Psychiatry Flashcards

1
Q

What are the 3 core symptoms of depression

A

Low mood
Anhedonia
Low energy levels

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2
Q

Cognitive symptoms of depression

A
Low mood
Feelings of guilt
Feelings of uselessness
Feelings of worthlessness
Suicidal thoughts
Poor concentration
Mood congruent hallucinations and delusions
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3
Q

Functional symptoms of depression

A

Early morning waking - 2 hours before their normal time
Difficulty getting to sleep, waking up multiple times during the night
(Diurnal variation of symptoms - worse in early morning and late at night)
Weight loss - loss of appetite, nausea
Weight gain - comfort eating
Decreased libido
Slow thoughts/actions
Agitated/fidgety
Memory problems

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4
Q

Diagnostic criteria of depression

A

1 core symptoms + 3 others
3 others = mild
4-5 others = moderate
7+ others = severe

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5
Q

What does melancholia mean

A

Emotional numbness

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6
Q

Medications that increase the risk of depression

A
Steroids
Beta blockers
Statins
Oral contraceptive
Isotretinoin
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7
Q

Risk factors for depression

A
FH
Female
Stress/trauma
Substance abuse
Previous psychiatric diagnosis
Chronic disease
Unemployed
Single
Post-natal
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8
Q

Differentials for depression

A

Hypothyroidism
Bipolar disorder
Parkinson’s disease
Addison’s disease

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9
Q

Depression screening questionnaire

A

PHQ-9

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10
Q

What is bipolar I disorder

A

One or more manic episodes (lasting 1+ weeks) with or without major depressive episodes

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11
Q

What is bipolar II disorder

A

One episode of hypomania and one major depressive episode but no episodes of mania

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12
Q

What is rapid cycling in bipolar

A

4+ manic/hypomanic/major depressive episodes per year

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13
Q

What is cyclothymia

A

Persistent manic/depressive mood swings over the course of 2 years, which are not sufficiently severe to justify a diagnosis of bipolar disorder

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14
Q

How long do you have to allow before seeing beneficial effects of SSRIs

A

4-6 weeks

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15
Q

Common initial side effects of SSRIs

A
Dry mouth
Mild nausea
GI upset
Sexual dysfunction
Drowsiness
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16
Q

Side effects of tricyclic antidepressants

A
Dry mouth
Blurred vision
Constipation
Urinary retention
Sweating
Dizziness
Drowsiness
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17
Q

Venlafaxine and Duloxetine belong to which class of antidepressants

A

SNRIs

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18
Q

What are the 10 main symptoms of depression and how long do you need to have had symptoms for

A

At least 2 over a 2 week period

  1. Persistent low mood
  2. Anhedonia
  3. Fatigue/low energy
  4. Disturbed sleep
  5. Poor concentration/indecisiveness
  6. Low self-confidence
  7. Poor/increased appetite
  8. Suicidal thoughts or acts
  9. Agitation or slowing of movement
  10. Guilt or self-blame
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19
Q

What are the main differences between a manic and hypomanic episode

A

Manic lasts at least 1 week
Hypomanic lasts at least 4 days
Manic results in significant dysfunction (work/school), requires hospitalisation (risk to self or others), or has psychotic features. Whereas hypomanic doesnt result in significant dysfunction, hospitalisation or psychotic features

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20
Q

Features of mania and hypomania

A

Increased goal directed activity - sexually, work, socially
Psychomotor agitation
Increased talkativeness/pressure of speech
Flight of ideas or racing thoughts
Loss of social inhibition, socially inappropriate and reckless behaviour, aggressive/hostile
Decreased need for sleep
Overconfidence
Easily distracted

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21
Q

What is dysthymia

A

A chronic depression of mood, lasting at least several years, which is not sufficiently severe, or in which individual episodes are not sufficiently prolonged, to justify a diagnosis of severe, moderate, or mild recurrent depressive disorder

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22
Q

Describe how acute stress reactions present

A

Often initial state of “daze” with lowered field of consciousness, narrowed attention, disorientation. Followed by either further withdrawal or agitation and over-activity (flight reaction). Signs of panic are commonly present. Symptoms usually appear within minutes of the impact of the stressful stimulus or event and disappear within 2-3 days (often within hours). Partial or complete amnesia may be present.

