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What are the chapters included in the ICD10?

Chapter 5 – mental and behavioural disorders
• F00-F09 Organic, including symptomatic, mental disorders
• F10-F19 Mental and behavioural disorders due to psychoactive substance use
• F20-F29 Schizophrenia, schizotypal and delusional disorders
• F30-F39 Mood [affective] disorders
• F40-F48 Neurotic, stress-related and somatoform disorders
• F50-F59 Behavioural syndromes associated with physiological disturbances and physical factors
• F60-F69 Disorders of adult personality and behaviour
• F70-F79 Mental retardation
• F80-F89 Disorders of psychological development
• F90-F98 Behavioural and emotional disorders with onset usually occurring in childhood and adolescence
• F99-F99 Unspecified mental disorder


Described the interactions between mental health and physical health

Physical illness can precede mental illness – grief, loss, chronic pain, change in role/work. People with any chronic physical disease tend to feel more psychological distress than do healthy people. Poor physical health brings an increased risk of depression, as do the social and relationship problems that are very common among chronically ill patients.

Mental illness can precede physical illness – poor/maladaptive coping, self-harm, drug misuse. Depression linked to coronary heart disease, stroke, colorectal cancer, back pain, irritable bowel syndrome, multiple sclerosis, and possibly type 2 diabetes.


What is dysthymia?

A mood disorder consisting of the same cognitive and physical problems as in depression, with less severe but longer-lasting symptoms


Why might depression be more common in women?

Bio – Genetic predisposition, fluctuating hormone levels (think childbirth and menopause)

Psych – women ruminate more, men more likely to be stoic, angry or abuse substances. Women more invested in relationships.

Sociocultural – Women under more stress than men, women live lon ger – bereavement, loneliness, poor physical health. Women more likely to seek out a diagnosis of depression


What social factors make people vulnerable to depression?

• Death of a loved one
• Divorce or marital problems such as infidelity
• Loss of a job, financial problems, or poverty leading to homelessness
• A chaotic, unsafe, and dangerous home life such as violence in the family
• Abusive relationships that undermine self-confidence
• Social failures such as friendships
• Moving to another city
• Experiences that cause learned helplessness in which one believes that they have no control in life
• Serious trauma such as abuse, neglect, rape, etc.
• Social isolation


What are the indications for ECT?

It should only be used if other treatment options have failed or the condition is potentially life-threatening (eg, personal distress, social impairment or high suicide risk).
• Severe depressive illness or refractory depression.
• Catatonia.
• A prolonged or severe episode of mania


Action TCAs

TCAs raise serotonin and norepinephrine


What are the advantages and disadvantages of SSRIs compared to tricyclic antidepressants?

• SSRIs and TCAs have similar efficacy for the treatment of depression
• SSRIs have fewer anticholinergic and cardiovascular side effects
• TCA have fewer sexual and gastrointestinal side effects

• SSRIs are better tolerated by patients
• TCAs are associated with more frequent treatment discontinuations (i.e. more people dropping out tricyclics than SSRIs)
• SSRIs are safer in overdose than TCAs


What is “thought broadcast”?

Belief that others can hear or are aware of an individual's thoughts


What are core symptoms of schizophrenia according to the ICD10 classification?

Positive symptoms - Hallucinations, delusions, disordered thinking & speech

(Negative symptoms - or little emotion, poverty of speech, inability to experience pleasure, lack of desire to form relationships, and lack of motivation)


What is a delusion and how can it be distinguished from normal experience?

A delusion is a belief, out of keeping with the individual's cultural origins, that is held with strong conviction despite superior evidence to the contrary.

As a pathology, it is distinct from a belief based on false or incomplete information, confabulation, dogma, illusion, or other effects of perception


What is the difference between second person and third person auditory hallucinations?

Second order hallucinations are auditory hallucinations in which a voice appears to address the patient in the second person. For example the voice may be talking directly to the patient - "You are going to die" - or the voice may be telling the patient to do some action - "kill him". These types of auditory hallucinations are not diagnostic in the same way as third person auditory hallucinations, but the content of the hallucination, and the patient's reaction to it, may help in diagnosis

Third person hallucinations are auditory hallucinations in which patients hear voices talking about themselves, referring to them in the third person, for example "he is an evil person".


Which forms of hallucinations are characteristic of a) schizophrenia? b) organic disorders?

a) Third person auditory hallucinations
b) Visual and tactile hallucinations


What are the components of insight? (How should it be recorded?)

Can be said to have three components:
- recognition that one has a mental illness
- compliance with treatment
- he ability to re-label unusual mental events (such as delusions and hallucinations) as pathological

(the clinician should not describe it as simply present or absent, but should report the patient's explanatory account descriptively)


Why is an assessment of insight important?

Impaired insight is characteristic of psychosis and dementia, and is an important consideration in treatment planning and in assessing the capacity to consent to treatment.


What is a “word salad”?

Confused or unintelligible mixture of seemingly random words and phrases


What is a hallucination?

