Term
| when is the most appropriate time to take blood sample to monitor lithium? |
|
Definition
|
|
Term
| what is the first line rx for mild depression? |
|
Definition
|
|
Term
| which antidepressant is safe to use following a MI? |
|
Definition
|
|
Term
| SRRIs aren't recommended in children but if you had to prescribe one which one would it be? |
|
Definition
|
|
Term
| ECT is recommended under which circumstances |
|
Definition
severe depression that is life threatening
prolonged or severe manic episode
catatonia |
|
|
Term
| how long can a normal grief reaction last up to? |
|
Definition
|
|
Term
how to remember the biochemical findings in anorexia nervosa?
most things low but C and G are raised |
|
Definition
cortisol raised
high cholesterol
GH raised
glucose raised
carotineamia
salivary Glands enlarged |
|
|
Term
| how long after starting anti psychotics might neuroleptic syndrome present? |
|
Definition
| soon after ie not a long time after being on the rx as it is an acute side effect |
|
|
Term
| SSRI withdrawal symptoms include? |
|
Definition
diarrhoea
vomiting and
abdo pain |
|
|
Term
| what distinguishing feature separates mania from hypomania? |
|
Definition
the presence of psychotic symptoms
these include delusions of grandeur and auditory hallucinations |
|
|
Term
| SSRI withdrawal symptoms include? |
|
Definition
diarrhoea
vomiting and
abdo pain |
|
|
Term
| what distinguishing feature separates mania from hypomania? |
|
Definition
the presence of psychotic symptoms
these include delusions of grandeur and auditory hallucinations |
|
|
Term
| what important interaction occurs with SSRIS and NSAIDS? |
|
Definition
| increased risk of GI bleed. give PPI |
|
|
Term
| risk factors for suicide? |
|
Definition
male
unemployed
divorced/widowed
advancing age
hx of mental illness
hx of DSH
hx of alcohol drug misuse |
|
|
Term
| factors associated with risk of suicide following episode of deliberate self harm? |
|
Definition
efforts to avoid discovery
planning
leaving a written note
voilent method
sorting out finances etc |
|
|
Term
| difference between suicide and DSH? |
|
Definition
suicide: form of protest or avoiding pain or shame
DSH: way of communicating a message or gaining power by escalating conflict. |
|
|
Term
|
Definition
Assessment of needs
agree to plan
provide support
check intent
identify and encourage protective factors
be vigilan in prescribing meds that can be used in OD to the pt and family members. |
|
|
Term
|
Definition
| intentional act of self harm irrespective of the motivation or apparent purpose of the act |
|
|
Term
assessing depression using scales
PHQ-9
HAD
list features of each |
|
Definition
PHQ-9: asks 'over the past 2 weeks have you often been bothered by any of these problems?'
there are 9 items scored 0-3 including thoughts of self harm
0-4 = not depressed
20-27 = severe depression
HAD: 14 questions, 7 for anxiety and 7 for depression scored 0-3
score out of 21.
0-7 normal
11+ = depression. encourage pt to answer questions quickly |
|
|
Term
| list 3 self report depression scales that are commonly used |
|
Definition
Patient Health Questionnaire 9
Hospital Anxiety and Depression Scale
Becks Depression Inventory |
|
|
Term
| which 2 questions are used to screen for depression? |
|
Definition
during the last month, have you often been bothered by feeling down, depressed or hopeless?
during the last month have you often been bothered by having little interest or pleasure in doing things?
