Psychology - Psychiatry Mnemonics part 1

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Memory (stages of processing)
ESR (as in the blood test)
·                 Encoding (registration) – information placed into memory
·                 Storage (retention) – short term memory (7+2) and working memory*
·                 Retrieval (recollection) – recall information from memory. People remember first and last info best,  primacy and recency effects
*Working memory – manipulation of information and includes the phonological loop and visuospatial sketchpad 


Freud’s stages of psycho sexual development
Old Age Psychiatrists Love Geriatrics
Or
Old Age Pensioners Love Grapes
·                 Oral
·                 Anal
·                 Phallic
·                 Latent
·                 Genital


Hypo mania/mania features
MESSIAH’S DOG (or GOD)
·                 Mood elevated
·                 Energy increased
·                 Sleep – decreased need for
·                 Speech (more talkative, possible pressure of speech) / Sociability
·                 Irritability
·                 Attention reduced
·                 Horny – sexual promiscuity and increased sexual energy
·                 Social/occupational functioning affected*
·                 When asking about risky behaviours, a lead on from sexual risk is:
·                 Driving – wreckless, too fast
·                 Overspending perhaps pointless, irrelevant items
·                 Gambling
Messiah referring to over-importance, increased self-worth.
*If delusions or hallucinations present (i.e. psychosis) or severe effect on social or occupational functioning then a diagnosis of mania may be made


Mania features
DIG FAST, Pal!
·                 Distractibility and easily frustrated
·                 Inhibition loss e.g. sexual disinhibition
·                 Grandiosity
·                 Flight of ideas
·                 Activity increased, perhaps with weight loss
·                 Sleep decreased
·                 Talkativeness
·                 Psychosis e.g. hallucinations/delusions


Depression features
DEAD SWAMP
·                 Depressed mood
·                 Energy loss
·                 Anhedonia
·                 Death thoughts – suicide
·                 Sleep disturbance
·                 Worthlessness, guilty / Weight gain
·                 Appetite loss
·                 Memory / Mental decrease (concentration and thinking)
·                 Psychomotor agitation / retardation
OR

IDEA SWAMP
·                 Insomnia
·                 Depressed mood
·                 Energy loss
·                 Appetite disturbance
·                 Suicidal thoughts
·                 Worthlessness
·                 Anhedonia
·                 Memory / Mental decrease (concentration and thinking)
·                 Psychomotor agitation / retardation

                
Psychiatric functional enquiry
MOAPS
·                 Mood – depression, elation
·                 Organic – alcohol/drug abuse, physically unwell, dementia
·                 Anxiety – worries, obsessions, phobia
·                 Psychosis – hallucinations, delusions, thought disorder
·                 Suicide/homicidal thoughts

MMSE
OO RAR LV (Ooh, RAR!, love)
·                 Orientation to place
·                 Orientation to time
·                 Registration
·                 Attention and concentration
·                 Recall
·                 Language
·                 Visual construction


Factors in determining risk
Patients at risk of relapse, pay attention to following to SAVE them and others:
SAVE
·                 Stress
·                 Alcohol and other substance abuse
·                 Violence in past
·                 Empathy-lacking
Then go on to do a formal risk assessment.


Mental State Examination
ASEPTIC
·                 Appearance / Behaviour
·                 Speech
·                 Emotion (mood and affect)
·                 Perception (hallucinations, illusions)
·                 Though (content, form)
·                 Insight
·                 Cognition (AMT, MMSE)

Suicide risk assessment
SAD PERSONS
·                 Sex – male
·                 Age – older
·                 Depression
·                 Previous suicide attempt
·                 Ethanol abuse
·                 Rational thinking loss e.g. hallucinations, delusions, hopelessness
·                 Suicide in family
·                 Organised plan
·                 No spouse
·                 Sickness e.g. chronic disability
One point for each.  Score calculated and suicide risk graded:
·                 0-4 – low risk
·                 5-6 – medium risk
·                 7-10 – high risk



Attention Deficit Hyperactivity Disorder (ADHD) symptoms
ADHD
·         Attention impaired – short attention span
·         Distractibility
·         Hyperactive – over activity
·         Devil-may-care attitude – impulsivity
Or,
in keeping with the 3 core symptoms:
1.      Attention Deficit
2.      Hyperactivity
3.      Devil-may-care attitude – impulsivity


Male sexual response stages
DEOR
·                 Desire
·                 Excitement
·                 Orgasm
·                 Resolution


Substantia nigra functions
niGRA
·                 Gestures (movement)
·                 Reward
·                 Addiction


Cingulate gyrus functions
Two main functions are dealing with pain and regulating aggression.
To remember, think of some awful contestant singing on that awful show, X-factor. Criticism from the judges for her singing (CINGulate) causes pain initially which leads on to aggression (usually towards the judges).