Perception in the absence of external stimulus that has qualities of real perception


In what conditions can hallucinations occur?

Infectious disorders e.g. encephalitis, herpes simplex

Neoplasms e.g. temporal lobe tumor

Mental/psychiatric e.g. psychosis, schizophrenia, mania

Poisoning e.g. amphetamine, delirium tremens, alcohol halluinosis

Progressive disorders e.g. parkinsons and lewy body dementia

Charles bonnet syndrome

Focal epilsepsy


What is the definition of a neurotic disorder?

Class of functional mental disorders involving distress but neither delusions nor hallucinations.


What disorders are included under “neurosis”?

Anxiety disorders


Obsessive compulsive disorder


What are patients with dependent personalities at risk of developing depression?

Inability to make decisions without advice (poor self-efficacy & locus of control)

Intense helplessness when relationships end

Over-sensitivity to criticism

Pessimism and lack of self-confidence

Poor assertiveness skills (self-sacraficing)

More willing to tolerate mistreatment and abuse from others


What are simple phobias?

Specific or simple phobias centre around a particular object, animal, situation or activity. They often develop during childhood or adolescence and may become less severe as you get older.

Common examples of simple phobias include:
•animal phobias – such as dogs, spiders, snakes or rodents
•environmental phobias – such as heights, deep water and germs
•situational phobias – such as visiting the dentist or flying
•bodily phobias – such as blood, vomit or having injections
•sexual phobias – such as performance anxiety or the fear of getting a sexually transmitted infection


What defines someone’s personality?

A collection of characteristics or traits that we have developed as we have grown up and which make each of us an individual.

These include the ways that we:
 think
 feel
 behave


What are the big five personality traits?

openness to experience



How would you define a personality disorder?

For whatever reason (often due to difficult life experiences), parts of your personality can develop in ways that make it difficult for you to live with yourself and/or with other people. You don't seem to be able to learn from the things that happen to you. You find that you can't change the bits of your personality (traits) that cause the problems. These traits, although they are part of who you are, just go on making life difficult for you - and often for other people as well.


What are symptoms of paranoid PD?


feel that other people are being nasty to you

feel easily rejected

tend to hold grudges


What are the symptoms of an emotionally unstable PD?

impulsive - do things on the spur of the moment

find it hard to control their emotions

feel bad about themselves - often self-harm, e.g. cutting yourself or making suicide attempts

feeling 'empty’

make relationships quickly, but easily lose them

can feel paranoid or depressed

when stressed, may hear noises or voices


What are the symptoms of a dissocial PD?

don't care much about the feelings of others

easily get frustrated

tend to be aggressive

commit crimes

find it difficult to make close relationships

impulsive - do things on the spur of the

moment without thinking about them

don’t feel guilty about things you've done

don’t learn from unpleasant experiences


What problems are associated with long term use of benzodiazepines?

Dependence, tolerance and withdrawal


Why are anticholinergic drugs used to treat Parkinsonism?

Used to improve tremor and salivation e.g Procyclidine, orphenadrine


What is neuroleptic malignant syndrome? List the symptoms.

Life-threatening neurological disorder most often caused by an adverse reaction to neuroleptic or antipsychotic drugs.

NMS typically consists of muscle rigidity, fever, autonomic instability] and cognitive changes such as delirium


What is the enzyme associated with NMS

Elevated plasma creatine phosphokinase


What are investigations routinely investigated with someone presenting to psychiatry?

• TFTs (endocrine disorders eg, hyperthyroidism, hypothyroidism)
• FBC (anaemia)
• Vitamin D and Calcium levels
• LFTS, U&Es
• LH/FSH ?menopause
• Toxicology screen (eg, cocaine abuse, side effects of some CNS depressants)
• Monospot test (Infectious disease eg, mononucleosis)
• Nervous system illnesses (e.g. tumors, head trauma, stroke, syphilis)
• Review any corticosteroid medications


Side effects of TCAs?

Related to antimuscarinic properties - dry mouth, dry nose, blurry vision, lowered gastrointestinal motility or constipation, urinary retention, cognitive and/or memory impairment, and increased body temperature


Why should chlorpromazine be avoided in elderly?

Patients with dementia at increased risk of death


What are the extrapyramidal effects and what symptoms do they include?

Drug-induced movement disorders that include acute and tardive symptoms -

Dystonia (continuous spasms and muscle contractions)

Akathisia (motor restlessness)

Parkinsonism (characteristic symptoms such as rigidity, bradykinesia and tremor)

Tardive dyskinesia (irregular, jerky movements).


What is rapid tranquilisation and what are the dangers associated with it?

Intramuscular or intravenous antipsychotics, benzodiazepines or other sedative drugs

Cardiac effects - sudden death
Prolonged QT can precede the serious ventricular arrhythmia torsade de pointes


What are the symptoms of lithium toxicity?

Stomach pain, diarrhoea, nausea and vomiting
Slurred speech


What are the adverse effects of lithium?


