Adult Psychiatry Flashcards
(152 cards)
1
Q
How many healthy British people experience hallucinations?
A
4%
2
Q
MacArthur assessment tool (MacSAC-CD)
A
Looks at fitness to plead.
Looks at understanding, appreciation and reasoning
3
Q
Relative contraindications to ect:
A
Pregnancy, retinal detachment, history of cva, cerebral tumour
4
Q
How long do group 1 drivers (cars and motorcyclists) need to be stable for after an episode of ACUTE psychosis before they can drive?
A
3 monthes
5
Q
How long do group 2 drivers who have had severe anxiety and depression need to be stable for?
A
6 monthes
6
Q
Freeman
A
Transorbital leucotomy
7
Q
What is most important predictor of efficiency of assertive community teams according to uk 700 study?
A
Case load
8
Q
Psychosurgery
A
Involves gamma radiation
As a side effect can alter personality
9
Q
Transcranial magnetic stimulation
A
Used for depression
Targets dorsolateral prefrontal cortex
10
Q
Number of adults experiencing at least one mental health problem in their life time
A
1 in 4
11
Q
Number of patients with a depressive episode that develop a chronic course of illness
A
1 in 10
12
Q
Number of older adults in the community that have depression at any given time
A
1 in 7
13
Q
Number of people living with a mental health problem at any given time in the uk
A
1 in 6
14
Q
What is zuclopenthixol more suitable for?
A
Aggressive patients but has a higher burden of epse symptoms
15
Q
What is the risk of schizophrenia to a child if both parents have schizophrenia?
A
40-50%
16
Q
Ssri induced sexual dysfunction is due to
A
5ht2 stimulation
17
Q
How can a community worker screen for depression in a high risk group?
A
Self rated becks depression inventory
18
Q
What scale can a trained clinician use in an ocd patient to screen for depression?
A
Hamilton depression rating scale
19
Q
How long does an untreated and treated depression episode last for?
A
Untreated: 6-13 monthes
Treated: 3 monthes
20
Q
What is the biggest predictor of relapse in a bipolar patient?
A
Presence of residual symptoms
21
Q
What is anti-depressant mania most likely to be induced by?
A
Tricyclics such as amitryptilline
22
Q
According to nice guidelines what 2 drugs can be used by gps for ptsd and what 2 require specialist
A
Gp: paroxetine and mirtazapine
Specialist: phenelzine and amitryptilline
23
Q
Herbal treatment for anxiety
A
Kava shrub (piper methysticum)
24
Q
What is the definition of treatment response in ocd in terms of ybocs
A
Reduction of 35%
25
What % of people with restless leg syndrome present with perioidic limb movement during sleep
80-90%
26
Low hypocretin 1
Narcolepsy
27
Dysommnias
Narcolepsy
| Breathing related sleep disorders
28
Poor prognosis of anorexia
Male
29
Life time prevalence of schizophrenia
1%
30
Risk of postpartum psychosis in bipolar disorder and in those with a past history of postpartum psychosis
50%
| 50-90%
31
Cannabis consumption at age of 15 increases risk of schizophrenia by
4.5 fold
32
Cannabis consumption at age 17 increases risk of schizophrenia by
1.7
33
A z hypnotic with a long half life that can prolong course of sleep troubled by frequent interruptions
Temazepam
34
Serotonin syndrome
Sternbacks triad: altered mental state, neuromuscular abnormalities, autonomic hyperactivity
Clonus
Hyper-reflexia
Muscle rigidity
35
Mechanism behind prolonged qt
Blockage of potassium channels
36
When do night terrors take place
Nrem stage 3-4
37
Neuropathological studies show brains from schizophrenic patients:
Weigh less
Larger ventricles
Large ventricles do not progress
Reduction in mesial temporal lobe structures (hippocampus, amygdala)
Mri shows: smaller thalamus, hippocampus and superior temporal lobes bilaterally
Basal ganglia enlargement occurs with typical anti-psychotics and can be reversed by treatment with clozapine
38
Most common neurological side effect of fluoxetine
Tremor
39
What changes to sleep pattern occur in older adults:
Reduction in slow wave sleep
Reduction in rem sleep
Increase in frequency of awakenings after sleep onset
40
Life time risk of schizophrenia in a monozygotic twin and dizygotic twin is
48%
| 17%
41
Lifetime risk of a sibling for schizophrenia is
9%
42
What is the risk of suicide one year after an act of self-harm
1%
43
Proportion of patients diagnosed with schizophrenia that experience recurrent relapse and continued disability is
75%
44
What is preserved in apperceptive visual agnosia?
