 or more is significant |
|
|
What are the risk factors for alcoholism
|
1) Genetic: alcoholism runs in families. Possibilities include fast acting Aldehyde dehydrogenase, GAGA-A and dopamine receptor, serotonin transporter promoter variants
2) Psychiatric comorbidity (depression, bipolar, personality disorder) 3) Cultural factors (cultural acceptance of alcohol use) |
|
|
Discuss DT's
|
5% of withdrawal cases with 5% mortality rate.
Occurs 48-96 hors post witdrawal: autonomic activation including diaphoresis, fever, tremor, tachycardia, hypertensive crisis, delerium with loss of consciousness |
|
|
What are the broad goals and anatomical targets of CBT
|
Problematic emotions (limbic system - amygdala)
Problem solving, coping skills (pre-frontal cortex) |
|
|
What are 5 targets of drug therapy and how do CNS targets differ in their predicted effect compared to peripheral targets
|
ligand gated ion channels
receptors enzymes transporter molecules Difference: responses are less predictable due to complexity of the CNS |
|
|
What are the classes of neurotransmitters and give examples
|
Amino acids: glutamate, GABA
Amines: 5HT, dopamine, noradrenaline, acetylcholine Other: NO |
|
|
What are the 2 types of dependence and how are they different
|
Psychological: craving, long lasting, withdrawal causes psycholigical symptoms of anxiety, agitation
Physical: resolves within 2 weeks, physical effects vary with the drug but can involve autonomic and CNS dysfunction |
|
|
Compare acute and chronic drugged states. How is the person motivated differently to abuse drugs in each case.
|
Acute: reward seeking via mesolimbic and dopamine pathways
Chronic: tolerance, dependence and avoidance of withdrawal symptoms: adaptation of receptors, transporters, transcription factors |
|
|
What investigations indicate alcoholism
|
High mcv
Low chloride (hypervolaemia) Low urea (poor diet) Elevated LFTs |
|
|
What axis do bulaemia, ocd and sexual orentation disorder fall in
|
Axis 1
|
|
|
List 5 types of delusion
|
grandiose, persecutory, bizarre, control, reference (taking the wrong meaning from benign comments)
|
|
|
List 3 organic causes of psychosis
|
delerium
dementia metabolic -thyroid, electrolytes, hepatic encephalopathy, renal failure |
|
|
What are the elements of a mental state examination
|
appearance
behaviour speech mood thought - process and content perception orientation insight judgement cognition |
|
|
What are risk factors concerning delusions
|
Danger to others or self if persecutory or paranoid. Danger to self from grandiose delusions eg special relationship to god, the world.
|
|
|
What axis do bulaemia, ocd and sexual orentation disorder fall in
|
Axis 1
|
|
|
List 5 types of delusion
|
grandiose, persecutory, bizarre, control, reference (taking the wrong meaning from benign comments)
|
|
|
List 3 organic causes of psychosis
|
delerium
dementia metabolic -thyroid, electrolytes, hepatic encephalopathy |
|
|
What are the elements of a mental state examination
|
appearance
behaviour speech mood thought - process and content perception orientation insight judgement cognition |
|
|
What are risk factors concerning delusions
|
Danger to others or self if persecutory or paranoid. Danger to self from grandiose delusions eg special relationship to god, the world.
|
|
|
What are the diagnostic criteria for bipolar 1
|
distractability
pressured speech goal directed activities hedonism grandiosity insomnia Depression is not essential for diagnosis but frequently coexists |
|
|
Define bipolar 2
|
At least one of each episode of hypomania and major depression
|
|
|
Define cyclothymia
|
Hypomania plus periods of non-major depression
|
|
|
A patient exhibits distractability, irritability, insomnia and claims to have experienced depression. No psychosis is present. What are the ddx
|
Bipolar 1 if full mania
Bipolar 2 if hypomania and the depression is major Cyclothymia if both mania and depression are mild |
|
|
What are the considerations for admitting a bipolar patient
|
severity
risk to self and others insight, judgement psychotic symptoms social support |
|
|
How long should treatment of a first episode of bipolar continue. What about subsequent episodes
|
1) 1-2 years
2) lifetime |
|
|
What are precipitating causes of relapse
|
non adherance (missing the highs)
substance abuse stress antidepressants |
|
|
Whar are adjunctive therapies for bipolar
|
cbt
supporting psychotherapy stress counselling |
|
|
The lateral ventricles are grossly enlarged. What are the ddx
|
Normal pressure hydrocephaly
cerebral degeneration Long lasting bipolar or schizophrenia |
|
|
What are the most common neuropsych disorders
|
delerium
dementia |
|
|
How is delerium different to dementia
|
Acute and fluctuating level of consciousness (hypo, hyper or mixed level of activity), perceptions (distractability, delusions, hallucinations, abnormal behaviour, movenents, speech) and cognition (memory, orientation, perceptial clarity). Dementia doesn't fluctuates and isn't acute.