Lethargy/ leucocytosis
Intentional tremor
Insipidus (diabetes)
Urine excess
Metalic taste


Who can apply for section 5(2)?

Doctor on inpatient ward


Who can apply for section 5(4)?

RMN - 6hrs


What are four stages to consider in making a capacity assessment?

Weight up
Communicate a decision


What are main differences between CBT and psychodynamic therapy?

Features of CBT:
•It is relatively brief and time-limited (twelve weeks to six months).
•It is highly instructional in nature and homework is a central element.
•It is highly structured and directed with the therapist setting the agenda for each session (based on mutually set goals).
•It focuses on the here-and-now only and not a person’s history.
•The relationship with the therapist is not a focus of the treatment.

Features of Psychodynamic Therapy:
•While it can be brief, it is often longer term (six months or longer).
•It is less structured, typically without homework assignments.
•The client, not the therapist sets the agenda for the session by talking about whatever is on their mind.
•It focuses on the here-and-now as well as on personal history.
•The relationship with the therapist is included as a focus of therapy.


What is transference?

Uunconscious redirection of feelings from one person to another


Why is motivation important in assessing a patients suitability for psychodynamic psychotherapy?

Predicts success of treatment
Treatment is hardwork


What is difference between delirium and dementia?

Onset - Dementia gradual, delirium sudden

Cause - Dementa disease eg Alzheimer's, vascular dementia, lewy body dementia, frontotemporal dementia; Delirium triggered by a urinary tract infection, pneumonia, dehydration, illicit drug use, or withdrawal from drugs or alcohol. Medications that interact with each other can also cause delirium, so make sure your

Duration - Dementia chronic, progressive and incurable. Delium 2 weeks - 2 months and treatable when cause identified

Communication (gradually deteriorates in dementia)

Attention span and memory (less effected in delirium)

Energy (Delirium effects energy more suddenly)



Paraphrenia is a mental disorder characterized by an organized system of paranoid delusions with or without hallucinations (the positive symptoms of schizophrenia) without deterioration of intellect or personality (its negative symptom).


What is an encapsulated delusion?

A delusion that usually relates to one specific topic or belief but does not pervade a person's life or level of functioning.


What are the neuropathological features of Alzheimer's disease?

Amyloid plaques
Neurofibrillary tangles
Cortical atrophy
Ventricular enlargement
Grey matter atrophy


In what ways may excessive use of alcohol present to the psychiatrist?

Psychosis - hearing voices when there is nobody there

Dementia - memory loss, rather like Alzheimer's dementia

Depression & anxiety


What are health risks of illicit opioid use?

Overdose or death (resp depression)
Dependence, tolerance
Can induce anxiety (withdrawal)
Psychological avoidance
Cost socially


What is meant by harm minimisation?

Harm minimisation is just that - minimising the damage you are doing to yourself


Signs of opiate withdrawal?

Sweating, lacrimation, pyloerection, yawning


What is recommended weakly intake of alcohol for men and women?

14 units (6 pints of 4% lager or 6 glasses 175ml 13% wine)


What are the symptoms of acute alcohol withdrawal (delirium tremens)?

Hallucinations, shaking, shivering, irregular heart rate, and sweating.

Occasionally, a very high body temperature or seizures may result in death


Which illicit drugs may produce schizophrenia-like state?

Amphetamines, cocaine, cannabis


What are the common causes of acute confusional states?

Acute infections:
•Urinary tract infection.
•Viral infections.
•Cerebral abscess.

Prescribed drugs:
•Analgesics - eg, morphine.
•Anti-Parkinsonism medications.


Toxic substances:
•Substance misuse or withdrawal.
•Alcohol - acute intoxication or withdrawal.
•Carbon monoxide (CO) poisoning.
•Exposure to heavy metals.
•Barbiturate withdrawal.

Vascular disorders:
•Cerebrovascular haemorrhage or infarction.
•Cardiac failure or ischaemia.
•Subdural haemorrhage.
•Subarachnoid haemorrhage.
•Vasculitis - eg, systemic lupus erythematosus (SLE).
•Cerebral venous thrombosis.

•Metabolic causes:
•Electrolyte abnormalities - eg, hyponatraemia and hypercalcaemia.
•Hypoglycaemia or hyperglycaemia.
•Hepatic impairment.
•Renal impairment.

Vitamin deficiencies:
•Thiamine deficiency.
•Nicotinic acid deficiency.
•Vitamin B12 deficiency.

•Hypothyroidism and hyperthyroidism.
•Hypoparathyroidism or hyperparathyroidism.
•Cushing's disease.

Head injury.

For example, postictally.

•Primary cerebral malignancy.
•Secondaries in the brain.
•Paraneoplastic syndromes.

•Urinary retention.
•Faecal impaction.

•Multiple aetiology.
•Unknown aetiology.


What is the cause of Wernicke's encephalopathy?

Depleted B vitamins particularly B1 - Thiamine


How does Wernicke's encephalopathy present? (triad)

Triad - ophthalmoplegia, ataxia, and confusion