Mental health across the lifespan Flashcards

1
Q

What is the average life expectancy reduction in people with drug/alcohol use?

A

9-24 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are mental health presentations that may present in childhood/adolescence?

A

Disruptive/behavioural disorders
ADHD, ASD
Separation anxiety (SAD) and school refusal
Trauma and attachment disorders

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Autism is equally common in males and females TRUE/FALSE

A

FALSE

M:F ratio is 4:1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What age group is separation anxiety normal in?

A

7 months through preschool years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

TRUE/FALSE

Puerperium is a period of increasing risk of new maternal illness and relapsing existing illness

A

TRUE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the risk factors for puerperal psychosis?

A
Thyroid disorder
Previous episode
FH
Unmarried
1st pregnancy
C section 
Perinatal death
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What percentage of 65+ have a mental illness?

A

25%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Demyelinating disorders typically affect functionally and anatomically related groups of neurones TRUE/FALSE

A

FALSE

Degenerative disorders affect functionally and anatomically related groups of neuornes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are degenerative disorders pathologically characterised as?

A

Simple neuronal atrophy and loss with subsequent gliosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Which degenerative disorders affect the cerebral cortex?

A

Alzheimer’s disease
Picks disease
CJD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Which degenerative disorders affect the brainstem and basal ganglia?

A

Parkinson’s disease, progressive supra nuclear palsy, multiple system atrophy and Huntington’s

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Which degenerative disorders affect the spinocerebellar area?

A

Spinocerebellar ataxia (e.g. Friedreich Ataxia)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Which degenerative disorder affects the motor neurones?

A

Motor Neurone disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is dementia?

A

Progressive loss of neurones typically affecting functionally related groups, often symmetrical insidious impairment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

In dementia consciousness is clouded TRUE/FALSE

A

FALSE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the primary dementias?

A

Alzheimers disease
Lewy body dementia
Pick’s disease (frontotemporal dementia)
Huntington’s disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are other disorder that give risk to dementia?

A

Multi-infarct (vascular)
Infection (HIV, Syphillis)
Trauma
Metabolic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

If cognitive impairment then alongside a full screen what else should you check?

A

B12 and folate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is the most useful investigation for frontotemporal dementia?

A

SPECT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

true/false

dementia must be reported to the DVLA

A

TRUE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

With Alzheimers disease the later the onset the more severe and rapid changes TRUE/FALSE

A

TRUE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

How does a familial presentation of alzeimers disease differ from that of a regular presentation?

A

Early onset
Unusual presentation
More relatives affected

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

A family history of which gene mutations would increase the risk of Alzheimers disease?

A

APP
Presenillin (PSEN) 1&2
ApoE4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Which gene variant decreased the risk of alzheimers?

A

ApoE2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Why does Down syndrome increase the risk of Alzheimers disease?

A

As amyloid precursor protein (APP) is on chromosome 21

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What 3 things would be found on histology of someone with Alzheimers disease?

A

Excess accumulation of extracellular B-amyloid plaques
Intracellular neurofibrillary tangles
Amyloid angiopathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What is the central component of neuritic plaques produced by?

A

Cleavage of amyloid precursor protein (APP)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What protein are intracellular neurofibrillary tangles accumulations of?

A

Tau

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Explain amyloid angiopathy

A

Extracellular eosinophilic accumulation in the walls of the arteriole which stiffens and thickens the vessel walls
Disrupts BBB leading to serum leaking, oedema and local hypoxia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

In Alzheimers there is narrowing of the gyro and widening of the sulci TRUE/FALSE

A

TRUE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What are the 3 areas first to be affected in alzhimers?

A

Nucleus basalis of meynert
Enthorhinal cortex
Hippocampus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Clinically what does alzhimers look like?

A

Insidious, progressive onset of worsting memory (esp short term), dysphagia, dyspraxia and agnosia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

With alzheimers disease all tasks are affected including well practised tasks TRUE/FALSE

A

FALSE- Well practised tasks are not affected

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

All dementias are associated with behavioural or personality changes in the early stages of the disease?

A

FALSE
AD- not associate din the early stages. however as it progresses these become more prominent
Frontotermporal and vascular dementia are

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What do CSF markers in Alzheimers disease show?

A

Increased in phosphorylated tau protein

Decrease in B-amyloid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What drug is used for patients with mild-moderate AD?