|
|
|
Whqt are the aetiologies of delerium
|
Primary cerebral disease, secondary effects (metabolic encephalopathy, sepsis), substance intoxication (can be prescription drugs in demented patients) and witdrawal
|
|
|
What are the hx and ex for
|
Hx of pre morbid state
MSQ, MSE if less acute Neurological exam CNS exam Investigations (fbc, u&e, glucose, lft, alcohol, vitals) plus brain imaging |
|
|
What are the levels of attention and concentration
|
arousal (use GCS)
divided alternating (be able to do 2 tasks) selective sustained |
|
|
A doctor orders benzo's, a TCA and benztropine plus restrains for a delerious patient. What would you tell him
|
Mobilise and use appropriate stimulation (eg radio, music, low lighting, engage in conversation)
Minimise overstimulation Promote normal circadian rhythm Correct hydration Simplify to minimise confusion and over stimulation: single room, single nurse, relative present Avoid anticholinergics - worsens cognition. Avoid benzos. |
|
|
What are the criteria for dementia
|
Impaired memory for new learning and abnormal thinking that interferes with ADL's (basic and instrumental)
|
|
|
Other than memory, what other symptoms are present in dementia
|
language (not able to name things)
visual construction praxis Executive function (planning activities such as working out a new route) |
|
|
A patient is concerned about feeling down, loss of concentration and a MSE shows loss of social and occupational function, loss of insight, disinhibition, mental inflexibility, loss of personal care. What are the ddx
|
frontal lobe temporal dementia
Lewey body dementia, Alzheimes's, dementia depression, dysthymia, bipolar, early schitzoaffective |
|
|
On the Hachinski vascular dementia scale, what are the stand out signs differentiating this from AD
|
Hx of CVS
Fluctuating symptoms Focal symptoms |
|
|
List the 6 forms of mood disorder
|
Depression
Cyclothymia Bipolar Dysthymia Adjustment disorder Mood disorder associated with a chronic illness |
|
|
What are the 9 risk factors for mood disorder
|
Gender
Age (peaks late 20's) Child abuse Family Hx of depression Social isolation Low socioeconomic status Adverse life events Sleep deprivation (can trigger mania) |
|
|
Define adjustment disorder with depression
|
Sadness, lack of concentration, worry, anxiety causing significant social impairment as a result of a stressor within the last 3 months
|
|
|
Define a manic episode
|
Showing 4 of the following symptoms that cause significant social impairment and usually requires hospitalisation, especially if experiencing psychosis:
1) grandiosity 2) pressured speech 3) Goal directed behaviour 4) Flight of ideas 5) Distractability 6) Agitation 7) Decreased sleep |
|
|
How is hypomania different from mania
|
1) Less severe manifestations
2) Minimal social impairment 3) No psychosis 4) No hospitalisation |
|
|
What are the 5 classifications of bipolar
|
1) Bipolar I: depression and mania
2) Bipolar II: depression and hypomania 3) Rapid cycling bipolar: more than 4/year cycles of depression and mania 4) Cyclothymia: 2 years of cycling of low grade mood swings between hypomania and low mood that doesn't meet classification of depression |
|
|
What are Ddx's of mania
|
1) Stimulants: amphetamines
2) Sympathomimetics 3) Metabolic: hyperthyroidism, Wilson's 4) Neurological: CVA, trauma, Huntington's) |
|
|
What strategies can the treating Doctor utilise to motivate a patient between Contemplation, Preparation and Action?
|
Decisional balance (Pro’s and con’s), ID high risk situations, plan, goal setting
|
|
|
What are some strategies to be used with a patient who has relapsed?
