Day: May 16, 2024

Psychosis is the misrepresentation of thoughts and perceptions that originate from a patient’s own mind which are experienced as reality. It is a symptom, not a diagnosis in itself and affects about 3% of the population.   Causes: With most psychiatric conditions, the aetiology of psychosis is seen with a biopsychosocial model: Biological: Genetics –> Twin studies have shown schizophrenia has 50% concordance rate in MZ  twins Dopamine–> Antipsychotics block D2 receptors whereas L-Dopa induces psychosis Neurodevelopmental –> Higher in people with low birth weight, developmental delay etc.   Psychological: Prodrome –> Often preceded by patients exhibiting anxiety, depression and ideas of reference –

  Acute stress reaction This is an acute reaction which occurs rapidly (minutes to hours) after a sudden and stressful event. – This can include sexual assault, an injury, a near-death experience etc. – This leads to several symptoms in response which usually arise very quickly and terminate within 3 days   Symptoms: – Initial state of being dazed and confused – Purposeless overactivity and withdrawal – Intense brief anxiety – Autonomic arousal –> sweating, dry mouth, vomiting   Management – Help patient to re-orientate with trauma-focussed CBT Prognosis – Most cases resolve rapidly within 3 days. If symptoms persist > 1

Affective (mood disorders) are characterised by emotional disturbances resulting in functional impairment.   Causes: The aetiology of affective disorders can be seen using a biopsychosocial model:  Biological: 5-HT–> Low levels of endogenous 5-HT and Na are thought to decrease mood Cortisol –> Overactivation of the HPA axis increases both risk and persistence of low  mood   Psychological: Beck’s triad –> Negative views about the self, the world and the future seen in depression Attributional style –> Higher incidence in people who blame themselves for life events   Social: Stress –> Linked to negative life events, adversity and childhood stress.   Depression This is a mental

  Somatisation Disorder (SYMPTOMS) This is a disorder where patients believe that have physical symptoms present for at least 2 years, despite no physical or organic explanation – The most common symptoms mentioned usually involve the GI tract (abdominal pain) or the skin – Patients don’t accept negative test results and instead feel great distress and worry over their symptoms – It is more common in young women and can lead to multiple operations/investigations despite absence of disease   Hypochondrial Disorder (DISEASE) This is a disorder where patients believe they have a serious underlying disease e.g. cancer, HIV, AIDS –

Affective (mood disorders) are characterised by emotional disturbances resulting in functional impairment.   Causes: The aetiology of affective disorders can be seen using a biopsychosocial model:  Biological: 5-HT–> Low levels of endogenous 5-HT and Na are thought to decrease mood Cortisol –> Overactivation of the HPA axis increases both risk and persistence of low  mood   Psychological: Beck’s triad –> Negative views about the self, the world and the future seen in depression Attributional style –> Higher incidence in people who blame themselves for life events   Social: Stress –> Linked to negative life events, adversity and childhood stress.   Depression This is a mental

This is an acute confusional state which is characterised by rapid onset of a global but fluctuating dysfunction of the CNS due to a variety of insults on the brain. – It is more commonly seen in people aged >65 and those with diffuse brain disease (dementia) – However, it can be experienced by anyone in hospital and is an important thing to keep watch out for   Causes – The main causes can be remembered using the acronym PINCH-ME: P – Pain In – Infection (often a UTI in elderly) C – Constipation H – Hydration M – Medication (drugs) E – Electrolytes (e.g. hyponatraemia) E – Environment

  Eating disorders refer to a group of conditions which are characterised by a disorganised pattern of food consumption which causes physical and emotional distress. – They are more common in females than males (3:1) with an onset around age 15-30. – The two most common are anorexia nervosa and bulimia nervosa, which share similar features.   Causes: With most psychiatric conditions, the aetiology can be considered using a biopsychosocial model. Biological: Genetics –> Twin studies have shown that eating disorders share a large genetic component 5-HT –> Altered brain serotonin contributes to dysregulation of appetite, mood and impulsivity   Psychological: Personality –> Higher

Personality is “the range of characteristic behavioural responses that a person deploys in order to negotiate the challenges produced by the outside world and their internal feelings.” – It is composed of 4 main components: cognition, impulse control, social communication and affect/emotions – As these components are continuous, psychiatrists assign cut-offs indicating when they become abnormal.   A personality disorder is where one or more of these components of personality has reached an abnormal level: i) The trait has to be pathological, pervasive and persistent (3P’s) ii) It must lead to stereotyped responses which can be traced to childhood iii)

  Affective (mood disorders) are characterised by emotional disturbances resulting in functional impairment.   Causes: The aetiology of affective disorders can be seen using a biopsychosocial model:  Biological: 5-HT–> Low levels of endogenous 5-HT and Na are thought to decrease mood Cortisol –> Overactivation of the HPA axis increases both risk and persistence of low  mood   Psychological: Beck’s triad –> Negative views about the self, the world and the future seen in depression Attributional style –> Higher incidence in people who blame themselves for life events   Social: Stress –> Linked to negative life events, adversity and childhood stress.   Depression This is a