A

Acetylcholinesterase (AChE) inhibitors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

When would you not used acetylcholinesterase inhibitors?

A

Active peptic ulcer
Severe asthma
COPD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What is used if AchE is contraindicated in the treatment of AD?

A

Memantine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

What drugs would be given if someone was having visual hallucinations?

A

Cholinesterase inhibitors

Antipsychotics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Give some examples of BPSD (behavioural and psychological problems of dementia)

A
Hallucinations
Delusions
Insomnia
Depression
Anxiety
Aggression
Agitation
anxiety
Disinhibition
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

In Alzheimer’s what is haemorrhage stroke due to?

A

B-amyloid deposits weakening cerebral blood vessels (cerebral amyloid angiopathy)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Frontotemporal dementia presents late in life TRUE/FALSE

A

FALSE

It presents early in life (one of the most common <65)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

What is frontotemporal dementia characterised by?

A

Progressive changes in character and social deterioration leading to impairment of intellect, memory and language

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

What are the 3 variants of frontotemporal dementia?

A

BEHAVIOURAL VARIANT

Primary progressive aphasia (split into SEMANTIC DEMENTIA and PROGRESSIVE NON-FLUENT APHASIA)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

What is the most common variant of FTD?

A

Behavioural variant (frontal lobe)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

What does the behavioural variant look like?

A

Causes loss on inhibition and social skills

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

What does semantic dementia look like?

A

Impaired word comprehension and object naming

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

What does progressive non-fluent aphasia look like?

A

Slow hesitant speech

Word-finding difficulties and agrammatism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

What are the histological hallmarks of frontotemporal dementia?

A

Swollen Neurones (Picks cells) and intracytoplasmic filaments (picks bodies)

Picks bodies are enriched in the protein Tau and Tau mutations are one of the causes of this dementia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

What should you not use to treat frontotemporal dementia and why?

A

Cholinesterase inhibitors - they make it worse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

How do you treat picks disease?

A

SSRIs

Trazodone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

What is used to distinguish picks disease from Alzheimers?

A

Lumbar puncture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

What is the second most common dementia in the west?

A

Multi-Infarct dementia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

What is multi-infarct dementia caused by?

A

Vascular changes secondary to cerebrovascular disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

Why are suffers of multi-infarct dementia prone to depression and anxiety?

A

As they have insight

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

Name 5 characteristic symptoms of multi-infant dementia?

A
Executive/attentional difficulties
Cognitive slowing
Behavioural changes (disinhibition)
Focal neurological problems
Difficulty walking/falls
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

Multi-infarct dementia is difficult to distinguish from alzhimers however it has…

A

Abrupt onset
Stepwise progression
History of hypertension or stroke

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

What are large vessel infarcts related to?

A

Atheroma of large cerebral arteries provoke thromboembolism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

What are small vessel infarcts related to?

A

Longstanding hypertension and atherosclerosis of small vessels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

MRI scans show the presence of lacunar infarcts TRUE/FALSE

A

TRUE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

What is Creutzefeldt-Jacob disease?

A

Transmissible prion neurodegenerative disease, causes cell death (spongiform changes in the cortex) and astrocytosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

How does Creutzfeldt-Jacob disease present?

A

Rapidly progressing dementia, ataxia and myoclonic jerks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

What is the difference between explicit and implicit memory?

A

Implicit- performance of task facilitated in absence of conscious recollection
Explicit- Performance of test requires conscious recollection of past experiences

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

What is Antegrate amnesia?

A

Difficulty in acquiring new material

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

What is retrograde amnesia?

A

Difficulty in remembering information prior to the onset of the illness/injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

What are classic reports of a memory problem?

A
Forgetting a message
Inability to remember a familial place
Losing track of a conversation
Increased misplacing of things
Forgetting to do things
Struggling to remember names
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

How does the onset of dementia, delirium and depression differ?

A

Dementia- insidious
Delirium- Acute
Depression- Gradual

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

What is 4AT a rapid test for?

A

Delerium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

What are the 4 things tested for in 4AT?

A

ALERTNESS
AMT-4
ATTENTION
ACUTE OR FLUCTUATING COURSE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

What is MoCA a test for?

A

mild cognitive dysfunction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

MMSE is used in the diagnosis of what?