Dopamine pathways
MiLC TINS
·                 MesoLimbic
·                 MesoCortical
·                 TuberoInfundibular
·                 NigroStriatal



Limbic system functions
A DEMON (or MOANED)
·                 Autonomic control
·                 Drives
·                 Emotion
·                 Memory
·                 Olfaction
·                 Neuroendocrine control
Main regions of the limbic system – hippocampus, amygdala


Neurotransmitter types
GOD SANG
·                 GABA
·                 Opiate
·                 Dopamine
·                 Serotonin
·                 Acetylcholine
·                 Noradrenaline
·                 Glutamate





Obsessive-compulsive disorder diagnosis
TORE (for obsessional symptoms)
·                 Thought or act resisted unsuccessfully
·                 Own thoughts in the patient’s mind (i.e. not psychotic)
·                 Repetitive and unpleasant obsessions (thoughts, images or impulses)
·                 Ego-dystonic – the patient does not enjoy these thoughts and finds them distressing
ICD-10 criteria. Obsessional symptoms or compulsive acts (or both) present on most days of the week for longer than 2 weeks. There needs to be associated distress or interference with activities as a result.

Neurotransmitter types
FEAR
·         Fear of a specific object or situation
·         Evasion of said fear
·         Anticipation anxiety e.g. if knows will be exposed to phobia
·         Restlessness and anxiety when exposed


Obsessive compulsive disorder symptoms
Having OCD is MURDER
·                 Mind – patient aware symptoms arise in the mind
·                 Unpleasant thoughts
·                 Resist – patient must want and try to resist obsessive thoughts
·                 Displeasure of feeling the obsession
·                 Ego-dystonic
·                 Repetitive thoughts


Five stages of grief
DABDA
·                 Denial
·                 Anger
·                 Bargaining
·                 Depression
·                 Acceptance

Post Traumatic Stress Disorder (PTSD) diagnosis
TRAUMA
·                 Traumatic event that would cause stress in any individual
·                 Reliving/re-experiencing event e.g. flashbacks, nightmares, intrusive thoughts
·                 Avoidance of things similar to event
·                 Unable to function e.g. socially, work
·                 Memory affected – inability to recall (partial or complete) important aspects of the event
·                 Arousal symptoms e.g. hyper-vigilance, startle reaction, irritability, poor concentration, poor sleep
Symptoms arise within 6 months (ICD-10) or 1 month (DSM-V)

Post Traumatic Stress Disorder (PTSD) features
IF AHEAD
·                 Insomnia – usually with nightmares (nocturnal flashbacks).
·                 Flashbacks – vivid reliving of trauma.
·                 Avoidance – of activities or events that resemble the traumatic event.
·                 Hypervigilance – autonomic hyperarousal and enhanced startle reaction.
·                 Emotional blunting – emptiness or numbness alternates with…
·                 Anxiety (intense) – experienced at similar events to trauma or anniversary of event.
·                 Detachment (emotionally) – from other people.


Lewy body dementia features
SHACK
·                 Stiffness, rigidity and movement difficulties e.g. in bed
·                 Hallucinations – visual or auditory
·                 Antipsychotic sensitivity e.g. to sedation and EPSE
·                 Cognitive impairment which fluctuates (think delirium-like picture)
·                 Klumsiness – falls
VIP
·                 Visual hallucinations
·                 Inattention, fluctuating course
·                 Parkinsonism


Kluver-Bucy syndrome
Damage to bilateral medial temporal lobes (amygdala and hippocampus)
Oral Sex DVD
·                 hyperOrality
·                 hyperSexuality
·                 Docility
·                 Visual agnosia
·                 Dietary changes – hyperphagia, carbohydrate craving