Affective (mood disorders) are characterised by emotional disturbances resulting in functional impairment.   Causes: The aetiology of affective disorders can be seen using a biopsychosocial model:  Biological: 5-HT–> Low levels of endogenous 5-HT and Na are thought to decrease mood Cortisol –> Overactivation of the HPA axis increases both risk and persistence of low  mood   Psychological: Beck’s triad –> Negative views about the self, the world and the future seen in depression Attributional style –> Higher incidence in people who blame themselves for life events   Social: Stress –> Linked to negative life events, adversity and childhood stress.   Depression This is a mental

Eating disorders refer to a group of conditions which are characterised by a disorganised pattern of food consumption which causes physical and emotional distress. – They are more common in females than males (3:1) with an onset around age 15-30. – The two most common are anorexia nervosa and bulimia nervosa, which share similar features.   Causes: With most psychiatric conditions, the aetiology can be considered using a biopsychosocial model. Biological: Genetics –> Twin studies have shown that eating disorders share a large genetic component 5-HT –> Altered brain serotonin contributes to dysregulation of appetite, mood and impulsivity   Psychological: Personality –> Higher association

Alcohol Alcohol abuse is defined as the regular or binge consumption of alcohol which can lead to physical, neuropsychiatric or social damage. – 1 unit (10mL) of alcohol is about equivalent to a small glass of wine, or a single peg of spirits. – Units = Volume (L) * ABV (%) – e.g. a 750ml bottle of wine, strength 12% has 750/1000 *12 = 9 units – Both men and women should drink no more than 14 units a week. If you do, it is best to spread this evenly over 3 days or more. There are several problems of

ADHD This is a disorder which is characterised by inattention, hyperactivity and impulsivity – It is much more common in boys than girls and diagnosed in the primary school years – In order to distinguish this condition from simply bad behaviour, there are 3 key things that must be present in order to satisfy the diagnostic criteria: –> Persistent – This means that the disruptive behaviour must be constant – If behaviour does fluctuate, then this could simply be an acute reaction to a change in the environment of the child.   –> Pervasive – This means that the disruptive behaviour must be seen

  ADHD This is a disorder which is characterised by inattention, hyperactivity and impulsivity – It is much more common in boys than girls and diagnosed in the primary school years – In order to distinguish this condition from simply bad behaviour, there are 3 key things that must be present in order to satisfy the diagnostic criteria: –> Persistent – This means that the disruptive behaviour must be constant – If behaviour does fluctuate, then this could simply be an acute reaction to a change in the environment of the child.   –> Pervasive – This means that the disruptive behaviour must be

  Somatisation Disorder (SYMPTOMS) This is a disorder where patients believe that have physical symptoms present for at least 2 years, despite no physical or organic explanation – The most common symptoms mentioned usually involve the GI tract (abdominal pain) or the skin – Patients don’t accept negative test results and instead feel great distress and worry over their symptoms – It is more common in young women and can lead to multiple operations/investigations despite absence of disease   Hypochondrial Disorder (DISEASE) This is a disorder where patients believe they have a serious underlying disease e.g. cancer, HIV, AIDS –

Alcohol Alcohol abuse is defined as the regular or binge consumption of alcohol which can lead to physical, neuropsychiatric or social damage. – 1 unit (10mL) of alcohol is about equivalent to a small glass of wine, or a single peg of spirits. – Units = Volume (L) * ABV (%) – e.g. a 750ml bottle of wine, strength 12% has 750/1000 *12 = 9 units – Both men and women should drink no more than 14 units a week. If you do, it is best to spread this evenly over 3 days or more. There are several problems of

  Eating disorders refer to a group of conditions which are characterised by a disorganised pattern of food consumption which causes physical and emotional distress. – They are more common in females than males (3:1) with an onset around age 15-30. – The two most common are anorexia nervosa and bulimia nervosa, which share similar features.   Causes: With most psychiatric conditions, the aetiology can be considered using a biopsychosocial model. Biological: Genetics –> Twin studies have shown that eating disorders share a large genetic component 5-HT –> Altered brain serotonin contributes to dysregulation of appetite, mood and impulsivity   Psychological: Personality –> Higher

The commonest aetiologies of dementia are: Alzheimer’s disease, Vascular and Lewy body dementia. – These conditions are difficult to diagnose and there are many assessment tools e.g. GPCOG, abbreviated mental test score (AMTS) and the mini-mental state examination (MMSE)   Investigation pathway: – 1st do a cognitive assessment e.g. MOCA – Exclude reversible causes – do FBC, U&E, LFTs, calcium, glucose, TFT, Vit B12 and folate (2) – Imaging – CT head (structural causes) and MRI (vasculature changes)    Alzheimer’s disease The number one cause of dementia in the UK is Alzheimer’s disease. The disease is characterised by a progression degeneration

