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Yr 4 - Psychiatry > Corrections > Flashcards

Corrections Flashcards

1
Q

What is likely to be seen on a CT scan in normal pressure hydrocephalus?

A

Enlarged ventricles and ABSENT sulci

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2
Q

CJD is caused by which infective organism or molecule?

A

Prion

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3
Q

What is a prion?

A

Misfolded proteins that induce other proteins to misfold.

This causes neurones to die, leaving holes in the brain tissue.

This leads to a sponge-like appearance (spongiform encephalopathy)

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4
Q

What is a likely side effect of memantine?

A

Constipation

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5
Q

A 72-year-old woman is assessed in memory clinic after her partner noticed she was more forgetful. Around twelve months ago, she seemed to suddenly become quite forgetful. Roughly six months after this, her memory seemed to deteriorate further and has since remained at this level. She has no past medical history aside from hypercholesterolaemia and osteoarthritis of the knee.

What is an appropriate pharmacological management of this patient’s memory loss?

A

Patient has vascular dementia. AChIs are NOT indicated in vascular dementia.

Patient has hypercholesterolaemia –> can prescribe a statin to address CVS risk factors.

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6
Q

For how long can a patient be legally detained under section 5(2) of the MHA?

A

72 hours

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7
Q

Why can AChEIs not be prescribed in patients with QT prolongation?

A

These drugs can cause QT prolongation and could theoretically be dangerous in some patients with LQTS.

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8
Q

Contraindications of AChEIs?

A
  • QT prolongation
  • 2nd/3rd degree heart block in an unpaced patient
  • Sinus bradycadia <50 bpm
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9
Q

What is an alternative to AChEIs in patients with dementia with a contraindication e.g. QT prolongation?

A

Cognitive stimulation therapy

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10
Q

What is the most appropriate treatment for patients with SEVERE Alzheimer’s?

A

Memantine

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11
Q

What section of the Mental Health Act 1983 can be used to detain patients for up to 6 months for treatment?

A

3

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12
Q

What is section 4 of the MHA?

A

Designed for emergencies when applying Section 2 would cause an unnecessary delay.

Requires the recommendation of a single doctor and the involvement of either an AMHP or the nearest relative.

The patient can be detained for a maximum of 72 hours, typically followed by a transition to Section 2.

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13
Q

What are the side effects of AChEIs?

A

Cholinergic side effects (due to increase ACh) e.g. diarrhoea, N&V, braydcardia, increased salivary production, and urinary incontinence

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14
Q

What is semantic memory?

A

Ability to associate meaning to objects present via visual or auditory modalities

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15
Q

What is semantinc dementia a type of ?

A

FTD

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16
Q

What is FTD also known as?

A

Pick’s disease

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17
Q

Why are those with Down’s syndrome more likely to get early onset Alzheimer’s?

A

The exta copy of APP can lead to early onset beta amyloid plaques

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18
Q

What is the definitive diagnostic test for CJD?

A

Tissue biopsy - via brain biopsy or at post-mortem

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19
Q

Which dementia subtype is the use of haloperidol contraindicated in?

A

Dementia with Lewy bodies –> these patients are highly sensitive to neuroleptics which can cause a deterioration in parkinsonism

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20
Q

Which antipsychotic is most likely to cause neutropenia?

A

Clozapine

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21
Q

What neutrophil count should lead to the discontinuation of clozapine?

A

<0.5

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22
Q

Symptoms of neutropenia?

A

A fever, which is a temperature of 100.5°F (38°C) or higher (symptoms of infection)
Chills or sweating.
Sore throat, sores in the mouth, or a toothache.
Abdominal pain.
Pain near the anus.
Pain or burning when urinating, or urinating often.
Diarrhea or sores around the anus.
A cough or shortness of breath.

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23
Q

What blood test is needed to assess white blood cells?

A

FBC

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24
Q

What other side effects is akathisia associated with?

A

Due to distressing nature:
- Aggression
- Low mood
- Suicidal ideations

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25
Q

What is neuroleptic malignant syndrome (NMS)?