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23
Q

Typical symptoms of PTSD

A
Flashbacks
Dreams/nightmares
Persisting background sense of emotional blunting
Social detachment
Anhedonia
Avoidance of triggers
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24
Q

What is the difference between somatoform/somatisation disorders and hyochondriacal disorder

A

Somatization disorder more general and changing symptoms whereas hypochondriacal disorder usually preoccupied with the possibility of having one or more serious and progressive disorders.

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25
Q

Describe how acute stress reactions present

A

Often initial state of “daze” with lowered field of consciousness, narrowed attention, disorientation. Followed by either further withdrawal or agitation and over-activity (flight reaction). Signs of panic are commonly present. Symptoms usually appear within minutes of the impact of the stressful stimulus or event and disappear within 2-3 days (often within hours). Partial or complete amnesia may be present.

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26
Q

Typical symptoms of PTSD

A
Flashbacks
Dreams/nightmares
Persisting background sense of emotional blunting
Social detachment
Anhedonia
Avoidance of triggers
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27
Q

What is the difference between somatoform/somatisation disorders and hyochondriacal disorder

A

Somatization disorder more general and changing symptoms whereas hypochondriacal disorder usually preoccupied with the possibility of having one or more serious and progressive disorders.

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28
Q

5 screening questions for eating disorders

A
Sick? - do you make yourself sick after meals
Control? - do you feel you've lost control over how much you eat
One stone (in 3 months)?
Fat? - do you believe yourself to be fat when others say you are thin
Food? - would you say food dominates your life
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29
Q

Differentials for eating disorders

A
Anxiety/depression/stress
Malignancy
Addison's disease
Chronic infection
Malabsorption syndrome
Drug/alcohol dependency
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30
Q

Physical effects of an eating disorder

A
Tooth damage due to acid
Cold
Bradycardic
Think hair
Think skin
Amenorrheic
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31
Q

Differentials for anxiety

A
OCD
Hyperthyroidism
Psychotic illness
Substance abuse
Substance withdrawal
Phaeochromocytoma
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32
Q

What are Schneider’s first rank symptoms of schizophrenia

A
Thought echo
Thought insertion/withdrawal
Thought broadcasting
3rd person auditory hallucinations
Delusional perceptions
Passivity/somatic passivity - belief that movements/emotions/thoughts are being controlled
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33
Q

What are the positive symptoms of schizophrenia

A

Delusions
Hallucinations
Thought disorders
Schneider’s first rank symptoms

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34
Q

What are the negative symptoms of schizophrenia

A
Decline in normal function
Affective blunting - lack of facial expression, flat voice, lack of eye contact
Social isolation/withdrawal
Anhedonia
Poverty of speech
Avolition - lack of motivation
Apathy
Poor self-care
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35
Q

What are delusions

A

Fixed beliefs that are not reality based and cannot be explained as part of the patients cultural background

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36
Q

Types of delusions

A
Persecution
Reference
Grandeur 
Control - includes thought broadcasting, insertion, withdrawal
Nihilistic
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37
Q

What is the difference between thought disorders and delusions

A

Formal thought disorder refers to an impaired capacity to sustain coherent discourse, and occurs in the patient’s written or spoken language. Whereas delusions reflect abnormal thought content, formal thought disorder indicates a disturbance of the organization and expression of thought

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38
Q

Types of auditory hallucinations

A

Commands
Derogatory
Conversing
Running commentry

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39
Q

Drug-induced psychosis usually causes which type of hallucination

A

Tactile

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40
Q

Types of formal thought disorder

A
Tangentiality/flight of thought
Derailment/knights move thinking
Word salad - no connection between words
Incongruent affect
Circumstantiality
Pressured speech
Distractible speech - cant maintain attention, distracted by irrelevant things
Perseveration
Neologisms - new word or new meaning to an existing word that is only apparent to them
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41
Q

Describe the prodromal period before schizophrenia

A

Before disease develops tendency as a child to be withdrawn, have loss of interest, self-neglect, depression.anxiety, brief psychotic episodes
Periods of stress/intense emotion/significant event can trigger schizophrenia in a susceptible individual

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42
Q

What drug class is used to treat schizophrenia

A

Dopamine (D2) receptor antagonists

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43
Q

Examples of typical antipsychotics

A
Haloperidol
Chlorpromazine
Promethazine
Flupenthixol
Decanoate (IM)
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44
Q