A

Dementia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

What are the 6 questions used in GP land in order to test cognitive ability

A

1- More trouble remembering things that happened recently used to?
2-Trouble recalling conversations a few days later?
3-Difficulty in finding the right words or tend to use the wrong words more often?
4- Less able to manage money and financial affairs?
5-Less able to manage medication?
6- Need more assistance with transport?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

What does clock drawing test?

A

Fronto-parietal functioning

  • Executive function (planning)
  • Visuospatial ability
  • Abstraction (ability to use symbols)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

What is the ICD-10 criteria for dependence?

A
A strong desire to take the substance
Difficulties in controlling substance use
A physiological withdrawal state
Tolerance
Neglect of alternative pleasures
Persistence despite evidence of harm
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

What are the CAGE signs of addiction?

A

Cut down
Annoyed
Guilty
Eye-opener

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

What is incentive salience due to?

A

Dopimanergic activity in the mesolimbic pathway- it is a motivating signal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

When someone takes lots of drugs a tolerance develops. Why?

A

Downregulate the dopamine receptors

(OVERSTIMULATION–> DESENSITISATION)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

What is addiction driven by?

A

Initial stages- driven by reward (positive reenforcement)

Eventually becomes a thirst (negative reenforcement)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

How is the pre-frontal cortex involved in the neurobiology of addiction?

A

Helps intention guide behaviour

Modulates effects of the reward pathway, keeps emotions/impulses under control to achieve long-term goal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

When is the pre-frontal cortex fully developed?

A

Not until mid-20s (as cortical maturation is in a back to front direction, vulnerable while developing)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

TRUE/FALSE

Frontal lobe areas mature later than limbic (emotional) symptoms

A

TRUE

82
Q

What 3 things does dopamine release effect?

A
  1. Ability to update info in PFC
  2. Goal setting
  3. Ability to avoid compulsive repetition
83
Q

What part of the brain makes the decision about whether to carry out an activity?

A

Orbitofrontal cortex (provides internal representation of the saliency of events and assigns value to them)

84
Q

Addicted brains shows increased activation of OFC TRUE/FALSE

A

TRUE

85
Q

Which three parts of the brain are critical in acquisition, consolidation and expression of drug stimulus learning?

A

Hippocampal
Striatum
Amygdala

86
Q

What is the most heritable psychiatric condition?

A

Addiction

87
Q

How does stress motivate drug seeking in dependent individuals?

A

Triggers release of dopamine in neural reward pathway

88
Q

What does chronic stress lead to?

A

Dampening of dopaminergic activity through down regulation fo D receptors (reduces sensitivity to normal receptors)

89
Q

How do you make heroin?

A

Opium–> Morphine –> Diamorphine (Heroin)

90
Q

What are the two most common ways of taking heroin?

A

IV & Smoking (fastest way to enter bloodstream)

91
Q

How can opiate misuse lead to poor dentition?

A

The analgesic effect means that they don’t realise when pain

92
Q

How long does it take for withdrawal symptoms to appear?

A

within 6-8h (therefore tend to use 3x a day to avoid)

93
Q

What are the withdrawal symptoms of opiates?

A

Dysphoria and craving, agitation, tachycardia and hypertension, piloerection
Diarrhoea, N&V
Dilated pupils
Joint pains
Yawning, Running nose (rhinorrhoea) and watery eyes (lacrimation)
Insomnia
BP + HR^

94
Q

Opiate withdrawal may cause psychosis or harm TRUE/FALSE

A

BIG LIFE

Opiate withdrawal does not cause psychosis or harm

95
Q

What it opiate substitution therapy (OST)

A

Replace short acting opiod with long acting opiod

Either Buprenorphine or Methadone

96
Q

What is opiate detoxify?

A

Achieve complete abstinence from ALL opiates

97
Q

Why is there a huge risk of death with opiate detoxification?

A

As when detoxify decrease tolerance

BUT 70-80% relapse within 1y as although physically not dependent, psychologically dependent

98
Q

What is the definition of an alcoholic?

A

Someone whose repeated drinking leads to harm in work or social life. Lifetime prevalence ~10%

99
Q

How much is 1 unit?

A

10ml of alcohol

100
Q

How do you calculate the number of units?

A

%*volume/ 10

101
Q

What is used to identify someone with a harmful use of alcohol?

A

AUDIT (FAST is the quicker version)

CAGE

102
Q

What channels does alcohol affect?