Drawing objects
45
Sleep terror
Lasts 15 mins
Nrem disorder
Increase in muscle tone with 2-4 fold increase in heart rate
Poor memory on arousal
46
Subcortical dementia
Gross psychomotor slowing, abnormal movements, low mood, mild amnesia, apathetic personality.
Examples: Parkinson's disease dementia, huntingtons disease, hiv associated dementia, binswangers disease, Wilson's disease
47
Side effect of modafinil
Headaches
48
Fahrs disease
Idiopathic calcium deposits in basal ganglia
Onset between ages 20-40
Assoc. schizophreniform psychosis and Catalonia
Mri shows hypointensity of striatum
Eeg shows decreased alpha activity
49
How many women with postpartum psychosis will develop schizophrenia later in their lifetime?
16%
50
What is seen at end stage of hiv dementia
Paraparesis
51
Caudate atrophy with box car ventricles
Huntingtons
52
Knife blade gyri
Picks disease
53
Multiple white matter hyperintensities
Vascular dementia
54
Pulvinar sign
Variant Cjd
55
Case fatality rate in herpes encephalitis
70%
56
How often are baby blues reported
3 in 4 women
57
Doctor shopping
Somatisation disorder
58
What is the most common co-morbidity associated with hypochondriasis
Gad
59
Male: female ratio of hypothyroidism
1:6
60
Kluver bucy syndrome
Herpes simplex encephalitis is the most common cause
Emotional blunting
Hyperphagia
Visual agnosia
Inappropriate sexual behaviour
Carbamazepine can be used to control symptoms
61
Primary meige
Oral facial dystonia - repetitive blinking and chin thrusting
affects more women
Movement present both when active and Passive but disappears on sleep
Patients may chew gum, whistle or touch their faces to reduce it
62
Weak inhibitor of cytochrome p450 enzyme system
Citalopram
63
Which drug has best evidence base for hiv dementia
Zidovudine
64
Lifetime prevalence of depressive symptoms in patients with multiple sclerosis is
40-50%
65
What gene is affected in huntingtons disease
Short arm chromosome 4
66
What can lamitrigine cause if taken during pregnancy
Cleft palate
67
How do you screen for ebsteins anamoly
Level 2 ultrasound and echo at 6 and 18 weeks
68
What is the chance of malformation if lithium is continued throughout first trimester
1 in 10
69
What is the rate of depression in pregnancy
10%
70
What is the relative risk of developing ebsteins anamoly when a mother is on lithium throughout pregnancy
9.5
71
What anti-depressants can be used in breast feeding mothers
Paroxetine or sertraline
72
What anti-psychotics can be used in breast feeding mothers
Olanzapine or sulpiride
73
What mood stabiliser can be used in a breast feeding mother
Valproate
74
What sedative and sleeping tablet can be used in a breast feeding mother
Lorazapam
| Zolpidem
75
What % of new mothers develop postpartum depression
10-15%
76
What is the risk of developing spina bifida in children of women treated with carbamazepine
0.5-1%
77
What is the absolute spontaneous risk of developing ebsteins anamoly
1 in 20,000
78
Lifetime suicide prevalence in schizophrenia is
6%
79
What is the lifetime prevalence of dsh in someone with possible psychotic illness
25%
80
What % of people at suicide death have a recognisable psychiatric illness
90%
81
Number of people who attend thier gp in the week preceding their suicide is
2 in 5
82
What proportion of people progress to having suicide ideas to attempts within one year
60%
83
Clubhouse
Patients run a rehab program themselves
84
Male to female ratio for anorexia
1:10
85
M:f for major depression and gad
1:2
86
M:f for agarophobia
1:3
87
S/e of trazadone
Painful prolonged erection (priapism)
88
What is Hopkins symptom checklist (hscl-25)
Measures symptoms of anxiety and depression
89
S/e thrombocytopenia
Valproate
90
S/e urinary hesitancy
Reboxetine
91
This depot has an anti-depressant effect
Flupenthixol
92
This depot has fewer extra pyramidal side effects
PipotaZine
93
This depot can induce a depressed mood
Fluphenazine
94
This depot requires aqueous suspension and a test dose is not required
Risperidone
95
What is the minimum dose of olanzapine required to be effective in first episode schizophrenia
5mg
96
What is the minimum dose of risperidone required to be effective in first episode schizophrenia
1-2mg
97