Narcolepsy features
Sleepy People Can Have Hallucinations
·                 Sleepiness (excessive during the day)
·                 Paralysis (sleep)
·                 Cataplexy
·                 Hypnagogic Hallucinations


Extrapyramidal side effects (EPSE)
ADaPT
·                 Akathisia
·                 acute Dystonia
·                 Parkinsonism
·                 Tardive dyskinesia

Balint syndrome features
Damage to bilateral parietooccipital lobes
SOOT
·                 Simulatnagnosia – inability to simultaneously perceive different aspects of a picture to appreciate it as a whole
·                 Ocular apraxia – difficulty keeping the eyes still
·                 Optic ataxia – difficulty moving the eyes to a specific position
·                 Tunnel vision
Simultaneous Operatic Occupation
·                 Simulatnagnosia
·                 Optic ataxia
·                 Oculomotor apraxia


Subcortical dementia features
LAPSED
·                 Language sparing/preservation
·                 Anamnesis (memory retrieval) impaired
·                 Personality change
·                 Slowing of psychomotor activities
·                 Executive dysfunction
·                 Depression


Delirium causes
PINCH ME
·                 Pain
·                 INfection
·                 Constipation
·                 Hydration
·                 Medication
·                 Electrolyte imbalance e.g. low calcium / Environment
I WATCH DEATH
·                 Infection – UTI, pneumonia, encephalitis, meningitis
·                 Withdrawal – alcohol, benzodiazepines, barbituates
·                 Acute metabolic disorder – derranged electrolytes, hepatic, renal failure
·                 Trauma – head injury, post-op
·                 CNS pathology – stroke, haemorrhage, tumour, seizure
·                 Hypoxia – anaemia, cardiac failure, PE
·                 Deficiency – vitamin B12, folate, thiamine (B1)
·                 Endocrine disorder – thyroid, glucose, parathyroid, adrenal
·                 Acute vascular – shock, vasculitis
·                 Toxins, substance abuse
·                 Heavy metals – mercury, lead


Dementia reversible causes
DEMENTIA
·                 Drugs and alcohol esp. anticholinergics
·                 Emotions e.g. depression
·                 Metabolic derangement e.g. hypothyroid, electrolyte abnormalities
·                 Eyes and ears in decline
·                 Normal pressure hydrocephalus
·                 Tumor
·                 Infection e.g. encephalitis, HIV, syphilis
·                 Anemia e.g. vit B12, folate deficiency


Parkinson’s disease features
TRAP
·                 Tremor – usually hands (pill-rolling, 3-6Hz), present at rest, worsened by anxiety, improves on action
·                 Rigidity – lead-pipe rigidity. Cogwheeling = tremor + rigidity
·                 Akinesia – reduced facial expression, monotonous speech, abnormal gait/stance, ‘slowed down’
·                 Postural instability



Anxious (avoidant) personality disorder features
ANxIOUS
·                 Avoidance of social interaction – fear of criticism/rejection
·                 Need for physical security which places restrictions in life
·                 Insecure – belief that one is socially inept/unappealing
·                 Ostracised, worried about
·                 Unwilling to be involved unless certain of being liked
·                 Socially inept (beliefs of such)
Dissocial (antisocial) personality disorder features
CORRUPT Blame
·                 Callous unconcern for the feelings of other
·                 Obligations (social) and rules ignored
·                 Remorse lacking (no empathy)
·                 Relationships unable to be maintained (although can often be started)
·                 Underhanded – deceitful, lying and manipulative although can have superficial charm
·                 Punishment does not yield benefit – unable to profit from punishment
·                 Temper – low tolerance to frustration and low threshold for anger
·                 Blames others or attempts to offer rational explanations for behaviour


Histrionic personality disorder features
PRAISE ME (source)
·                 Provocative or seductive behaviour
·                 Relationships considered more intimate than they are
·                 Attention required (need to be the centre)
·                 Influenced easily
·                 Style of speech (impressionistic, lacking detail)
·                 Emotions shallow, rapidly shifting, dramatic
·                 Manipulative / Make up (physical appearance used to draw attention to self)
·                 Ego-centric