if answered YES to either then you need to do a in depth assessment. |
|
|
Term
| which criteria does NICE use to grave depression? |
|
Definition
|
|
Term
| rx of mild-moderate depression? |
|
Definition
watchful waiting and review again in 2 weeks
low intensity psychosocial interventions guided by patient eg online CBT |
|
|
Term
| when would you recommend medication i.e in what severity of depression? |
|
Definition
|
|
Term
| in Bipolar disorder which usually lasts longer? manic or depressive episodes? |
|
Definition
|
|
Term
|
Definition
| >4 mood swings in 12months |
|
|
Term
| what is the difference between bipolar I and bipolar II? |
|
Definition
bipolar I : at least one episode of mania lasting more than 1 week
Bipolar II: > 1 episode of severe depression but only mild manic episodes AKA hypomania. |
|
|
Term
|
Definition
| modd swings not as severe as in full bipolar disorder but can be longer and can develop into full bipolar disorder. |
|
|
Term
|
Definition
|
|
Term
| medications used in bipolar? |
|
Definition
mood stabilizers e.g lithium
atypical antipsychotics e.g olanzapine |
|
|
Term
| why should you be weary of prescribing SSRIS in bipolar disorder? |
|
Definition
| the subsequent mood elevation may lead to mania/hypomania |
|
|
Term
| non medical mx in bipolar? |
|
Definition
CBT
education and lifestyle advise to help recognise prodromal features
keeping mood diaries.
for those prone to mania avoid stimulants or things that can affect mood in any way |
|
|
Term
| most 1st episodes of bipolar occur before age of 30. does it differ in occurrence between sexes? |
|
Definition
| No. it equally occurs in men and women |
|
|
Term
| for severity of depression it is the core symptoms plus 4,5/6 or 7 or> associated symptoms. what category of depression do these indicate? |
|
Definition
core plus 4 = mild
core plus 5/6 associated symptoms = moderate
core plus 7 or > is severe |
|
|
Term
| how often do symptoms needs to be present for? |
|
Definition
| for 2 weeks and symptoms should be present for most of every day |
|
|
Term
| what are the 3 core symptoms of depression? |
|
Definition
persistant sadness or low mood
anhedonia
anergia |
|
|
Term
| what is the name given to depression that has a cause/trigger? |
|
Definition
|
|
Term
| list mx for mild moderate and severe depression |
|
Definition
mild = exercise, lifestyle changes and counselling
moderate = antidepressants and CBT
severe =hospitalisation and ECT may be needed. |
|
|
Term
|
Definition
| this allows a person who has been detained in hospital for rx to leave hospital and get rx in the community. |
|
|
Term
| how many sections are there in the MHA in total? |
|
Definition
|
|
Term
| what must be considered before successfully applying the MHA to detain someone? |
|
Definition
they need to have a mental disorder
to a degree/severity that warrants hospital detention.
this could be due to their personal safety or safety of others
treatment has to be available in hospital
management should include medical rx including nursing/psychological and rehab therapies. |
|
|
Term
| a ot is detained under section 2 or 3 for e.g they are granted leave under section 17 by their RC. does this mean they have been transferred to section 17? |
|
Definition
no.
they still remain under their original section. |
|
|
Term
| which section are CTO given under? |
|
Definition
|
|
Term
what is a section 58? which section must the pt be under?
what is 58a? what is 58 b? |
|
Definition
if a pt is detained under section 3 it is valid for rx for 6 months. however after 3 months of rx the pt is asked to give continuning permission for the treatment. if they agree then it is continued under section 58a.
however if they disagree, this means we follow the section 58b pathway which requires a second opinion from an approved doctor to continue treatment. |
|
|
Term
| what is the 3 step approach for bipolar management? |
|
Definition
modd stabiliser plus atypical
add BDZ
combination of mood stabilisers |
|
|
Term
| when should therapeutic levels of lithium be checked in its safety monitoring? |
|
Definition
| 12 hours after the last dose. |
|
|
Term
| how is the tremor in lithium treatment? |
|
Definition
|
|
Term
| what medication is licensed for prophylaxis of a manic depressive episode in pts unresponsive to lithium? |
|
Definition
|
|
Term
| over activity of DA in which of the dopamine pathways is thought to cause positive psychotic effects? |
|
Definition
mesolimbic.
blockade of these receptors improves positive symptoms. |
|
|
Term
| amisulpride and zotepine are which class of medications? |
|
Definition
|
|
Term
| what happens to the qt interval with increasing heart rate? |
|
Definition
| it shortens. this is why it is corrected. ie QTc |
|
|
Term
| at low levels of mirtazapine what is the effect on sedation? |
|
Definition
there is a high level of sedation.