Side effects of typical antipsychotics

A

Extrapyramidal - parkinsonism, akathisia, dytonia, dyskinesia
Hyperprolactinaemia - sexual dysfunction, osteoprosis, amenorrhea, galactorrhea, gynaecomastia, hypogonadism
Metabolic - weight gain, T2DM risk, hyperlipidaemia, metabolic syndrome
Anticholinergic - tachycardia, blurred vision, dry mouth, constipation, urinary retention
Neuro - seizures, neuroleptic malignant syndrome
Increased QT interval

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45
Q

Examples of atypical antipsychotics

A
Clozapine
Olanzapine
Quetiapine
Risperidone
Amisulpride
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46
Q

Life threatening potential side effect of Clozapine

A

Agranulocytosis

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47
Q

Organic causes of psychosis

A
Dementia
Temporal lobe epilepsy
Infection - encephalitis, AIDS
Brain injury
Brain tumour
Huntington's disease
Low B12
Cushings
High dose steroids
SLE
Thyroid disease
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48
Q

What are the 5 main differentials of psychosis

A

Schizophrenia
Drug induced/withdrawal
Severe depression (psychosis would be mood congruent)
Manic phase of bipolar disorder (psychosis would be mood congruent)
Dementia

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49
Q

Describe section 2 of the mental health act

A

Allows for assessment +/- treatment
Lasts 28 days
AMHP (approved mental health practitioner) activates it
2 doctors need to approve it, one of whom needs to be section 12 approved

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50
Q

Describe section 4 of the mental health act

A

Allows emergency admission for assessment
Lasts 72 hours
AMHP or nearest relative can activate it
One doctor needed to approve it

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51
Q

Describe section 3 of the mental health act

A

Allows treatment for up to 6 months

Treatment for 1st 3 months then need consent or 2nd opinion application by AMHP or NR, needs 2drs approval

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52
Q

Describe section 5 (4) of the mental health act

A

Can hold a patient for up to 6 hours in an emergency

Can be done by a registered nurse

53
Q

Describe section 5 (2) of the mental health act

A

Can hold a patient for up to 72 hours in an emergency

Can be done by a doctor or approved clinician in charge of the patients care

54
Q

Describe section 135 of the mental health act

A

Can be used once to remove a patient from their home

55
Q

Describe section 136 of the mental health act

A

Can be used once to remove a patient from a public place

56
Q

Clinical features of Alzheimers dementia

A

Progressive memory loss
Struggling with ADLs
Reduced executive function - planning, organising
Nominal dysphasia - word finding, names, objects, paraphrasing
Disorientation to time and place - misplacing objects, getting lost
Visuo-spatial deficits
Behaviour/personality/affect - aggression, apathy, sleep more, disinhibition, paranoia, delusions, hallucinations, depression
Prospopagnosia - cant recognise familiar faces
In later stages - incontinence, effects of institutionalisation, loss of spontaneous speech, poor self-care, confusion

57
Q

Does alzheimer’s dementia affect men or women more commonly

A

Women

58
Q

Patho of alzheimers dementia

A

Deposits of senile plaques, beta amyloid plaques and neurofibrillary tangles
Neuronal loss
Cortical atrophy

59
Q

Medications used to slow progression of cognitive impairment in alzheimers dementia

A

Cholinesterase inhibitors - Donepezil
NMDA receptor antagonists - Memantine
Rivastigmine - inhibits acetylcholinesterase and butyrylcholinesterase

60
Q

Donepezil (cholinesterase inhibitor) slows progression of alzheimers dementia by how long for what % of patients

A

6-12 month delay for 50% of patients

61
Q

Contraindications to use of Donepezil

A

Bradycardia
LBBB
Long QTc interval
Need to do an ECG before initiating treatment

62
Q

Side effects of Memantine

A

Headache
Confusion
Dizziness
Risk of acute renal failure - need to do U+Es before initiating treatment

63
Q

Management of BPSDs (behavioural and psychological symptoms of dementia)

A

Non pharm – CBT, routine, programmed activities, orientation (large clocks, easy to read calendars), music therapy, aromatherapy, exercise
SSRIs for depression
Carbamazepine for aggression/agitation