Schizoid personality disorder features
DISTANT Fantasy (source)
·                 Detached or flattened affect
·                 Indifferent to criticism or praise
·                 Sexual experiences of little interest
·                 Tasks done alone (solitary)
·                 Absence of close friends
·                 Neither desires nor enjoys close relationships
·                 Takes pleasure in few activities
·                 Fantasy and introspection, preoccupation with such


Paranoid personality disorder features
SUSPECT (source)
·                 Sensitive (excessively) to setbacks and rebuffs
·                 Unforgiving and bears grudges persistently
·                 Spousal infidelity suspicions
·                 Perceives friendly/neutral acts as hostile/contemptuous
·                 Excessive self-worth/importance
·                 Conspiratorial beliefs
·                 Tenacious sense of self rights


SCOFF eating disorder screening tool
SCOFF
·                 Do you make yourself Sick because you feel uncomfortably full?
·                 Do you worry you have lost Control over how much you eat?
·                 Have you recently lost more than One stone over a three month period?
·                 Do you believe yourself to be Fat whilst others say you are thin?
·                 Would you sy that Food dominates your life?
One point for each positive answer. A score of   >  =2 suggests she has anorexia nervosa or bulimia.
84.6% sensitivity and 98.6% specificity with a negative predictive value of 99.3%.

Anorexia nervosa features
Low FAT
·                 Low weight (BMI   <   17.5 kg/m2)
·                 Fear of weight gain/increasing
·                 Amenorrhoea
·                 Thin aspirations (desire to be thin)



Anankastic Personality Disorder features
PERFECT List
·                 Perfectionism which interferes with task completion
·                 Excessive doubt and caution
·                 Relationships/social life affected by excessive preoccupation
·                 Flexibility poor (rigid and stubborn) and forces others to their ways
·                 Egoistic
·                 Conventions (social) not commonly adhered to
·                 Thoughts/images are persistent and welcome (the opposite of OCD)
·                 Lists, rules and details very much a preoccupation


Emotionally Unstable Personality Disorder (EUPD) features – borderline
AM SUICIDE (source)
·                 Abandonment
·                 Mood instability
·                 Suicidal behaviour
·                 Unstable and intense relationships
·                 Impulsivity
·                 Control of anger difficult
·                 Identity disturbance
·                 Dissociated and paranoid symptoms that are stress-related and transient
·                 Emptiness, chronic feelings of
RAISED
·                 Relationships often unstable
·                 Abandonment, fear of (and efforts to avoid abandonment)
·                 Image of self is disturbed/unclear
·                 Suicidal / Self-harm thoughts and actions
·                 Emptiness feelings (chronic) / Emotionally labile
·                 Dissociated feelings
IMPULSIVE
·                 Impulsiveness
·                 Mood labile, often low
·                 Paranoia or dissociation under stress
·                 Unstable self-image
·                 Labile, intense relationships
·                 Suicidal gestures
·                 Inappropriate anger
·                 Vulnerable to abandonment
·                 Emptiness (feelings of)




Valproate side effects
VALPROATE
·                 Vomiting and nausea
·                 Appetite increase, so weight gain
·                 Lethargy / Liver failure (monitor LFTs during 1st 6 months)
·                 Pancreatitis
·                 Reversible hair loss (grows back curly, apparently)
·                 Oedema
·                 Ataxia
·                 Teratogenicity, Tremor, Thrombocytopaenia
·                 Encephalopathy (due to hyperammonaemia) / Enzyme inducer
Main effects: Valproate Take Lots Of Hair AWay
·                 Vomiting and nausea (also any kind of gastric disturbance e.g. diarrhoea)
·                 Thrombocytopaenia / Tremor
·                 Lethargy
·                 Oedema
·                 Hair loss / Hyperammonaemia (confusion)
·                 Appetite increased / Weight gain



Lithium side effects
LITHIUM
·                 Lethargy / Leukocytosis
·                 Intension (or fine) tremor
·                 Teratogenic
·                 Hypothyroidism – need to check TFTs
·                 Insipidus (diabetes) – need to check U&Es
·                 Urinary frequency/excess
·                 Metallic taste
Source here