A

Inhibits the action of excitatory NMDA- gutamate controlled ion channels
ALSO
Potentiate the actions of GABA type A controlled ion channels

103
Q

What does alcohol withdrawal lead to

A

Excess glutamate activity (toxic to nerve cell)

Reduced GABA activity

104
Q

When does withdrawal syndrome start to appear?

A

10h after the last drink

105
Q

What is the weekly allowance of alcohol?

A

14u/ week spread over 3 days with alcohol free days

106
Q

The first symptoms of withdrawal syndrome start to occur within hours and peak at 24-48h. When do they resolve?

A

5-7 days

107
Q

When does Delirium tremens peak?

A

within 2 days of abstinence

108
Q

What is the mortality of delirium tremens?

A

Mortality 2-5%

109
Q

What does delirium tremens look like?

A
Night time confusion
disorientation
Agitation
Hypertension
Fever
Visual/auditory hallucination
Paranoid ideation
Epileptic seizures can occur
110
Q

How do you treat withdrawal syndrome?

A

Chlordiazepoxide

111
Q

Lab tests are useful for screening and monitoring response for alcohol related problems TRUE/FALSE

A

FALSE

Useful for monitoring but not useful for screening

112
Q

What treatment can be used in alcoholics to detox?

A

Reassurance
Advice (adequate hydration, analgesia, antiemetics, treat infections and environment)
Benzodiazepines
Vitamin supplementation

113
Q

Name 3 symptoms of Wernickes encephalopathy?

A

Ataxia
Nystagmus
Ophthalmoplegia

114
Q

NO BENZODIAZEPINES BEYOND THE DETOXIFICATION PERIOD

A

tis a fact of life

115
Q

What percentage of people will relapse?

A

50%

116
Q

Name 3 drugs used to prevent relapses

A

Disulfiram (deterrent)
Acamprosate (reduce craving)
Naltrexone (reduces the reward)

117
Q

What are some of the CNS effects of alcohol?

A
Self-neglect
Decrease memory/cognition
Cortical atrophy
Retrobulbar neuropathy
Fits
Falls
Wide-based gait
Wericke-Korsakoff's encephalopathy
118
Q

What are alcohol contraindications?

A
Driving
Hepatitis, Cirrhosis
Peptic Ulcer
Drugs (e.g. antihistamines, metronidazole)
Carcinoid
Pregnancy
119
Q

What is the treatment for alcoholic hepatitis?

A

Supportive + prednisolone

120
Q

What is the criteria for diagnosing anorexia nervosa?

A
BMI <17.5
Self-induced wt loss
Body image disturbance
Fear of fatness
Amenorrhoea
121
Q

What are some of the physical signs of anorexia nervosa?

A
Muscle wasting 
Hair loss
Cold dry peripheries, dry skin
Hypercartenaemia
Bradycardia, hypotension
Bruising
Osteopenia/Osteoporosis
122
Q

What is referring syndrome?

A

Caused by depletion of already inadequate stores of nutrients (Use marsipan guidelines)

123
Q

What are the criteria for bulimia?

A
Persistent preoccupation with eating
Irresistible craving for food 
Binges
Attempts to counter the effects of binges
Morbid dread of fatness
124
Q

Physical signs of bulimia?

A

Calluses on knuckles (Russels sign)
Parotid Hypertrophy
Dental caries
U+Es

125
Q

What can be some medical complications of bulimia?

A
Hypokalaemia (common and problematic)
Oesophageal reflux
Oesophageal tears/rupture
Subconjunctival haemorrhage
Dehydration
Seizures
126
Q

What is psychosis?

A

A loss of contact with reality

127
Q

What does psychosis look like?

A

Hallucinations
Delusions
Disorder of the form of thought
Agitation/aggression

128
Q

What is a hallucination?

A

A perception that occurs in the absence of visual stimulus

129
Q

What is a delusion?

A

Fixed, falsely held belief with unshakable conviction (misinterpretation of real sensory stimuli w/o evidence to support)

130
Q

You can be swayed from an overvalued idea TRUE/FALSE

A

true

131
Q

What are functional hallucinations?

A

Hallucinations triggered by a stimulus in the same modality, can co-occur with it

132
Q

What is paranoia?

A

Belief that external events are related to ones self (vary in intensity, be aware of colloquialism)

133
Q

What are ideas of reference?