64
Q

Risk factors for vascular dementia

A

Smoking
DM
Hyperlipidaemia/hypercholesterolaemia
Obesity

65
Q

Describe the typical presentation of vascular dementia

A

Acute/subacute onset of cognitive impairment
Stepwise history - varies between periods of stability followed by acute declines
Functional deficits before memory loss
Mood changes and emotional lability are common
May have psychosis, delusions, hallucinations, paranoia

66
Q

Describe the typical presentation of lewy-body dementia

A

Age >50
Hallucinations
Parkinsonism
Fluctuations in cognitive ability
Multitasking and cognitive tasks more affected than memory at presentation
Sleep disorders common
Rapidly progression (death usually within 7 years)

67
Q

Frontotemporal dementia tends to affect people under how old?

A

<65

68
Q

What are the 3 main presentations of frontotemporal dementia

A

Behavioural (most common)
Semantic
Non-fluent

69
Q

Features of behavioural predominant frontotemporal dementia

A
Apathy
Disinhibition
Impulsivity
Decline in interpersonal skills
Change in preferences e.g. food
Childlike amusements
Obsessions/rituals
70
Q

Features of semantic predominant frontotermporal dementia

A

Progressive decline in understanding of word meanings
Speech may be fluent but difficulty in name retrieval and use of less precise terms
Unable to determine meaning of common words
Loss of ability to recognise objects or familiar faces

71
Q

Features of non-fluent predominant frontotemporal dementia

A
Speech takes effort
Not fluent
Apraxia - poor articulation
Disorders of speech sound
Impaired sentence comprehension
72
Q

Types of dementia in order of how common they are

A

Alzheimers (60%)
Vascular (25%)
Lewy body (15%)
Frontotemporal

73
Q

Organic diseases you need to rule out before dementia diagnosis

A
Delirium
Depression/pseudodementia
Stroke
SOL
B12 deficiency
Hypothyroidism
Substance abuse
Metabolic - e.g. Calcium
HIV
74
Q

Main points of diagnosing Alzheimer’s dementia

A

Insidious onset
Decline in at least 2 cognitive domains
Impaired ADLs
No other cause

75
Q

Classic triad of normal pressure hydrocephalus features

A

Gait disturbance
Memory problems/dementia
Urinary incontinence

76
Q

What are the associated functions of the frontal lobe

A
Problem solving/reasoning/planning
Emotion/personality
Primary motor cortex
Brocas area (motor aspects of speech, usually left)
Inhibitory functions
77
Q

What are the associated functions of the temporal lobe

A

Perception/recognition of sound
Memory
Speech
Wernicke’s area - formulation/understanding of speech

78
Q

What are the associated functions of the parietal lobe

A

Recognition
Movement
Orientation
Primary sensory cortex

79
Q

What are the associated functions of the cerebellum

A

Posture
Balance
Co-ordination of movement

80
Q

What tool/questionnaire can be used to screen for dementia

A

Mini mental state examination

81
Q

What are the 4 defining features common to all personality disorders

A

Distorted thinking patterns
Problematic emotional responses
Over/under regulated impulse control
Interpersonal difficulties

82
Q

Describe the Cluster A personality disorders

A

Odd/eccentric

Dominated by distorted thinking with common features of social awkwardness and withdrawal

83
Q

3 subtypes of Cluster A personality disorders

A

Paranoid PD
Schizoid PD
Schizotypal PD

84
Q

Describe the Cluster B personality disorders

A

Dramatic, emotional, erratic

Problems with impulse control and emotional regulation

85
Q

4 subtypes of Cluster B personality disorders

A

Borderline PD
Narcissistic PD
Histrionic PD
Antisocial PD

86
Q

Describe the Cluster C personality disorders

A

Anxious/fearful

87
Q

3 subtypes of Cluster C personality disorders

A

Avoidant PD
Dependent/Asthenic PD
Obsessive-compulsive PD

88
Q

What’s the difference between CBT and psychodynamic approach

A

CBT is shorter than PA
CBT looks at how we think and feel affects our behaviour and how changing patterns of thinking can change emotion
Whereas PA looks at how the past has shaped the present

89
Q

What is a ‘care programme approach’

A

A package of care for people with mental health problems
Care plan is written down + sets out what support the patient will get day to day and who’ll give it to you – meds, money problems, housing, support at home, help to get out of the house, risks, what should happen in an emergency/crisis, problems with drugs/alcohol.
Patients get given a CPA care-coordinator (usually a nurse, social worker or OT) to manage care plan and review it at least annually.