as you increase the dose, sedation decreases. |
|
|
Term
| disorders under psychotic disorder |
|
Definition
schizoohrenia
schizotypal
delusional disorder
schizo affective
acute or transient psychotic disorder |
|
|
Term
| which condition is thought of a milder short live form of schizophrenia? |
|
Definition
schizophreniform
in this condition the symptoms do not necessarily result in impairment of functioning. |
|
|
Term
| positive symptoms in psychosis |
|
Definition
hallucinations
delusions
thought insertion
broadcasting
references of delusion |
|
|
Term
negative symptoms in psychosis.
clue: they all begin with A |
|
Definition
anhedonia
avolition: decrease in motivation to do self directed purposeful activities
asociality
apathy
Alogia: impairment of speech like apahasia |
|
|
Term
first rank symptoms
A,B,C,D, |
|
Definition
A - auditory hallucinations
B - broadcast thoughts + insertion + withdrawal
C - controlled thoughts + passivity and delusional thinking
D -delusions of reference. |
|
|
Term
|
Definition
| genuinely held false belief that is unresponsive to logical objections. |
|
|
Term
|
Definition
| a perceptual interpretation without any stimulus |
|
|
Term
|
Definition
| misinterpretation of a stimulus |
|
|
Term
| difference between hallucination and delusions? |
|
Definition
hallucination: perceptual interpretation without any stimulus
illusions: is a misinterpretation of a stimulus |
|
|
Term
| what term is used to describe a pattern of disordered speech and language that implies disordered thinking? |
|
Definition
|
|
Term
| ill put that in my hat hat hat and shoes shoe shoes is an example of which thought disorder? |
|
Definition
|
|
Term
q: what would you like for dinner?
a: for dinner dinner dinner
this is an example of? |
|
Definition
|
|
Term
| what is the term when thoughts and ideas move quickly from one topic to another usually with a connecting link? |
|
Definition
|
|
Term
| you ask a pt where they are from.. they answer well I live in England but I don't know where my relatives comes from so I don't know if im irish or French... is an example of?? |
|
Definition
|
|
Term
| what term is given when sounds that are often rhyming rather than words appear to govern speech? |
|
Definition
|
|
Term
| disorders of the form of thought can all be grouped together as loosening of associations. is this true or false? |
|
Definition
|
|
Term
| I got chocolates on valentines day, quality st. I prefer roses. are Yorkshire or Lancashire best at cricket? are you telling lies? your nose will grown and your conscience will get you! is an example of?? |
|
Definition
knights move thinking.
thoughts move from one to another and has no apparent connection the the first much like how a knight moves in chess. |
|
|
Term
| what term is given to speech that is very delayed at getting to the point by unnecessary long windiness? |
|
Definition
|
|
Term
| which 4 areas is dopamine found in the brain? |
|
Definition
mesolimbic
mesocortical
nigrostriatal
tuberinfundibular pathway |
|
|
Term
| of the 4 areas where dopamine is found in the brain, which 2 areas are linked to positive effects of anti psychotic medications? |
|
Definition
mesolimbic
mesocortical
the other two nigrostriatal and tuberinfundibular are linked to side effects of antipsychotic medications. |
|
|
Term
| explain the diathesis-stress vulnerability model in the aetiology of schizophrenia? |
|
Definition
diathesis= mixture of genetic predisposition
stress = exposure to environmental factors |
|
|
Term
| which atypical antipsychotics are available as oral and IM injections? |
|
Definition
| olanzapine and risperidone |
|
|
Term
prognosis of schizophrenia
clue: remember it can be split into 20% |
|
Definition
20% recover after one episode
20% have delayed recovery
20% relapse and remit
20% chronically ill
20% suicide |
|
|
Term
|
Definition
antipsychotic meds generally atypicals
CBT with focus on symptom recognition AKA psychosocial intervention (PSI)
family therapy |
|
|
Term
| explain PSI psychosocial intervention |
|
Definition
| a form of CBT used in schizophrenia with an emphasis on symptom recognition. |