Clozapine side-effects (common)
Some Say Clozapine Has Too Many Nasty Adverse Effects
·                 Sedation
·                 Seizures
·                 Constipation
·                 Hypotension/Hypertension/Hypersalivation (sialorrhoea in 30%)
·                 Tachycardia
·                 Mass increase (weight gain)
·                 Nausea
·                 Agranulocytosis
·                 Enuresis (nocturnal)

Carbamazepine side effects
HARD SAND
·                 Headache
·                 Ataxia
·                 Rash – itchy, erythematous in 1/10 patients
·                 Dizziness
·                 Sexual dysfunction
·                 Anaemia (aplastic), agaranulocytosis
·                 Nausea
·                 Diplopia

Clozapine – receptors affected by it
Clozapine Has Such Affinity for Dopamine
·                 Cholinergic
·                 Histaminergic
·                 Serotonergic
·                 Adrenergic
·                 Dopaminergic
Greater affinity to D4 than D2 receptors. D4 receptors are highest in the frontal cortex and amygdala and low in the basal ganglia. D2 receptors are higher in the basal ganglia so this may explain why there are reduced extra-pyramidal side effects (EPSE) with clozapine compared to other atypical antipsychotics.




Bleuler’s four A’s of schizophrenia
Am Aff Au Ass
·                 Ambivalence
·                 Affect disturbed
·                 Autism
·                 Association, loosening of


Schizophrenia types
Crazy People Hear Something
·                 Catatonic – unresponsive, fixed stupor
·                 Paranoid – often delusional, angry, jealous
·                 Hebephrenic – disintegration of personality, erratic speach
·                 Simple – disintegration of thinking process


Schizophrenia – Schneider’s first rank symptoms
BADS Made VIA
Broadcasting, insertion and withdrawal of thought
Auditory hallucinations
·                 Thought echo – thoughts spoken aloud (echo de la pensee)
·                 3rd person arguing – 2 or more voices arguing about the patient: “He’s a bad man.” “No, he’s good!”
·                 Commentary – “he is folding his arms now”

Delusional perception (i.e. taking a normal sensory perception to mean a bizarre situation such as taking seeing an aeroplane as indicating that the president has been shot)
Somatic passivity / delusions of control
Made:
·                 Volition – someone controlling the action, usually completed act
·                 Impulses – someone controlling the desire to act
·                 Affect – someone controlling mood/affect


Schizophrenia symptoms
Positive symptoms
THREAD
·                 Thinking disturbed, neologisms
·                 Hallucinations, typically auditory
·                 Reduced contact with reality
·                 Emotional control affected – incongruous affect
·                 Arousal may lead to worsening of symptoms
Negative symptoms
LESS
·                 Loss of volition, under-activity, social withdrawal
·                 Emotionally flat
·                 Speech reduced, monosyllabic
·                 Slowness in movement and thought, psychomotor retardation


Schizophrenia negative symptoms
The six A‘s
·                 Affective flattening – unchanging facial expression, reduced movement, poor eye contact
·                 Alogia – poverty of speech, thought block, delayed response
·                 Anergia – loss of energy
·                 Anhedonia – loss of interest in things/sex/relationships
·                 Apathy – poor hygiene, lack of interest
·                 Asociality – not engaging with peers, little interest in sex
Amisulpride – best evidence for treatment (handily begins with A also).


Narcissistic personality disorder features
SPECIAL
·                 Special treatment expected (grandiose), feelings of entitlement
·                 Power, success and high intelligence (fantasises over)
·                 Envious of others and beliefs others are equally jealous of them
·                 Conceited (vain)
·                 Interpersonal exploitation – exploits others to achieve personal gain
·                 Admiration of others needed
·                 Lacking empathy



Dependent personality disorder features
RELIANT
·                 Relies on others to make important decisions (needing reassurance)
·                 Encourages others to make decisions
·                 Limited capacity themselves to make decisions (about life responsibilities)
·                 Inability to care for oneself (fears of such) so are uncomfortable alone
·                 Abandonment fears of caring for oneself
·                 Needs of others put first and unduly compliant with others’ requests
·                 Tolerance – inability to disagree with others



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notes.nursium.com: Psychology - Psychiatry Mnemonics part 1
Psychology - Psychiatry Mnemonics part 1
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