A

A rare but life-threatening reaction to antipsychotics

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26
Q

Symptoms of NMS?

A

Sweating, fever, rigidity, confusion, fluctuating consciousness, fluctuating BP, tachycardia

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27
Q

What blood test is needed in NMS?

A

Creatinine kinase

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28
Q

Effect of NMS on creatinine kinase? Why?

A

Raised creatinine kinase

As NMS invovles the breakdown of muscle tissue

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29
Q

What is alogia?

A

Paucity of speech (a common negative symptom of schizophrenia)

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30
Q

What is the 1st line treatment for paranoid schizophrenia?

A

Atypical antipsychotics e.g. risperidone

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31
Q

Symptoms of clozapine toxicity?

A

Confusion, drowsiness, ataxia, tachycardia

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32
Q

What can clozapine toxicity be precipitated by? Why?

A

Acute infection e.g. pneumonia

Clozapine is metabolised by P450 system –> downregulation of these enzymes during infection/inflammation can lead to increased clozapine level

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33
Q

Which specific ECG change can be associated with haloperidol use?

A

QT interval prolongation

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34
Q

A 35 year old woman with schizophrenia is clerked by the on-call psychiatrist.

In the conversation, he asks her about her upcoming plans. She replies “I thought I’d take a trip to London but I was worried about the tube, smarties often come in tubes and they’re my favourite sweet, I’ve been trying to cut down on sweets to be healthier, I’d like to lose some weight before my trip, I’ve decided to take a trip to Brighton next week”.

What aspect of formal thought disorder is this patient displaying?

A

Circumstantiality

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35
Q

What is circumstantiality?

A

Moving on to different topics but there is a train of thought that can be followed

Eventually return to original question

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36
Q

What is thought blocking?

A

Patient suddenly halts in their thought process and cannot continue e.g. abrupt silence

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37
Q

Which antipsychotic has a much lower risk of inducing hyperprolactinaemia?

A

Aripiprazole

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38
Q

What class of drug is procyclidine?

A

Anticholinergic

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39
Q

When is schizophrenia deemed ‘treatment resistant’?

A

Not responded to sequential treatment with TWO DIFFERENT antipsychotics

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40
Q

What electrolyte abnormality is most likely to be found in blood tests following a panic attack?

Why?

A

Hypocalcaemia

A sudden feeling of intense anxiety can cause hyperventilation –> this REDUCES arterial CO2 and INCREASES blood pH (alkalosis)

Alkalosis promotes calcium binding to albumin –> reduces levels of free calcium –> hypocalcaemia

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41
Q

What are some symptoms of hypocalcaemia?

A

Tingling or numbness in hands, feet or around mouth

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42
Q

How do obsessive compulsive disorder and obsessive compulsive PERSONALITY disorder differ?

A

Both feature a preoccupation with rules, details, and organisation to the detriment of other aspects of their life.

BUT, in obsessive compulsive disorder –> these thoughts and behaviours are DISTRESSING and associated with significant anxiety

In obsessive compulsive personality disorder –> these activities are PLEASURABLE and DESIRABLE with no associated distress

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43
Q

What is dysthmyia

A

A persistent low mood that does not quite meet the criteria for major depressive disorder.

Low mood is NOT the primary symptom.

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44
Q

What is schizotypal personality disorder characterised by?

A

Unusual social behaviour, bizarre or magical thinking and distorted perceptions.

Unlike schizophrenia, patients are able to maintain a grasp on reality.

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45
Q

What beta blocker can be used to treat the somatic symptoms of generalised anxiety disorder?

Why this one?

A

Propanolol - is non-selective

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46
Q

Why are atenolol and bisoprolol not suitable for GAD?

A

Is a cardio-selective beta blocker

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47
Q

What ECG change may be seen in refeeding syndrome?

Why?

A

Prominent U waves - feature of hypokalaemia

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48
Q

What do prominent U waves on an ECG indicate?