|
ID why and use it as a learning tool
|
|
|
List the DSM IV criteria for Major Depressive Disorder
|
5 or more of the following over a 2 week period
At least one of: Dysphoria or Anhedonia, plus Wt. loss/gain and appetite change Insomnia/hypersomnia psychomotor agitation/retardation fatigue/loss of energy ↓ self esteem (worthlessness, guilt) ↓ conc. rr indecisiveness recurrent thoughts of death or suicide |
|
|
List some RF for depression
|
Youth (<21)
Cumulative stressful events Single (widowed, divorced…) Low SES Perceived lack of social support Past psychiatric history History of substance abuse |
|
|
Define Dysthymia
|
Chronic, low grade dysphoria
|
|
|
What are the four elements comprising the clinical depression model and what are they about?
|
Dynamic – Attachment. Forms basis of success or failure in a child.
Cognitive – Core beliefs. Developed in childhood, maintains more that initiates depression Psychosocial – Life events and their meaning to the pt. Biological |
|
|
What effect does depression have on a pt. w chronic disease?
|
Incr. mortalitiy, morbidity, perceived pain, func disability, hospital visits, hospital stay length, depressive Sx. and wish to die in palliative setting. Dec. Tx. adherence.
|
|
|
What treatment strategies are used to combat the endogenous vs. exogenous causes of depression?
|
Endogenous (10% of pt.) = issue with neurotransmitter -> drugs
Exogenous (90% of pt.) = CBT |
|
|
List some RF for Mania
|
♀, age (late 20’s), ↓ SES, FHx (genetic – neurotransmitter abnormalities?), childhood abuse, adverse life events, lack of confiding relationship, ↓ sleep (manic), substance abuse (manic)
|
|
|
What is the DSM IV criteria for Bipolar disorder?
|
1 or more manic episodes, define as 4/7 of the following for >1wk
Inflated self esteem/grandiosity Decreased need for sleep Increased talkativeness/ Pressure of speech Racing thoughts/ Flight of ideas (+ connection, - goal) Distractibility Increased activity/psychomotor agitation Excessive involvement in goal orientated activities with massive potential for painful consequences (money, sex…) No organic cause Not a mixed episode (fulfils both manic and depressive criteria for one week) |
|
|
What is…
Bipolar I |
Episodes of mania with potentially depressive episodes
|
|
|
What is…
Bipolar II |
Episodes of hypomania with depression
|
|
|
What is hypomania
|
>4d, 3/7 of criteria, Not severe enough to cause disability, handicap or require hospitalisation.
|
|
|
Rapid cycling bipolar
|
4+ episodes a year of depression, mania or hypomania over 12mths
|
|
|
Mixed bipolar
|
Simultaneous or quick succession (over 1hr)
|
|
|
Cyclothymic
|
Chronic low grade mood cycling for >2yrs (hypomania and low grade depression)
|
|
|
When assessing a suicide attempt, what information should you garner?
|
Details of the attempt
Ongoing risk (present) Screen for mental illness Mental state Collateral Psych opinion and history |
|
|
What are some RF associated with suicide attempts?
|
Demographic: sex, age (25-34, >75), ATSI, low SES, rural, single
Illness: previous self harm, mood/anxiety/personality disorders, subs. Abuse, chronic |
|
|
Define self harm
|
Any behaviour involving deliberate infliction of pain or injury to oneslf.
|
|
|
What is the aim of CBT?
|
To logically challenge the false beliefs of the patient.
|
|
|
Describe a mechanism of addiction
|
Learned behaviour: habit
Pharmacological: dependence, reward circuits Underlying co-morbidity: self medication Social context: peer pressure, availability, perceived legality |
|
|
What are the elements of an MSE
|
Appearance and behaviour, Speech, Affect, Mood, Thought, Perception, Cognitive func., Insight and judgement
|
|
|
What aspects of a manic pt. may require them to be involuntarily admitted?