A

Innoculus or coincidental events ascribed meaning by the person e.g. thinking the TV is talking to them directly

134
Q

Is primary or secondary delusions more common?

A

Secondary (trying to explain why weird stuff is happening)

135
Q

A formal thought disorder cannot be directly observesd therefore has to be inferred from patterns of speech TRUE/FALSE

A

TRUE

136
Q

What is neologisms?

A

Coining of a new word or expression

137
Q

What are the 5 types of thought interference?

A
Thought insertion
Thought withdrawl
Thought broadcasting
Thought blocking
Thought echo
138
Q

What is passive phenomena?

A

Not having control of your body, emotions changed by others

139
Q

What increased the risk of schizophrenia by 50%?

A

Childhood viral CNS infection

140
Q

What is heritability?

A

Proportion of observable differences in a trait between individuals in a population

141
Q

What drugs are most and least likely to cause a drug induced psychosis?

A

Heroin least likely

Cannabis most likely

142
Q

3rd person auditory hallucinations are most likely…

A

Schizophrenia

143
Q

Self-referential delusions are most likely…

A

tbh not specific

delirium?

144
Q

What is depressive psychosis typified by?

A

Mood congruent of psychotic symtpoms

145
Q

What is this describing?
Delusions of grandeur/special ability/persecutory/religiosity
2nd person hallucinations/auditory
Symptoms of 1st rank present in 20% manic episode

A

Mania with psychosis

146
Q

What is an indictor of poor outcome in brain structural abnormalities?

A

Decreased frontotemporal volume/ frontal lobe grey matter

Enlarged lateral ventricle

147
Q

In schizophrenics what are the grey matter reductions due to?

A

Arborisations, not neuron loss

148
Q

With psychosis there is progressive ventricle enlargement TRUE/FALSE

A

FALSE

There is ventricle enlargement but it is not progressive

149
Q

What is the neurobiology of schizophrenia?

A

Overactivity of dopamine pathways in the brain

150
Q

Dopamine is inhibitory to what?

A

Prolactin

151
Q

Of the dopamine receptor subtypes which is most abundant and which is most important?

A

D1- Most abundant (stimulate cAMP)

D2-Most important

152
Q

How do typical antipsychotics work?

A

Work by D2 inhibition

153
Q

TRUE/FALSE
With typical antipsychotics there is a strong correlation between average antipsychotic dose required to improve clinical symptoms and D2 receptor binding activity

A

true

154
Q

How do atypical (2nd generation work)?

A

Many are 5-HT2A antagonists

155
Q

Typicals often have extrapyramidal side effects TRUE/FALSE

A

true

156
Q

name 4 of the anticholinergic side effects of typical antipsychotics

A

Acute dystonic reaction
Parkinsonism
Akathisia
Tardive dyskinesia

157
Q

How long does tar dive dyskinesia take to develop?

A

years

158
Q

What are side effects of atypicals?

A

Wt gain, sedation & metabolic syndrome

159
Q

Why are never atypical not sedating?

A

They do not cross the BBB

160
Q

Why is clozapine 3rd line in treatment of psychosis?

A

Response is great (50%)
BUT
small risk of agranulocytosis

161
Q

What is a functional disorder?

A

Symtpoms where one cannot easily associate the symptoms with classically identifiable organic disease processes

162
Q

What are common symptoms of functional disorders?

A
pain
altered sensation
dizziness
movement disorders
weakness
seizures- v common to have functional background
cognitive symptoms
163
Q

define dissociation

A

detachment from reality

164
Q

Define depersonalisation

A

Feeling that your body does not quite belong to you or is disproportionate from you

165
Q

What is derealisation?

A

A feeling that you are disconnected from the world around you or “spaced out”

166
Q

What percentage of functional symptoms have a good response to treatment?

A

60%

167
Q

What is the standard treatment of choice for functional problems?

A

CBT

168
Q

Define personality

A

Cluster of relatively predictable patterns of thinking, feeling and behaving, generally consistent across time, space and context

169
Q

What are the 5 things that the structure of personality consists of?

A

Openess, neuroticism, agreeableness, extraversion and conscientiousness

170
Q

What is a personality disorder?

A

Enduring pattern of inner experiences and behaviour that deviate markedly from the expectations of the individuals culture. The pattern is inflexible and pervasive.

