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Mental Health Quiz

Mental Health Quiz. Rick Allen. List the Six Stages of Behavioural Change Pre-contemplation, Contemplation, Preparation, Action, Maintenance, Relapse What strategies can the treating Doctor utilise to motivate a patient between Contemplation, Preparation and Action?

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Mental Health Quiz

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  1. Mental Health Quiz Rick Allen

  2. List the Six Stages of Behavioural Change • Pre-contemplation, Contemplation, Preparation, Action, Maintenance, Relapse • What strategies can the treating Doctor utilise to motivate a patient between Contemplation, Preparation and Action? • Decisional balance (Pro’s and con’s), ID high risk situations, plan, goal setting… • What are some strategies to be used with a patient who has relapsed? • ID why and use it as a learning tool.

  3. List the DSM IV criteria for Major Depressive Disorder • 5 or more of the following over a 2 week period • At least one of: Dysphoria or Anhedonia, plus • Wt. loss/gain and appetite change • Insomnia/hypersomnia • psychomotor agitation/retardation • fatigue/loss of energy • ↓ self esteem (worthlessness, guilt) • ↓ conc. rr indecisiveness • recurrent thoughts of death or suicide • What does Alexithymia mean? • No words for feelings • List some RF for depression • Youth (<21) • Cumulative stressful events • Single (widowed, divorced…) • Low SES • Perceived lack of social support • Past psychiatric history • History of substance abuse

  4. Define Adjustment Disorder • An abnormal emotional response to an event • Define Dysthymia • Chronic, low grade dysphoria • What are the four elements comprising the clinical depression model and what are they about? • Dynamic – Attachment. Forms basis of success or failure in a child. • Cognitive – Core beliefs. Developed in childhood, maintains more than initiates depression • Psychosocial – Life events and their meaning to the pt. • Biological • What effect does depression have on a pt. w chronic disease? • Incr. mortalitiy, morbidity, perceived pain, func disability, hospital visits, hospital stay length, depressive Sx. and wish to die in palliative setting. Dec. Tx. adherence. • What treatment strategies are used to combat the endogenous vs. exogenous causes of depression? • Endogenous (10% of pt.) = issue with neurotransmitter  drugs • Exogenous (90% of pt.) = CBT

  5. List some RF for Mania • ♀, age (late 20’s), ↓ SES, FHx (genetic – neurotransmitter abnormalities?), childhood abuse, adverse life events, lack of confiding relationship, ↓ sleep (manic), substance abuse (manic) • What is the DSM IV criteria for Bipolar disorder? • 4/7 of the following for >1wk • Inflated self esteem/grandiosity • Decreased need for sleep • Increased talkativeness/ Pressure of speech • Racing thoughts/ Flight of ideas (+ connection, - goal) • Distractibility • Increased activity/psychomotor agitation • Excessive involvement in goal orientated activities with massive potential for painful consequences (money, sex…) • No organic cause • Not a mixed episode

  6. What is… • Bipolar I • Episodes of mania with potentially depressive episodes • Bipolar II • Episodes of hypomania with …. • What is hypomania • >4d, 3/7 of criteria, Not severe enough to cause disability, handicap or require hospitalisation. • Rapid cycling bipolar • 4+ episodes a year of depression, mania or hypomania over 12mths • Mixed bipolar • Simultaneous or quick succession (over 1hr) • Cyclothymic • Chronic low grade mood cycling for >2yrs (hypomania and low grade depression)

  7. When assessing a suicide attempt, what information should you garner? • Details of the attempt • Ongoing risk (present) • Screen for mental illness • Mental state • Collateral • Psych opinion and history • What are some RF associated with suicide attempts? • Demographic: sex, age (25-34, >75), ATSI, low SES, rural, single • Illness: previous self harm, mood/anxiety/personality disorders, subs. Abuse, chronic • Define self harm • Any behaviour involving deliberate infliction of pain or injury to oneslf.

  8. What is the aim of CBT? • To logically challenge the false beliefs of the patient. • Explain the ABC paradigm that CBT aims to address • A: the event the individual is exposed to • B: the thoughts, beliefs and self-verbalisations the ind. engages in response to A • C: the emotional and behavioural response to B • Describe a mechanism of addiction • Learned behaviour: habit; operant (consequence) vs classical (Pavlov) conditioning • Pharmacological: dependence, reward circuits • Underlying co-morbidity: self medication • Social context: peer pressure, availability, perceived legality • Pharmacological Tx for… • Alcohol • Naltrexone (opiate antagonist), Acamprosate, Benzo’s, Thiamine • Benzo’s • None. Slow withdrawal • Cocaine • Symptomatic. Risperidone for paranoia??? • Opiates • Naloxone, methadone, buprenorphine, α-2 adrenergic agonists

  9. When estimating a pt.s level of conciousness, what does AVPU stand for? • Alert, Voice, Pain, Unresponsive • What is the aim of a mental status exam? • Provide a snapshot in time of a pt’s psychological and behavioural well being • What elements is it comprised of? • Appearance and behaviour, Speech, Affect, Mood, Thought, Perception, Cognitive func., Insight and judgement • What is affect? • The moment-to-moment emotion observed • Roughly what is the lifetime risk in Aus for MDDand Bipolar I • MDD Male = 11.6%, Female = 17.9%, Bipolar = 1.34% • What aspects of a manic pt. may require them to be involuntarily admitted? • Poor insight, unpredictable, danger to themselves or others

