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Adult Psychiatry > Adult Psychiatry > Flashcards

Adult Psychiatry Flashcards

1
Q

How many healthy British people experience hallucinations?

A

4%

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2
Q

MacArthur assessment tool (MacSAC-CD)

A

Looks at fitness to plead.

Looks at understanding, appreciation and reasoning

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3
Q

Relative contraindications to ect:

A

Pregnancy, retinal detachment, history of cva, cerebral tumour

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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

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5
Q

How long do group 2 drivers who have had severe anxiety and depression need to be stable for?

A

6 monthes

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6
Q

Freeman

A

Transorbital leucotomy

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7
Q

What is most important predictor of efficiency of assertive community teams according to uk 700 study?

A

Case load

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8
Q

Psychosurgery

A

Involves gamma radiation

As a side effect can alter personality

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9
Q

Transcranial magnetic stimulation

A

Used for depression

Targets dorsolateral prefrontal cortex

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10
Q

Number of adults experiencing at least one mental health problem in their life time

A

1 in 4

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11
Q

Number of patients with a depressive episode that develop a chronic course of illness

A

1 in 10

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12
Q

Number of older adults in the community that have depression at any given time

A

1 in 7

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13
Q

Number of people living with a mental health problem at any given time in the uk

A

1 in 6

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14
Q

What is zuclopenthixol more suitable for?

A

Aggressive patients but has a higher burden of epse symptoms

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15
Q

What is the risk of schizophrenia to a child if both parents have schizophrenia?

A

40-50%

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16
Q

Ssri induced sexual dysfunction is due to

A

5ht2 stimulation

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17
Q

How can a community worker screen for depression in a high risk group?

A

Self rated becks depression inventory

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18
Q

What scale can a trained clinician use in an ocd patient to screen for depression?

A

Hamilton depression rating scale

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19
Q

How long does an untreated and treated depression episode last for?

A

Untreated: 6-13 monthes
Treated: 3 monthes

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20
Q

What is the biggest predictor of relapse in a bipolar patient?

A

Presence of residual symptoms

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21
Q

What is anti-depressant mania most likely to be induced by?

A

Tricyclics such as amitryptilline

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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

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23
Q

Herbal treatment for anxiety

A

Kava shrub (piper methysticum)

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24
Q

What is the definition of treatment response in ocd in terms of ybocs

A

Reduction of 35%

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25
Q

What % of people with restless leg syndrome present with perioidic limb movement during sleep

A

80-90%

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26
Q

Low hypocretin 1

A

Narcolepsy

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27
Q

Dysommnias

A

Narcolepsy

Breathing related sleep disorders

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28
Q

Poor prognosis of anorexia

A

Male

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29
Q

Life time prevalence of schizophrenia

A

1%

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30
Q

Risk of postpartum psychosis in bipolar disorder and in those with a past history of postpartum psychosis

A

50%

50-90%

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31
Q

Cannabis consumption at age of 15 increases risk of schizophrenia by

A

4.5 fold

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32
Q

Cannabis consumption at age 17 increases risk of schizophrenia by

A

1.7

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33
Q

A z hypnotic with a long half life that can prolong course of sleep troubled by frequent interruptions

A

Temazepam

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34
Q

Serotonin syndrome

A

Sternbacks triad: altered mental state, neuromuscular abnormalities, autonomic hyperactivity
Clonus
Hyper-reflexia
Muscle rigidity

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35
Q

Mechanism behind prolonged qt

A

Blockage of potassium channels

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36
Q

When do night terrors take place

A

Nrem stage 3-4

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37
Q

Neuropathological studies show brains from schizophrenic patients:

A

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

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38
Q

Most common neurological side effect of fluoxetine

A

Tremor

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39
Q

What changes to sleep pattern occur in older adults:

A

Reduction in slow wave sleep
Reduction in rem sleep
Increase in frequency of awakenings after sleep onset

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40
Q

Life time risk of schizophrenia in a monozygotic twin and dizygotic twin is

A

48%

17%

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41
Q

Lifetime risk of a sibling for schizophrenia is

A

9%

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42
Q

What is the risk of suicide one year after an act of self-harm

A

1%

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43
Q

Proportion of patients diagnosed with schizophrenia that experience recurrent relapse and continued disability is

A

75%

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44
Q

What is preserved in apperceptive visual agnosia?

A

Drawing objects

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45
Q

Sleep terror

A

Lasts 15 mins
Nrem disorder
Increase in muscle tone with 2-4 fold increase in heart rate
Poor memory on arousal

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46
Q

Subcortical dementia

A

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

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47
Q

Side effect of modafinil

A

Headaches

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48
Q

Fahrs disease

A

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

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49
Q

How many women with postpartum psychosis will develop schizophrenia later in their lifetime?