171
Q

The first access of people with personality disorder to the services tends to be around age…

A

14

172
Q

Personality disorder is more common than asthma TRUE/FALSE

A

true

173
Q

What is in cluster A personality disorder?

A

Paranoid

Schizoid

174
Q

What is in cluster B personality disorder?

A

Antisocial
Bordeline
Histrionic

175
Q

What is in cluster C personality disorder?

A

Avoidant
Dependent
Obcessive-Compulsive

176
Q

What are some of the traits of antisocial personality disorder?

A
Disregard for and violation of the rights of others
Impulsive
Deceitfully charming
Fearless
Bad at reading emotional Qs
Tend not to learn from punishement
Blame the victim
177
Q

What are the three subtypes of schizophrenia?

A

Paranoid
Hebephrenic
Catatonic

178
Q

What is the peak onset of schizophrenia in men?

A

15-25

179
Q

What is schizophrenia?

A

A group of brain disorders characterised by disorders of thought, behaviour, perception and emotion

180
Q

What are the main symptoms of schizophrenia?

A

Delusions
Disorders of the form of thought
3rd person auditory hallucinations

181
Q

RF for schizophrenia?

A
Genes
Birth complications
Winter/spring birth
Drug use
Urban dwelling
Social adversity/deprivation
Neurodevelopmental changes
Neurochemical changes
182
Q

What are 4 good prognostic indicators for schizophrenia

A

Older age of onset
Female gender
Marked mood disturbance especially elation
Fix of mood disorders

183
Q

What is there an increased risk of suicide in schizophrenic patients?

A

In the 1st week post discharge

184
Q

What medication does post schizophrenic depression respond well to?

A

SSRIs

185
Q

What are the 3 main parts of ADHD?

A

Inattention
Hyperactivity
Impulsivity

186
Q

What is the most common neurobehavioral disorder of childhood?

A

ADHD

187
Q

Cause of ADHD

A

Genetic-80% genetically inherited
Perinatal factors-Tobacco/drug/alcohol use in pregnancy, prem, hypoxia, short/long labour, viral infections, forceps
Psychosocial adversity-Parenting styles, marital discord, maltreatment, trauma, criminality, low SES

188
Q

What is the neurobiology of those with ADHD

A

Underactive frontal lobe function
Excessively efficient dopamine-removal system
Reduction in norepinephrine

189
Q

Why is the diagnosis of ADHD delayed until school entry/later?

A

Most children will have hyperactivity as a toddler but this will abate with time

190
Q

What are the non-pharmacological treatment options for those with ADHD?

A
Parent training
social skill training
sleep 
diet
behavioural classroom management strategies
specific educational interventions
191
Q

What are the pharmacological treatment for those with ADHD?

A
1st line (stimulants)- Methylphenidate
2nd line (SNRI)- Atomoxetine
192
Q

How long does it take Atomoxetine to reach its full efficacy?

A

6 weeks

193
Q

What is autism?

A

Persistent deficits in social communication and interaction across multiple contexts with restrictive repetitive pattern of behaviour, interests and activities

194
Q

How is social communication I someone with autism impaired?

A

Hard to understand underlying meaning of conversation
Difficulties understanding jokes
Monotonous voice
Pedantic and idiosyncratic language
Narrow interests
Difficulties sharing thoughts and feelings

195
Q

How is social imagination impaired in those with autism?

A

Difficulties thinking flexibly
Takes things literally
Difficulty goal planning

196
Q

How is social interaction more difficult for someone with autism?

A

Difficulties with non-verbal clues

Struggle to make/sustain personal and social relationships

197
Q

What are the repetitive behaviours of someone with autism?

A

Stereotyped/repetitive motor movements

Ritualised patterns of behaviour

198
Q

What is the 3 criteria for autism diagnosis?

A

Present in early developmental period
Cause significant impairment in functioning
Not explained by mental health, intellectual disability or global developmental delay

199
Q

What is a larger amygdala associated with?

A

More severe anxiety and worse social and communication skills

200
Q

What is the aim of non-pharmacological treatment for someone with autism?

A

Lessen associated deficits/ family distress
Increases QOL
Functional independence

201
Q

What pharmacological management can be used for those with autism?

A

Risperidone- aggression
Metatonin- Sleep
SSRIs-Repetative behaviour