|
Poor insight, unpredictable, danger to themselves or others
|
|
|
Define dependence
|
Three or more of the following over 12mths
Increased tolerance Repeated withdrawal syndromes Taken over longer periods in larger amounts than initially intended Persistent desire to cut down with unsuccessful attempts Increased time spent getting, using or recovering from substance Continued use despite physical or psychological impairment |
|
|
List the DSM IV criteria for schizophrenia
|
Psychotic Sx. for >1mth
Significant impaired psychosocial function >6mths of continuous signs of illness Absence of a prominent mood disorder or an organic brain syn. Be mindful of a pervasive developmental disorder |
|
|
List some prodromal signs and symptoms of schizophrenia
|
Anxious, suspicious, unkempt, progressive social withdrawal, decreased social interactions, increased attention to the internal
|
|
|
List what are referred to as negative symptoms
|
Things that are ‘taken away/missing’
Alogia (speech poverty) Amotivation/avolition Social withdrawal Blunted affect/ decreased emotional expression Abstract thought |
|
|
List positive symptoms…
|
‘Added symptoms’
Delusions, hallucinations, catatonia, thought disorder. |
|
|
Explain catatonia
|
Bizarre posturing or mannerisms, disorganised/purposeless/disinhibited behaviour.
|
|
|
Describe the cognitive changes observed in a schizophrenic patient while suffering the condition and following effective treatment
|
During: decreased memory, attention and general intelligence.
After: intelligence does not reach levels prior to illness. |
|
|
Provide some epidemiological info regarding schizophrenia
♂ vs ♀ and age peak |
♂ > ♀ ♂ 18-25 y.o. ♀ 25-35y.o.
|
|
|
What brain changes are observed in the schizophrenic pt?
|
Increased ventricle size
Increased extracerebral space Decreased hippocampus Decreased gray matter (dendritic and axonal branch pruning) |
|
|
In a thought disorder, what is meant by derailment?
|
No logical link b/n ideas expressed. Subject shifting.
|
|
|
What are neologisms?
|
Creating new words that have no meaning to anyone else.
|
|
|
Explain the MOA of the anxiolytic benzodiazepine
|
Binds to an accessory/regulatory site on GABAa, acting allosterically to increase GABA affinity at the receptor.
This potentiates the opening of the channel for lower levels of GABA. It is NOT a GABA agonist Results in Cl influx into cell > hyperpolarisation > harder to reach AP threshold. |
|
|
Which antidepressants can cause serotonin syndrome and what symptoms are observed with this condition?
|
SSRI, + MAO-I. SNaRI
Agitation, confusion, diaphoresis, diarrhoea, tachycardia, HTN, mydriasis, tremor, hyperthermia, hyper-reflexia, clonus |
|
|
In what ways do typical and atypical antipsychotics differ?
|
Typicals block D2 receptors to a greater degree. Atypicals also block serotonin receptors.
Atypicals are less likely to cause EPSE, but morelikely to cause metabolic SE Atypicals are as effective at treating psychosis, but also treat negative Sx. |
|
|
List the four signs comprising EPSE
|
Acute dystonia, akathisia, Parkinsonian Sx, Tardive dyskinesia
|
|
|
What is the MOA of the mood stabiliser Sodium Valproate?
|
Inhibits Na channels > increased GABA in the brain
|
|
|
What are the recurrence rates for MDD
|
1 episode 50%
3 episodes 90% |
|
|
What other comorbidies may present with MDD and need to be assesses
|
Psychotic symptoms (delusions, hallucinations)
Panic, anxiety Eating disorder Substance abuse, alcoholism Axis 2 Cognitive decline, dementia |
|
|
What are the functions of the frontal lobe and MSE features are present in FLS
|
Functions: planning, verbal memory and speech, motivation, social awareness and behaviour, initiation of movement
Clinical: lack of planning ability with normal memory, poverty of speech (fluency, expressiveness), blunted or flattened affect, disinhibition, loss of social awareness (aggressiveness, irritability, impulsiveness), akanesia, primitive reflexes (grasp, rooting) |
|
|
A patient presents who has a history of binge drinking, angry outbursts. You ask him why he is so angry and he says you're the one who's angry. List the type and specific defence mechanism
|
All are primitive defence mechanisms
1) Binge drinking and outbursts: acting out 2) Projection |
|
|
A patient who self harms by cutting may have dissociative symptoms. What type of reaction is this ? How might they present.
|
Primitive defence mechanism.