A

Hypokalaemia

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49
Q

What area of the brain is responsible for the activation of the ‘flight or fight’ response?

A

Amygdala

–> the left amygdala appears to be larger in individuals with anxiety disorderes

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50
Q

On auscultation of the heart in anorexia nervosa, what is a common finding?

Cause?

A

Pan-systolic murmur and mitral valve prolapse

Caused by loss of cardiac muscle with the mitral valve remaining the same size

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51
Q

Splitting is a phenomenon seen in which personality disorder?

A

Emotionally unstable personality disorder

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52
Q

What is splitting?

A

Relationships alternate between idealisation and devaluation

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53
Q

People with ED may intentionally omit their insulin as a way to reduce weight gain.

How may they present?

A

DKA - confusion, abdo pain, nausea, vomiting, and dehydration

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54
Q

What test is used to assess muscle wasting in patients with anorexia nervosa?

What is a red flag?

A

Sit up-squat-stand (SUSS)

Sit up test –> patient lies flat on firm surface (e.g. floor) and attempts to sit up without using hands

Squat test –> patient asked to rise from squatting position without using hands

Inability to stand up from chair without using hands is a RED FLAG indicating severe muscle wasting

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55
Q

How long must the symptoms of post-traumatic stress disorder (PTSD) be present for before a diagnosis can be made?

A

1 month AND interfering with day-day

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56
Q

Low levels of which neurotransmitter are associated with the development of anxiety?

A

GABA

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57
Q

What medications predispose to lithium toxicity?

A
  • NSAIDs
  • Furosemide
  • Thiazide diuretics
  • ACE inhibitors
  • Some antidepressants
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58
Q

Why do diuretics predispose to lithium toxicity?

A

Cause reabsorption of lithium.

Particularly thiazides due to their main action in the proximal convoluted tubule, where lithium absorption is higher.

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59
Q

Symptoms of mild lithium toxicity?

A

N&D, blurred vision, polyuria, dizziness, coarse tremor, muscle weakness, drowsiness

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60
Q

Management of SEVERE lithium toxicity?

A

Haemodialysis

The dialysis machine can filter lithium out of the blood.

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60
Q

How does dehydration impact lithium levels?

A

Can increase lithium levels and predispose to toxicity.

Kidneys handle lithium similar to sodium. Loss of salt and water in dehydration leads to retention of lithium (and sodium).

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60
Q

Most common side effects of SSRIs?

A
  • GI upset and peptic ulcers
  • Increased anxiety and agitation (in first 2 weeks)
  • QT prolongation with citalopram
  • Sexual dysfunction
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61
Q

Clinical features of opiate intoxication?

A
  • Drowsiness
  • Confusion
  • Decreased respiratory rate
  • Decreased heart rate
  • Constricted pupils

If the substance, such as heroin, has been injected, there may be evidence of needle marks (often referred to as ‘track marks’), abscesses or vein collapse at injection sites

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61
Q

Clinical features of cannabis intoxication?

A

Common symptoms of cannabis intoxication include drowsiness, impaired memory, slowed reflexes and motor skills, bloodshot eyes, increased appetite, dry mouth, increased heart rate and paranoia

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61
Q

Clinical features of LSD?

A

Labile mood
Hallucinations
Increased blood pressure
Increased heart rate
Increased temperature
Sweating
Insomnia
Dry mouth

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62
Q

What receptor does LSD act on?

A

LSD primarily acts at dopamine receptors.

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63
Q

Clinical features of stimulant intoxication (e.g. cocaine, methamphetamine)?

A

Euphoria
Increased blood pressure
Increased heart rate
Increased temperature

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64
Q

Opiate withdrawal symptoms?

A

Agitation

Anxiety

Muscle aches or cramps

Chills

Runny eyes

Runny nose

Sweating

Yawning

Insomnia

Gastrointestinal disturbance such as abdominal cramps, nausea, diarrhoea and vomiting

Dilated pupils

‘Goose bump’ skin

Increased heart rate and blood pressure

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65
Q

Who are SNRIs contraindicated in?