|
|
Term
| ten terms associated with misuse or addiction |
|
Definition
intoxication
dependence
harmful use
salience
tolerence
narrowing of repertoire
abstinence
reinstatement
withdrawal state
detox |
|
|
Term
| how is dependence diagnosed? |
|
Definition
3 or more of the following
strong desire to use
impaired control of use
physiological withdrawal
tolerance
preoccupied by the use of drugs
persistence despite clear harm |
|
|
Term
| which drug in alcohol detox is used to reduce cravings? |
|
Definition
|
|
Term
| which drug can induce a flushing reaction if alcohol is drank whilst on it? |
|
Definition
|
|
Term
|
Definition
| reducing regime of BDZ and with parental pabrinex to avoid Wernicke-korsakoff syndrome. |
|
|
Term
|
Definition
onset 48 hours after abstinence
peak incidence of DT is at 72 hours |
|
|
Term
confusion
ataxia
opthalmoplegia in an alcoholic what are you thinking? |
|
Definition
wernickes encephalopathy
due to B1 deficiency
if untreated can lead to Korsakoffs psychosis which is irreversible |
|
|
Term
| methadone is a full agonist of opioid receptors. it can prolong QT interval. Because of this how often is an ECG recommended? |
|
Definition
every 6 months
Buprenorphine is a partial agonist |
|
|
Term
| what syndrome is characterised by visual hallucinations in people that are blind or severely visually impaired? |
|
Definition
Charles bonnet syndrome
increased in those with leprosy |
|
|
Term
| what is considered harmful drinking in males and females? |
|
Definition
|
|
Term
| how does naltrexone work? |
|
Definition
| it is an opioid antagonist, it reduces the reinforcing actions of alchol namely the pleasure alcohol gives. |
|
|
Term
| a person with a history of alcohol misuse presents with confabulation, chronic amnesia, their recall is very poor but their immediate memeory is fine. what is the diagnosis? is it manageable? |
|
Definition
Korsakoffs syndrome
korsakoffs psychosis is irreversible |
|
|
Term
| on which chromosome would you find the mutation involved in alzheimers disease that codes for amyloid precursor protein? |
|
Definition
|
|
Term
| which chromosomes are involved in early and late onset Alzheimers disease? |
|
Definition
ch 14 for early onset
ch 19 for late onset |
|
|
Term
| which dementia is categorised by cystic necrosis and reactive gliosis of infarcted areas? |
|
Definition
|
|
Term
| in Lewy body dementia where are lewy bodies found? |
|
Definition
| in the cortical and subcortical neurons. |
|
|
Term
| findings on CT in alcohol related dementia? |
|
Definition
| cortical shrinkage and enlarged frontal lobe ventricles. |
|
|
Term
| which type of dementia is influenced by mutations on chromosome 17 and has a high familial incidence? |
|
Definition
|
|
Term
| name the 3 most common acetylcholinesterases used in mx of alzhemiers disease |
|
Definition
rivastigine
donepezil
galantamine |
|
|
Term
| what risk does antipsychotics have in old people? |
|
Definition
| increased risk of ischemic stroke. |
|
|
Term
| predictors of poor outcome for schizophrenia |
|
Definition
early onset
FHx
withdrawal
apathy
prior history of thought disorder |
|
|
Term
| difference between excretion of methadone and buprenorphine. which one needs to be adjusted for in renal impairment? |
|
Definition
methadone: metabolised by liver and excreted in urine so needs to be adjusted but buprenorphine is :-
partially excreted by kidney but majority excreted in faeces so does not need to be significantly adjusted in pts with renal impairment. |
|
|
Term
|
Definition
buprenorphine and naloxone
prescribed to be taken sublingually. if taken as prescribed the naloxone will be ineffective but if abused such as crush and injected then the naloxone will be effective and produce withdrawal. |
|
|
Term
|
Definition
| glutamate receptor antagonist |
|
|
Term
| which alpha 2 receptor agonist is used in the management of symptoms of opioid withdrawal? |
|
Definition
|
|
Term
what am I defining?
an acquired global impairment of intellect, memory and personality which is usually progressive and irreversible |
|
Definition
dementia.