Numbness, deadened emotions, Self harm, substance abuse |
|
|
A patient moves his head in decreasing arcs when the cheek is stroked and the mentalist muscle twitches when the the near eminence is stroked. What do these signs suggest.
|
Rooting reflex and palmotemporal reflex indicate frontal lobe dementia
|
|
|
In a psychiatric history, what information is needed regarding personal profile
|
Profile: personal (age, race etc), people (marital status, kids), social (living arrangements, employment, supports)
|
|
|
In a psychiatric history, what information is needed regarding reliability
|
Subjective assessment of whether symptoms correlate with signs, MSE and collateral Hx if available
|
|
|
In a psychiatric history, what information is needed regarding referral
|
Who referred, referral letter, reason for referral
|
|
|
In a psychiatric history, what information is needed regarding PC and HPC
|
PC: short summary statement
HPC: Q) full description of each symptom L) Location where these occurred S) Safety issues (self & other harm, ideation, means, plan, protective factors) D) Time frame of the illness: first noticed deterioration from stable M) Modifying factors: help received, drugs +/- C) Context: precipitating factors A) Associated symptoms: psychiatric and biological |
|
|
Psychiatric systems review: affective
|
Sleep (dreams, nightmares)
Anhedonia Dysphoria, euphoria, hypomania, mania Appetite: regular meals? Fatigue Agitation or retardation Concentration Esteem Suicide ideation |
|
|
Psychiatric systems review: safety
|
suicidal or homicidal ideation
self har, other harm weapons and means plans |
|
|
Describe 3 types of phobias
|
1) Agoraphobia: fear of suffering a panic attack in a place where likely embarassment or lack of help is perceived
2) Specific phobia: excessive, unreasonable fear cued by a specific object or situation 3) Social phobia: excessive concern over negative evaluations and scrutiny by others |
|
|
What is an obsession and compulsion
|
Obsession: recurring and persistent intrusive thoughts or impulses that are intrusive and inappropriate
Compulsion: A repetitive behaviour whose goal is to reduce anxiety or distress |
|
|
A patient is worried most days of the week, is often tired, has difficulty sleeping and concentrating. What is the likely diagnosis
|
If symptoms > 6 months then GAD.
|
|
|
A person is a workaholic, obsessed with detail. What would make this a disorder
|
Only an obsession causes marked distress, occurs for more than one hour each day or causes social or occupational dysfunction.
|
|
|
What is anxiety
|
A sense of apprehension, vigilence and heigtened autonomic arousal accompanied by unpleasant sensations
|
|
|
After 3 months, what is the relapse of addiction rate post treatment or detox. What does this suggest
|
40%
Similar mechanism of addiction for all substances |
|
|
How does operant conditioning explain addiction
|
Positive reinforcement: pleasure, escapeism, euphoria
Negative reinforcement: avoid anxiety, withdrawal and to feel "normal" |
|
|
You are concerned about admitting an alcoholic. List the signs of withdrawal to watch out for.
|
Diaphoresis
Tremor, crampa Nausea Reduced appetite Mood disturbance Perceptual disturbance, seizures (medical emergency) |
|
|
What percentage of alchohol patients experience seizures. What are the risk factors
|
5-15%
RF's include: Previous seizures, epilepsy Hypomagnesemia Hypokalemia Hypoglycaemia Head trauma |
|
|
When is the greatest risk of delerium tremens and what are the signs
|
72-96hours
insomnia autonomic dysfunction – increased pulse, blood pressure, sweating delerium (fluctuating level of consciousness, confusion, impairment of recent memory) agitation and fear psychosis: paranoid delusions, hallucinations - auditory - threatening, persecutory |
|
|
1) What is the incidence of Wernicke's
2) What are the risk factors 3) What is the classic triad 4) What are the complications |
1) 10% of alcoholics
2) Thiamine deficiency, malnourishment 3) Triad: nystagmus, ataxia, confusion 4) 85% develop Korsakoff's (mainly memory impairment), 20% mortality |
|
|
A patient with generalised anxiety has just completed alcohol detox. What three drug treatments are available and which is preferred.
|
Acamprosate, naltrexone, disulfiram
Acamprosate: best for anxiolytic, increases abstinence, benefits persist after ceasing. GI SE's, CI: liver impairment Naltrexone: Reduces relapse, craving, cue related relapse. Compliance must be monitored Dilsulfiram: CI's seizures, liver impairment. Suitable where fear of reaction is important |
|
|
What are the acute and chronic effects of opioids
|
Acute: euphoria, drowsiness, respiratory depression, nausea, constipation, miosis
Chronic: depression (mainly anhedonia and insomnia), tolerance, dependence |
|
|
What are the two main drugs used for harm minimisation treatment of opioid addiction?