90
Q

Dependency syndrome criteria (7)

A

Craving
Increased tolerance
Substance use prioritised
Feel like they’ve lost control
Withdrawal symptoms
Reinstatement after a period of abstinence despite knowing its harmful
Narrowing repertoire (usually to cheapest available)

91
Q

What is the national recommended alcohol limit for men and women

A

<14 units per week

<3 units per day

92
Q

How do you calculate alcohol units

A

Volume (L) X % alcohol

OR

(Volume mL X % alcohol) / 1000

93
Q

Health problems caused by excessive alcohol intake

A
Depression/anxiety
HTN
Arrhythmias
Alcoholic cardiomyopathy
Hypoglycaemia
Liver cirrhosis
Oesophageal varices
Hepatitis
Altered medication breakdown
Gastritis
Pancreatitis
Thiamine deficiency - peripheral neuropathy
Symptoms of withdrawal
Sleep disturbances and memory impairment
Oral/oesophageal/hepatic cancer risk increased
94
Q

Medications used to treat alcoholism by causing bad side effects

A

Acetaldehyde dehydrogenase inhibitors
Disulfiram
Metronidazole
Chlorporamide

95
Q

Medication used for alcohol withdrawal

A

Benzos - Chlordiazepoxide or Diazepam. Reduce dose gradually over 7-10 days
Clonidine

96
Q

Which medication can be used to reduce alcohol cravings

A

Acamprosate

97
Q

What are the 5 stages of addiction

A
Pre-contemplation - not thinking about it
Contemplation - thinking about it
Preparation - planning
Action - tries
Maintenance
98
Q

Early symptoms of alcohol withdrawal

A
Autonomic overactivity:
Tremor
Nausea
Sweating
Agitation
Tachycardia
Palpitations
Raised BP
99
Q

Late symptoms of alcohol withdrawal

A
Delusions
Confusion
Diarrhoea
Convulsions
Auditory hallucinations
100
Q

When do the late symptoms of alcohol withdrawal peak

A

24-48 hours

101
Q

What is delirium tremens

A

Rapid onset of confusion caused by withdrawal from alcohol. When it occurs, it is often three days into the withdrawal symptoms and lasts for two to three days.
Massive autonomic overactivity
An emergency

102
Q

What causes Wernickes encephalopathy

A

Thiamine deficiency

103
Q

Features of Wernickes encephalopathy

A

Nystagmus
Ophthalmoplegia
Ataxic gait - wide based, small steps
Confusion

104
Q

What is the difference between Wernickes and Korsakoffs

A

Both cause by thiamine deficiency
Wernickes is acute and reversible
Korsakoffs is chronic and irreversible

105
Q

Features of Korsakoffs syndrome

A
Confabulation (fabricate memories to fill in the gaps)
Anterograde > retrograde amnesia
Personality changes
Disorientation
Hallucinations
106
Q

What is anterograde amnesia

A

Loss of the ability to create new memories after the event that caused amnesia, leading to a partial or complete inability to recall the recent past, while long-term memories from before the event may remain intact

107
Q

In Wernickes encephalopathy, do you give glucose or thiamine first and why

A

Thiamine first
Because glucose increases thiamine demand and will worsen encephalopathy, IV glucose infusions must be administered after thiamine

108
Q

Structure of a mental health history

A
PC
HPC
PMH and past psych history
DH, Alcohol/illicit drugs
FH
Personal hx - birth, milstones, childhood, school, employment, relationships, forensic
Present SH - home, financial, work, education, dependents
Pre-morbid personality
109
Q

What things need to be considered/explored as part of a post-suicide attempt risk assessment

A
Were they along
How far away was help/intervention
Precautions against discovery - none/passive/active
Did they get help during or after
Final acts - will, insurance, gifts
Any active preparation
Suicide notes
Overt communication of intent
Purpose of attempt
Expectation of fatality
Seriousness of attempt to end life
Attitude towards dying - didnt want to/not sure/wanted to
Conception of medical rescuability
Degree of premeditation
Reaction to attempt - regret/accepts/wishes it was successful
Number of previous attempts
Whether or not they took drugs/alcohol to facilitate the attempt
110
Q