A

16%

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50
Q

What is seen at end stage of hiv dementia

A

Paraparesis

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51
Q

Caudate atrophy with box car ventricles

A

Huntingtons

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52
Q

Knife blade gyri

A

Picks disease

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53
Q

Multiple white matter hyperintensities

A

Vascular dementia

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54
Q

Pulvinar sign

A

Variant Cjd

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55
Q

Case fatality rate in herpes encephalitis

A

70%

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56
Q

How often are baby blues reported

A

3 in 4 women

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57
Q

Doctor shopping

A

Somatisation disorder

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58
Q

What is the most common co-morbidity associated with hypochondriasis

A

Gad

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59
Q

Male: female ratio of hypothyroidism

A

1:6

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60
Q

Kluver bucy syndrome

A

Herpes simplex encephalitis is the most common cause
Emotional blunting
Hyperphagia
Visual agnosia
Inappropriate sexual behaviour
Carbamazepine can be used to control symptoms

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61
Q

Primary meige

A

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
Q

Weak inhibitor of cytochrome p450 enzyme system

A

Citalopram

63
Q

Which drug has best evidence base for hiv dementia

A

Zidovudine

64
Q

Lifetime prevalence of depressive symptoms in patients with multiple sclerosis is

A

40-50%

65
Q

What gene is affected in huntingtons disease

A

Short arm chromosome 4

66
Q

What can lamitrigine cause if taken during pregnancy

A

Cleft palate

67
Q

How do you screen for ebsteins anamoly

A

Level 2 ultrasound and echo at 6 and 18 weeks

68
Q

What is the chance of malformation if lithium is continued throughout first trimester

A

1 in 10

69
Q

What is the rate of depression in pregnancy

A

10%

70
Q

What is the relative risk of developing ebsteins anamoly when a mother is on lithium throughout pregnancy

A

9.5

71
Q

What anti-depressants can be used in breast feeding mothers

A

Paroxetine or sertraline

72
Q

What anti-psychotics can be used in breast feeding mothers

A

Olanzapine or sulpiride

73
Q

What mood stabiliser can be used in a breast feeding mother

A

Valproate

74
Q

What sedative and sleeping tablet can be used in a breast feeding mother

A

Lorazapam

Zolpidem

75
Q

What % of new mothers develop postpartum depression

A

10-15%

76
Q

What is the risk of developing spina bifida in children of women treated with carbamazepine

A

0.5-1%

77
Q

What is the absolute spontaneous risk of developing ebsteins anamoly

A

1 in 20,000

78
Q

Lifetime suicide prevalence in schizophrenia is

A

6%

79
Q

What is the lifetime prevalence of dsh in someone with possible psychotic illness

A

25%

80
Q

What % of people at suicide death have a recognisable psychiatric illness

A

90%

81
Q

Number of people who attend thier gp in the week preceding their suicide is

A

2 in 5

82
Q

What proportion of people progress to having suicide ideas to attempts within one year

A

60%

83
Q

Clubhouse

A

Patients run a rehab program themselves

84
Q

Male to female ratio for anorexia

A

1:10

85
Q

M:f for major depression and gad

A

1:2

86
Q

M:f for agarophobia

A

1:3

87
Q

S/e of trazadone

A

Painful prolonged erection (priapism)

88
Q

What is Hopkins symptom checklist (hscl-25)

A

Measures symptoms of anxiety and depression

89
Q

S/e thrombocytopenia

A

Valproate

90
Q

S/e urinary hesitancy

A

Reboxetine

91
Q

This depot has an anti-depressant effect

A

Flupenthixol

92
Q

This depot has fewer extra pyramidal side effects

A

PipotaZine

93
Q

This depot can induce a depressed mood

A

Fluphenazine

94
Q

This depot requires aqueous suspension and a test dose is not required

A

Risperidone

95
Q

What is the minimum dose of olanzapine required to be effective in first episode schizophrenia

A

5mg

96
Q

What is the minimum dose of risperidone required to be effective in first episode schizophrenia

A

1-2mg

97
Q

What is the minimum dose of quetiapine required to be effective in first episode schizophrenia

A

150mg

98
Q

What is the minimum dose of amisulpiride required to be effective in first episode schizophrenia

A

400mg

99
Q

What is the minimum dose of chlorpromazine required to be effective in first episode schizophrenia