|
Buprenorphine: partial u agonist, K antagonist. Long half life, less sedation and respiratory depression, cannot be diverted if combined with naloxone
Methadone: full u agonist, effecacious at higher doses (50mg+), can be diverted and injected |
|
|
What are the cons of opioid harm minimisation
|
1) diversion of methadone
2) No incentive to stop using street drugs 3) Creates power imbalance and lack of trust 4) Costly to maintain |
|
|
What are the acute symptoms of opioid withdrawal
|
Noradrenergic storm (locus coerelius): tachycardia, hypertension, dysphoria, mydriasis, diaphoresis, diarrhoea, shivering, restlessness, craving, insomnia, muscle pain
|
|
|
What are the treatment options for acute opioid withdrawal
|
1) Methadone
2) Buprenorphine 3) Clonidine (for NA storm): alpha-2 agonist 4) Antidiarrhoeal, muscle relaxant for cramps and insomnia (eg diazepam) |
|
|
A patient is admitted and you suspect amphetamine intoxication. What signs do you monitor
|
Think mania + anxiety + psychosis:
Euphoria Hyperarousal Talkative Insomnia Agitation, anxiety, panic Hallucinations Paranoia hypertensive crisis and heart failure Sweating |
|
|
What are the two main drugs used for harm minimisation treatment of opioid addiction?
|
Buprenorphine: partial u agonist, K antagonist. Long half life, less sedation and respiratory depression, cannot be diverted if combined with naloxone
Methadone: full u agonist, effecacious at higher doses (50mg+), can be diverted and injected |
|
|
What are the cons of opioid harm minimisation
|
1) diversion of methadone
2) No incentive to stop using street drugs 3) Creates power imbalance and lack of trust 4) Costly to maintain |
|
|
What are the acute symptoms of opioid withdrawal
|
Noradrenergic storm (locus coerelius): tachycardia, hypertension, dysphoria, mydriasis, diaphoresis, diarrhoea, shivering, restlessness, craving, insomnia, muscle pain
|
|
|
What are the treatment options for acute opioid withdrawal
|
1) Methadone
2) Buprenorphine 3) Clonidine (for NA storm): alpha-2 agonist 4) Antidiarrhoeal, muscle relaxant for cramps and insomnia (eg diazepam) |
|
|
A patient is admitted and you suspect amphetamine intoxication. What signs do you monitor
|
Think mania + anxiety + psychosis:
Euphoria Hyperarousal Talkative Insomnia Agitation, anxiety, panic Hallucinations Paranoia hypertensive crisis and heart failure Sweating |
|
|
What are the symptoms of stimulant withdrawal
|
Fatigue, exhaustion, depression (after 2 weeks - may require treatment), paranoia (low dose risperidone)
|
|
|
What is meant by dual diagnosis
|
Interrelationship between substance abuse and mental illness. (one precipitates the other and vice versa)
|
|
|
Give an example of a direct causal mechanism of alcohol leading to mental illness
|
Alcohol dependence -> loss of employment and social functioning -> poverty and isolation -> depression and suicidality
|
|
|
What is the greatest risk to a patient regarding dual diagnosis?
|
60-120x rate of suicide
Hx of self-harm increases risk of completing suicide |
|
|
What are the risk factors for dual diagnosis
|
Female
Multiple substance abuse Psychiatric history Borderline personality disorder |
|
|
How can undoing influence post natal depression
|
Undoing, for instance, poor upbringing by a mother can raise expectations, setting up for exhaustion, failure, guilt, anxiety and depression
|
|
|
What are the differentials for post partum depression
|
Adjustment disorder
Hypothyroidism Substance abuse PP psychosis |
|
|
What is the psychoanalytic theory of anxiety
|
Unresolved conflict between id, ego and superego. Defence mechanisms become activated such as denial, repression, suppression, acting out etc
|
|
|
What is a gender identity disorder
|
A persistent and strong preference for living as a person of the opposite sex
|
|
|
A patient says he has an intense dislike being born as a man and wishes he was a woman. What is this disorder
|
Gender dysphoria is the affective component of gender identity disorder
|
|
|
What are the two features of gender identity disorder
|
1) persistent distress over one's assigned sex
2) persistent desire to become the other sex (cross gender identification) |