Components of the mental state examination (9)

A
Appearance
Behaviour
Speech
Mood and Affect
Thought form
Thought content
Perceptions
Cognition
Insight/Judgement
111
Q

How can you describe a persons appearance in the MSE

A
Age
Build
Clothing
Hygiene
Grooming
Clues about quality of self-care
Appropriateness for weather and consultation
112
Q

How can you describe someones behaviour in the MSE

A
Facial expression
Eye contact
Body language
Response to the consultation
Rapport/social engagement
Level of arousal (calm/agitated)
Anxious/aggressive
Hyper/hypoactive
Unusual movements - tremors, slowed, repetitive, involuntary
113
Q

How can you describe a persons affect

A

Range - restricted, blunted, flat, expansive
Appropriateness - appropriate, inappropriate, incongruous
Stability - stable, labile

114
Q

How can you describe a persons speech in the MSE

A

Rate - normal, slow, rapid, pressured, reduced
Volume - loud, normal, soft
Flow - spontaneous, hesitant, slurred, stuttering, mute
Tone - monotonous, tremulous, hostile
Quantity - minimal, excessive
Ease of conversation

115
Q

How can you describe a persons cognition in the MSE

A
Level of consciousness - alert, drowsy, intoxicated
Orientation to time/place/person
Memory functioning
Attention/concentration
MMSE
116
Q

How can you describe a persons perception in MSE

A

Dissociative symptoms - derealisation, depersonalisation
Illusions
Hallucinations - visual, olfactory, tactile, gustatory, somatic, auditory

117
Q

How can you assess insight and judgement in the MSE

A

Insight - do they acknowledge a possible mental health problem, do they understand treatment options, will they comply with treatment, can they identify hallucinations and suicidal impulses
What do they attribute their symptoms to?
Judgement - problem solving

118
Q

How can you describe someones thought content

A

Negative - self worth, helpless, guilt, suicidal
Positive - inflated self worth, grand plans, overplanning, risk taking, sexual
Anxieties - worries, preoccupations
Overvalued ideas
Delusions - grandiose, persecutory, referential, bizarre, nihilistic, somatic
Passivity - thought insertion/withdrawal/broadcast/echo, feelings, body actions/impulses/urges

119
Q

How can you describe someones thought form

A
Circumstantiality
Tangential, loose associations
Derailment/knights move thinking
Flight of ideas
Word salads
Metonyms - word approximations e.g. paper holder for book
Neologism - new word or known word used in a new/unrecognised way
Perseveration
Thought racing or blocking
120
Q

What questions can you ask about someones auditory hallucinations

A
Internal vs external
Single or multiple voices
2nd or 3rd person
Is it a voice they recognise
Is the voice positive/negative/neither
Running commentary
Commanding
121
Q

Name some mood stabilisers

A

Lithium
Gabapentin
Valproate
Carbamazepine

122
Q

Symptoms of lithium toxicity

A
Coarse tremor
Diarrhoea, nausea, abdo pain, vomiting
Dizzy/drowsy/confused
Agitated
Slurred speech
Ataxia
Nystagmus
Seizures
123
Q

Lithium toxicity occurs when serum levels are ?

A

> 1.5 mmol/L

124
Q

Name some extrapyramidal side effects of typical antipsychotics

A

Acute dystonia
Akathisia
Tardive dyskinesia

125
Q

What is neuroleptic malignant syndrome

A

Life threatening reaction to antipsychotics
Usually within 2 weeks of the first dose
Confusion and EPS
High fever, tachycardia, tachypnea, diaphoresis

126
Q

What does FALTER stand for in relation to the clinical features of neuroleptic malignant syndrome

A
Fever
Autonomic instability
Leukocytosis
Tremor
Elevated enzymes - CK, transaminases
Rigor
127
Q

Side effects of tricyclic antidepressants

A
Orthostatic hypotension
Sedation, delirium, condusion
Arrhythmias, tachycardias
Long QT - risk for torsade-de-pointes
Constipation
Urinary retention
128
Q

Features of serotonin syndrome

A
Fever, sweating
HTN, tachycardia
Agitation, anxiety
Hyperreflexia
Tremor
Ataxia