What is the minimum dose of quetiapine required to be effective in first episode schizophrenia
150mg
98
What is the minimum dose of amisulpiride required to be effective in first episode schizophrenia
400mg
99
What is the minimum dose of chlorpromazine required to be effective in first episode schizophrenia
200mg
100
High dose first trimester is linked to cardiac malfunction i.e vsd
Paraxetine
101
Mercury poisoning
Bloody stools, diarrhoea, vomiting, restless, unable to concentrate
102
Lead poisoning
Loss of appetite
Colicky abdo pain
Cognitive impairment
103
Manganese poisoning
Headache, irritability, joint pain, tremors, rigidity, mask like face, dysarthria
104
Thallium poisoning
Vomiting and diarrhoea
Hair loss
Severe pain in legs
105
Arsenic poisoning
Pesticide
Impairment of new learning
Poor concentration
106
In the presence of af which anti-psychotic is a good choice
Aripripazole
107
What antipsychotic can be used in patients with arthymias
Risperidone
108
Memory impairment and shock like movements
Cjd
109
Neuroacanthocytosis
Peculiar gait of lurching with long strides and quick involuntary knee flexion
Tonic-clinic seizures
Sub-cortical dementia
110
What is the % of preventable deaths according to mental health teams
22%
111
What % of older adults saw their gps 1 week before committing suicide
40%
112
What % of suicides occur within 3 monthes of discharge from inpatient unit
25%
113
Adoption design
Separating environmental factors from genetic factors
114
Home movies
Presence of neurological or motor abnormalities that predate onset of illness
115
Study of army conscripts
Identification of cognitive and iq defects before illness onset
116
Unmedicated cohorts
Delineating the natural course of an illness
117
Risk of an illness
Incidence
118
Burden of a disease
Prevalence
119
Denominator of prevalence
Mid- year population
120
What proportion of all episodes of self-harm occur in people over the age of 65
5%
121
What is the risk of suicide 10 or more years after an episode of self harm
3%
122
Proportion of individuals who will harm themselves again in their life time
40%
123
Proportion of individuals who self-harm that will repeat at least 5 times in a year
10%
124
% of dsh without suicide intent
2%
125
How many people see their gp for major depression
5-10%
126
Dsh with suicide attempt
4%
127
Dsh with suicidal thoughts
15%
128
What is verbigeration?
Repetition of words while unable to articulate the next word
| Seen in expressive dysphasia
129
Dsh with suicide attempt
4%
130
Dsh with suicidal thoughts
15%
131
What is verbigeration?
Repetition of words while unable to articulate the next word
| Seen in expressive dysphasia
132
U.K licenced maximum dose of haloperidol
30mg/day
133
U.K licenced maximum dose of chlorpromazine
1000mg/day
134
U.K licenced maximum dose of olanzapine
20mg/day
135
U.K licenced maximum dose of quetiapine
750-800mg
136
U.K licenced maximum dose of risperidone
16mg/day
137
U.K licenced maximum dose of clozapine
900mg/day
138
U.K licenced maximum dose of mirtazapine
15-45mg
139
U.K licenced maximum dose of venlafaxine
75-375mg
140
U.K licenced maximum dose of duloxetine
60-120mg
141
U.K licenced maximum dose of citalopram
20-60mg
142
U.K licenced maximum dose of sertraline
50-200mg
143
U.K licenced maximum dose of escitalopram
10-20mg
144
2 factors predicting good prognosis in short term
- good response to placebo
| - good initial response to anti-psychotics
145
2 factors predicting good prognosis in the long term
- being female
| - acute onset of symptoms
146
2 factors predicting poor prognosis in short term
Daily use of cannabis
| Poor compliance with medication
147
2 factors predicting poor prognosis in the long term
Male gender
| Long duration of untreated psychosis
148
What 2 factors are not associated with prognostic significance in schizophrenia
Family history of schizophrenia
| Young age of onset
149
Treatment of ocd with moderate functional impairment
Ssri
| Intensive cbt
150
Ocd with severe functional impairment with unsuccessful first line therapy
Combination of Ssri and cbt
151
Treatment resistant ocd
Adding anti-psychotic to Ssri
Adding clomipramine
Refer to a team with expertise in ocd
152
3 first line prophylactic agents in bipolar disorder
Olanzapine, lithium and valproate