in dementia the awareness of the environment is preserved |
|
|
Term
| reversible causes of dementia? |
|
Definition
neurosyphyllis
B12 deficiency
hypothyroidism
drugs
neoplasms
subdural haematoma |
|
|
Term
| what is first to go in alzheimers disease? |
|
Definition
|
|
Term
| which variant of vascular dementia may present just like alzheimers disease? |
|
Definition
|
|
Term
| how would you distinguish dementia from depression from a cognitive test? |
|
Definition
| the pt may answer with a lot of don't know answers and appear not to be concentrating. |
|
|
Term
| examples of hyperactive delirium |
|
Definition
alcohol withdrawal
drug intoxication |
|
|
Term
| examples of hypoactive delirium |
|
Definition
encephalopathy
hypercapnia |
|
|
Term
| personality disorders in odd/eccentric (group A) |
|
Definition
schizoid
schizotypal
paranoid |
|
|
Term
personality disorders in group B
emotional/erratic |
|
Definition
EUPD: borderline/impulsive
histrionic
narcissistic
dissocial |
|
|
Term
personality disorders in Group C
anxious/fearful |
|
Definition
avoidant
anakastic: OCD
dependent |
|
|
Term
| what is the most common method for suicide in UK? |
|
Definition
hanging then
OD then
Jumping then
CO poisoning |
|
|
Term
|
Definition
deliberate acts to harm oneself in a non fatal manner.
DSH usually associated with PD |
|
|
Term
how to asses suicide/self harm risk?
give them a SLAP |
|
Definition
specificity
Lethality
Availability
Proximity |
|
|
Term
| which SSRI for panic disorder? |
|
Definition
|
|
Term
| clomipramine can be used for OCD and phobias. what class of medication is it? |
|
Definition
|
|
Term
| what questionnaire is used to detect eating disorders? |
|
Definition
SCOFF
do you make yourself SICK
worry you've lost CONTROL over food
lost > ONE stone in a 3 month period
think youre FAT when others say youre thin
does FOOD dominate your life |
|
|
Term
| how is SCOFF questionnaire interpreted? |
|
Definition
there are 5 questions. if you answer NO to all the questions then you do not have an eating disorder
if u answer yes to 1 question you don't have an eating disorder but may have issues with food or body image
if you answer yes to at least 2 this indicates you have anorexia or bulimia . important: it is not a diagnosis but indicates that further ix is necessary |
|
|
Term
|
Definition
general appearance
behaviour
speech
mood affect
cognition
thought
perception
insight |
|
|
Term
mneumonic to remember cognitive assessment is ORAL MEDS
what does this stand for? |
|
Definition
ORIENTATION
REGISTRATION
ATTENTION
LANGUAGE
MEMORY RECALL
EXECUTIVE FX
DRAW
SHAPES |
|
|
Term
| to test orientation what questions would you ask |
|
Definition
the date
time without looking at clock
where are we
what month is it/year
town city etc |
|
|
Term
| to test registration what questions would you ask? |
|
Definition
tell the pt you are going to say 3 words yo want them to repeat them
can repeat the instructions up to 5 times.
tell them you will be asking them to repeat this later |
|
|
Term
| how would you test attentiton in an old person? |
|
Definition
serial subtraction OR
spell WORLD backwards OR
month of years in reverse. |
|
|
Term
| how would you test Language and comprehension when assessing old people as part of ORAL MEDS? |
|
Definition
name 2 objects
multi stage instruction
repetition of sentence: usually no ifs, ands or buts
reading and follow sentence
writing a sentence of their choice. |
|
|
Term
| how to test memory recall in ORAL MEDS? |
|
Definition
|
|
Term
| how to test memory recall in ORAL MEDS? |
|
Definition
|
|
Term
| how to test memory recall in ORAL MEDS? |
|
Definition
|
|
Term
| how to test memory recall in ORAL MEDS? |
|
Definition
anterograde: ask them to recal the 3 items from registration.
retrograde: name of current prime minister
what year did WWII end? |
|
|
Term
| how to test executive fx in ORAL MEDS |
|
Definition
motor: 3 stage task. alteranating hand movements
similarities: apple/orange
table/chair |
|
|
Term
drawing shapes in ORAL MEDS
what shapes are common? |
|
Definition
clock face
copy wire diagram e.g. of a 3d rectangle. |
|
|