A

History of heart disease and high blood pressure

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66
Q

Why are SNRIs contraindicated in heart disease and high blood pressure?

A

Due to enhancement of noradrenaline activity, they can cause an increase in BP and HR

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67
Q

What is the impact of taking an antidepressant (e.g. sertraline) and amphetamines?

A

Can predispose to serotonin syndrome

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68
Q

What medication(s) should be prescribed first line to support detoxification from heroin?

A

Methadone is 1st line

Buprenorphine is equally suitable but methadone is 1st line (patient dependent)

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69
Q

What class of drug is imipramine?

A

Tricyclic antidepressant

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70
Q

Most common side effects of tricyclic antidepressants?

A

They are strongly associated with anti-cholinergic activity. Consequently, the common side effects include:

Urinary retention
Drowsiness
Blurred vision
Constipation
Dry mouth

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71
Q

For how long must symptoms be present for a diagnosis of depression to be made?

A

14 days

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72
Q

Why can lithium toxicity be precipitated by illness or dehydration?

A

Leads to retention of lithium

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73
Q

Which antidepressant is indicated in patients who have been previously hospitalised for an MI or unstable angina?

A

SSRIs

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74
Q

Clinical features of TCA overdose?

A
  • Confusion
  • Seizure
  • Tachycardia
  • Hypotension
  • Dilated pupils (mydriasis)
  • ECG changes (e.g. prolonged QRS and QTc interval)
  • Metabolic acidosis
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75
Q

Management of TCA overdose?

A

Supportive care and sodium bicarb

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76
Q

Effect of lithium on thyroid levels?

A

Can lead to hypothyroidism (high TSH but low T3/T4).

Symptoms –> constipation, weight gain, heavy periods, bradycardia, fatigue, hyporeflexia

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77
Q

Management of hypothyroidism when taking lithium?

A

Thyroxine replacement therapy

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78
Q

What is the pharmacological management in acute opioid withdrawal?

A
  • Methadone (can cause prolonged QTc)
  • Lofexidine (a2 receptor agonist)
  • Loperamine (for diarrhoea)
  • Anti-emetics (for nausea)
  • Benzos (for agitation)
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79
Q

What class of drug is Mirtazapine?

A

NaSSA

80
Q

Why should SSRIs not be prescribed alongside anticoagulants (e.g. warfarin)?

What should be prescribed instead?

A

Can increase risk of bleeding (especially among elderly)

Prescribe NaSSA (mirtazapine) instead

80
Q

General indication of mirtazapine?

A

2nd line treatment of depression whe n a SSRI is inappropriate or ineffective

81
Q

What is methyphenidate?

A

Ritalin

82
Q

Symptoms of illicit use of ritalin?

A
  • Insomnia
  • Restlessness
  • Increased temp
  • Increased BP
  • Increased HR
83
Q

Which antidepressant is most likely to cause anticholinertic syndrome?

A

TCAs

84
Q

Which section of the MHA is often used in an emergency by non-psychiatric trained doctors when patient poses a risk to themselves?

A

4

85
Q

What social factors can affect clozapine levels?

A

Smoking & drinking

Can cause increase in clozapine levels:
- Smoking cessation
- Alcohol binges

Can reduce levels:
- Starting smoking
- Stopping drinking

86
Q

What class of drug is mirtazapine?

A

Tetracyclic antidepressants

87
Q

What is the difference between bipolar disorder type I and bipolar disorder type II?

A

In bipolar I, the person has experienced at least one episode of MANIA

In bipolar II, the person has experienced at least one episode of hypomania, but NEVER an episode of mania. They must have also experienced at least one episode of major DEPRESSION.

88
Q

What class of drug is zuclopenthixol decanoate?

A

Typical antipsychotic

89
Q

What are potential effects of SSRIs when taking during pregnancy?

A

Use during the first trimester gives a small increased risk of congenital heart defects

Use during the third trimester can result in persistent pulmonary hypertension of the newborn

90
Q

Which SSRI has an increased risk of congenital malformations, particularly in the first trimester?