  10. Define substance abuse • Self administration of any substance for non-medical purposes with harmful effects • One or more of • Recurrent use and failure to perform/fulfil role or obligations • Recurrent use when physically hazardous • Recurrent substance related legal problems • Continued use despite persistent/recurrent social/interpersonal problems • Define dependence • Three or more of the following over 12mths • Increased tolerance • Repeated withdrawal syndromes • Taken over longer periods in larger amounts than initially intended • Persistent desire to cut down with unsuccessful attempts • Increased time spent getting, using or recovering from substance • Continued use despite physical or psych issues

  11. List the DSM IV criteria for schizophrenia • Psychotic Sx. for >1mth • Significant impaired psychosocial function • >6mths of continuous signs of illness • Absence of a prominent mood disorder or an organic brain syn. • Be mindful of a pervasive developmental disorder • Define Schizophreniform disorder • Sx. of schizophrenia with disruption for <6mths • Define Schizoaffective disorder • Elevated/depressed mood alternating/concurrent w Sx of schizophrenia • What are psychotic Sx? • Delusions, hallucinations, disorganised speech, disorganised thought/behaviour, catatonia, negative symptoms • List some prodromal signs and symptoms of schizophrenia • Anxious, suspicious, unkempt, progressive social withdrawal, decreased social interactions, increased attention to the internal

  12. List the DSM IV criteria for schizophrenia • Psychotic Sx. for >1mth • Significant impaired psychosocial function • >6mths of continuous signs of illness • Absence of a prominent mood disorder or an organic brain syn. • Be mindful of a pervasive developmental disorder • Define Schizophreniform disorder • Sx. of schizophrenia with disruption for <6mths • Define Schizoaffective disorder • Elevated/depressed mood alternating/concurrent w Sx of schizophrenia • What are psychotic Sx? • Delusions, hallucinations, disorganised speech, disorganised thought/behaviour, catatonia, negative symptoms • List some prodromal signs and symptoms of schizophrenia • Anxious, suspicious, unkempt, progressive social withdrawal, decreased social interactions, increased attention to the internal

  13. List what are referred to as negative symptoms • Things that are ‘taken away/missing’ • Alogia (speech poverty) • Amotivation/avolition • Social withdrawal • Blunted affect/ decreased emotional expression • Abstract thought • And positive symptoms… • ‘Added symptoms’ • Delusions, hallucinations, catatonia, thought disorder. • Explain catatonia • Bizarre posturing or mannerisms, disorganised/purposeless/disinhibited behaviour. • Describe the cognitive changes observed in a schizophrenic patient while suffering the condition and following effective treatment • During: decreased memory, attention and general intelligence. • After: intelligence does not reach levels prior to illness.

  14. Provide some epidemiological info regarding schizophrenia • ♂ vs ♀ and age peak • ♂ > ♀ ♂ 18-25 y.o. ♀ 25-35y.o. • What brain changes are observed in the schizophrenic pt? • Increased ventricle size • Increased extracerebral space • Decreased hippocampus • Decreased gray matter (dendritic and axonal branch pruning) • In a thought disorder, what is meant by derailment? • No logical link b/n ideas expressed. Subject shifting. • And neologisms? • Create new words that have no meaning to anyone else.

  15. Explain the MOA of the anxiolytic benzodiazepine • Binds to an accessory/regulatory site on GABAa, acting allosterically to increase GABA affinity at the receptor. • This potentiates the opening of the channel for lower levels of GABA. • It is NOT a GABA agonist • Results in Cl influx into cell  hyperpolarisation  harder to reach AP threshold. • Effects? • Anxiolysis, sedation, muscle relaxant, anticonvulsant, anterograde amnesia. • SE? • Impaired co-ordination and cognition, increasing tolerance and dependence, acute toxicity/OD or enhancement with alcohol/barbituates  resp depression • Does the medium-duration Temazopam have an active metabolite? • No

  16. Which antidepressant is most effective at combating severe depression? • TCA’s. Will let SNaRI pass too. • What is their MOA and what is their use limited by? • Variable inhibition of NET and SERT b/n drugs • SE and serious acute toxicity in OD (arrythmia, seizure, mania) • SE= Antimuscarinic, sedation, postural hypotension and wt ↑ • Which antidepressants can cause serotonin syndrome and what symptoms are observed with this condition? • SSRI, + MAO-I. SNaRI • Agitation, confusion, diaphoresis, diarrhoea, tachycardia, HTN, mydriasis, tremor, hyperthermia, hyper-reflexia, clonus

  17. Provide the names of two typical and atypical antipsychotics • Typical: chlorpromazine. Haloperidol • Atypical: Clozapine, risperidone • In what ways do typical and atypical antipsychotics differ? • Typicals block D2 receptors to a greater degree. Atypicals also block serotonin receptors. • Atypicals are less likely to cause EPSE, but morelikely to cause metabolic SE • Atypicals are as effective at treating psychosis, but also treat negative Sx. • List the four signs comprising EPSE • Acute dystonia, akathisia, ParkinsonianSx, Tardivedyskinesia • Why, if clozapine is the gold standard for antipsychotics, is it used as a last-line treatment? • SE of agranulocytosis, therefore requiring constant monitoring

  18. What is the MOA of the mood stabiliser Sodium Valproate? • Inhibits Na channels  increased GABA in the brain • T/F – Sodium Valproate stabilises all mood issues? • F • Why F? • It only controls mania • What is the MOA of lithium? • Who knows…but it’s the gold standard!

  19. For funnsies, write a generic MSE for • A patient with schizophrenia • A patient with MDD • A patient with bipolar I

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