  This is an acute confusional state which is characterised by rapid onset of a global but fluctuating dysfunction of the CNS due to a variety of insults on the brain. – It is more commonly seen in people aged >65 and those with diffuse brain disease (dementia) – However, it can be experienced by anyone in hospital and is an important thing to keep watch out for   Causes – The main causes can be remembered using the acronym PINCH-ME: P – Pain In – Infection (often a UTI in elderly) C – Constipation H – Hydration M – Medication (drugs) E – Electrolytes (e.g. hyponatraemia) E –

  Psychosis is the misrepresentation of thoughts and perceptions that originate from a patient’s own mind which are experienced as reality. It is a symptom, not a diagnosis in itself and affects about 3% of the population.   Causes: With most psychiatric conditions, the aetiology of psychosis is seen with a biopsychosocial model: Biological: Genetics –> Twin studies have shown schizophrenia has 50% concordance rate in MZ  twins Dopamine–> Antipsychotics block D2 receptors whereas L-Dopa induces psychosis Neurodevelopmental –> Higher in people with low birth weight, developmental delay etc.   Psychological: Prodrome –> Often preceded by patients exhibiting anxiety, depression and ideas of reference

Acute stress reaction This is an acute reaction which occurs rapidly (minutes to hours) after a sudden and stressful event. – This can include sexual assault, an injury, a near-death experience etc. – This leads to several symptoms in response which usually arise very quickly and terminate within 3 days   Symptoms: – Initial state of being dazed and confused – Purposeless overactivity and withdrawal – Intense brief anxiety – Autonomic arousal –> sweating, dry mouth, vomiting   Management – Help patient to re-orientate with trauma-focussed CBT Prognosis – Most cases resolve rapidly within 3 days. If symptoms persist > 1 month,

  Affective (mood disorders) are characterised by emotional disturbances resulting in functional impairment.   Causes: The aetiology of affective disorders can be seen using a biopsychosocial model:  Biological: 5-HT–> Low levels of endogenous 5-HT and Na are thought to decrease mood Cortisol –> Overactivation of the HPA axis increases both risk and persistence of low  mood   Psychological: Beck’s triad –> Negative views about the self, the world and the future seen in depression Attributional style –> Higher incidence in people who blame themselves for life events   Social: Stress –> Linked to negative life events, adversity and childhood stress.   Depression This is a

The mental state examination is a way of observing and describing a patient’s current state of mind. – The purpose of the MSE is to get a cross-sectional description of the patient’s mental state – It is a time-specific snapshot of the patient’s current mental state (allows comparison to before) – This is combined with the psychiatric history, allowing clinicians to get the overall sense of the patient’s condition   Mental State Exam Acronym = A Brilliant Scientist Makes All Theories Too Perfectly Complicated “In-it”   Appearance This is a general description of the patient’s general look and appearance. Important to include the following: – An opening sentence summarising

Psychotherapy works by helping people understand why they feel as they do. It uses a combination of reflecting about past events, learning new coping strategies and building a therapist-patient relationship. – There are 3 main areas of psychological therapy, each with its advantages and disadvantages: i) Supportive therapies e.g. Counselling + Supportive Psychotherapy This is the least intense level of psychotherapy which is used for mild depression and anxiety – The sessions are unstructured but allow the patient to establish rapport, reflect and get reassurance – It is a non-direct way of solving the problem –> works for stress, bereavement,

The main piece of mental health legislation in England is the Mental Health Act 1983. This was amended by the Mental Health Act 2007.   Who it applies to? The Mental Health act applies to people with a “mental disorder” – any disorder/disability of mind – However, it excludes anyone with dependence on drugs or alcohol – Also excludes patients with learning disability, unless their condition causes abnormally aggressive or seriously irresponsible conduct – Applies to people of any age, but children are usually treated with consent of their parent.   Sectioning (compulsory admission to hospital) This part allows admission

Mental Capacity can be defined as the ability to make your own decisions. – This is very important as it gives patients autonomy and the right to make choices about their own healthcare – It becomes complicated when people lack capacity, as others have to make decisions about patients – The Mental Capacity act applied to people aged 16 and over. If the child is younger than 16, they only have capacity to make decisions provided that they are Gillick Competent.   5 key principles of mental capacity: i) A person is assumed to have capacity is assumed until it

Disease = the objective physical pathology and known aetiology Illness = the patient’s subjective distress caused by a condition   A big problem in psychiatry is that many conditions have no known or understood pathophysiological cause. – This makes it very difficult to diagnose diseases, since there is no demonstrable pathology. – Therefore, psychiatry talks about mental illness – this is a level of subjective distress which is greater in severity or duration than occurs in normal human experience – This allows us to diagnose patients regardless of our understanding of the condition and provide treatment   A diagnosis is the art