A

200mg

100
Q

High dose first trimester is linked to cardiac malfunction i.e vsd

A

Paraxetine

101
Q

Mercury poisoning

A

Bloody stools, diarrhoea, vomiting, restless, unable to concentrate

102
Q

Lead poisoning

A

Loss of appetite
Colicky abdo pain
Cognitive impairment

103
Q

Manganese poisoning

A

Headache, irritability, joint pain, tremors, rigidity, mask like face, dysarthria

104
Q

Thallium poisoning

A

Vomiting and diarrhoea
Hair loss
Severe pain in legs

105
Q

Arsenic poisoning

A

Pesticide
Impairment of new learning
Poor concentration

106
Q

In the presence of af which anti-psychotic is a good choice

A

Aripripazole

107
Q

What antipsychotic can be used in patients with arthymias

A

Risperidone

108
Q

Memory impairment and shock like movements

A

Cjd

109
Q

Neuroacanthocytosis

A

Peculiar gait of lurching with long strides and quick involuntary knee flexion
Tonic-clinic seizures
Sub-cortical dementia

110
Q

What is the % of preventable deaths according to mental health teams

A

22%

111
Q

What % of older adults saw their gps 1 week before committing suicide

A

40%

112
Q

What % of suicides occur within 3 monthes of discharge from inpatient unit

A

25%

113
Q

Adoption design

A

Separating environmental factors from genetic factors

114
Q

Home movies

A

Presence of neurological or motor abnormalities that predate onset of illness

115
Q

Study of army conscripts

A

Identification of cognitive and iq defects before illness onset

116
Q

Unmedicated cohorts

A

Delineating the natural course of an illness

117
Q

Risk of an illness

A

Incidence

118
Q

Burden of a disease

A

Prevalence

119
Q

Denominator of prevalence

A

Mid- year population

120
Q

What proportion of all episodes of self-harm occur in people over the age of 65

A

5%

121
Q

What is the risk of suicide 10 or more years after an episode of self harm

A

3%

122
Q

Proportion of individuals who will harm themselves again in their life time

A

40%

123
Q

Proportion of individuals who self-harm that will repeat at least 5 times in a year

A

10%

124
Q

% of dsh without suicide intent

A

2%

125
Q

How many people see their gp for major depression

A

5-10%

126
Q

Dsh with suicide attempt

A

4%

127
Q

Dsh with suicidal thoughts

A

15%

128
Q

What is verbigeration?

A

Repetition of words while unable to articulate the next word

Seen in expressive dysphasia

129
Q

Dsh with suicide attempt

A

4%

130
Q

Dsh with suicidal thoughts

A

15%

131
Q

What is verbigeration?

A

Repetition of words while unable to articulate the next word

Seen in expressive dysphasia

132
Q

U.K licenced maximum dose of haloperidol

A

30mg/day

133
Q

U.K licenced maximum dose of chlorpromazine

A

1000mg/day

134
Q

U.K licenced maximum dose of olanzapine

A

20mg/day

135
Q

U.K licenced maximum dose of quetiapine

A

750-800mg

136
Q

U.K licenced maximum dose of risperidone

A

16mg/day

137
Q

U.K licenced maximum dose of clozapine

A

900mg/day

138
Q

U.K licenced maximum dose of mirtazapine

A

15-45mg

139
Q

U.K licenced maximum dose of venlafaxine

A

75-375mg

140
Q

U.K licenced maximum dose of duloxetine

A

60-120mg

141
Q

U.K licenced maximum dose of citalopram

A

20-60mg

142
Q

U.K licenced maximum dose of sertraline

A

50-200mg

143
Q

U.K licenced maximum dose of escitalopram

A

10-20mg

144
Q

2 factors predicting good prognosis in short term

A
  • good response to placebo

- good initial response to anti-psychotics

145
Q

2 factors predicting good prognosis in the long term

A
  • being female

- acute onset of symptoms

146
Q

2 factors predicting poor prognosis in short term

A

Daily use of cannabis

Poor compliance with medication

147
Q

2 factors predicting poor prognosis in the long term

A

Male gender

Long duration of untreated psychosis

148
Q

What 2 factors are not associated with prognostic significance in schizophrenia

A

Family history of schizophrenia

Young age of onset

149
Q

Treatment of ocd with moderate functional impairment

A

Ssri

Intensive cbt

150
Q

Ocd with severe functional impairment with unsuccessful first line therapy

A

Combination of Ssri and cbt

151
Q

Treatment resistant ocd

A

Adding anti-psychotic to Ssri
Adding clomipramine
Refer to a team with expertise in ocd

152
Q

3 first line prophylactic agents in bipolar disorder

A

Olanzapine, lithium and valproate

Adult Psychiatry (3 decks)

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