A

Paroxetine

91
Q

What class of drug is Duloxetine?

A

SNRI

92
Q

What is the SSRI of choice in children and adolescents?

A

Fluoxetine

93
Q

After initiating lithum, when should serum lithium levles first be monitored?

A

1 week - 12 hours after last dose

N.B. when checking lithium levels, the sample should be taken 12 hours post-dose

94
Q

How should sertraline dose be adjusted prior to ECT treatment?

A

Reduce BUT not stopped

95
Q

Which atypical antipsychotic has the most tolerable side effect profile?

A

Aripiprazole

96
Q

Depression and dementia can present with similiar symptoms, especially in older patients.

What are some similar sympotms?

How can they be differentiated?

A

Can both present with memory problems.

Factors suggesting diagnosis of depression over dementia:
- short history, rapid onset
- biological symptoms e.g. weight loss, sleep disturbance
- patient WORRIED about poor memory
- reluctant to take tests, disappointed with results
- mini-mental test score: variable
- global memory loss (dementia characteristically causes RECENT memory loss)

97
Q

What can cause memory loss in depression?

A

Lack of concentration

98
Q

What class of drug can induce psychosis?

A

Steroids

Steroid-induced psychosis is a recognised side effect of corticosteroid use.

99
Q

In patients taking antidepressants who present with mania/hypomania, whjat is the management?

A

Stop antidepressant and start atypical antipsychotics

100
Q

Why should triptans be avoided in patients taking SSRIs?

A

Both triptans and SSRIs have serotonergic activity –> can lead to serotonin syndrome (autonomic instability, neuromuscular hyperreactivity, mental status changes)

101
Q

What class of drug is selegiline?

A

MOAI

102
Q

What is the first line treatment for children and young people with anorexia nervosa?

A

Family based therapy

This approach involves the whole family in the treatment process, recognising their role in supporting recovery. It aims to empower parents to help their child regain weight and challenge eating disorder behaviours, while also addressing any underlying issues within the family dynamic.

103
Q

When should lithium levels be monitored?

A

After starting treatment/dose change –> one week and then weekly until the levels are stable.

Once levels are stable –> levels are usually measured every 3 months.

Lithium levels should be measured 12 hours post-dose.

104
Q

How does acute stress reaction differ from PTSD?

A

Acute stress disorder is defined as an acute stress reaction that occurs in the 4 weeks after a traumatic event, as opposed to PTSD which is diagnosed after 4 weeks.

105
Q

Circumstantiality vs tangentiality?

A

Circumstantiality –> The goal of the conversation is reached in the end by a circuitous route i.e. the patient does eventually answer the question but does so after giving unnecessary and excessive detail, which is a feature of circumstantiality.

Tangentiality –> The patient does NOT return to the topic of conversation. Patients wander away from a topic without returning to it.

106
Q

Schizoid vs schizotypal personality disorder?

A

Schizoid:
- Displays the negative symptoms of schizophrenia
- Solitary behaviour, indifference or lack of interest towards others and being affectively detached.

Schizotypal:
- Often diagnosed in people with odd beliefs and magical thinking, ideas of reference with retained insight and odd behaviour.
- Similarly to schizoid personality disorder, people with schizotypal personality disorder often do not form close relationships with friends or partners.

107
Q

In patients 25 and under, when you should review after starting them on an SSRI?

A

Patients ≤ 25 years who have been started on an SSRI should be reviewed after 1 week

108
Q

What class of drug is amitriptyline?

A

Tricyclic antidepressant

109
Q

Side effects of tricyclic antidepressants?

A
  • Inhibits serotonin (5-HT) reuptake (increasing conc)
  • Inhibits NA reuptake (increases conc)
  • antagonism of histamine receptors –> drowsiness
  • antagonism of muscarinic receptors –> dry mouth, blurred vision, constipation, urinary retention
  • antagonism of adrenergic receptors –> postural hypotension
  • lengthening of QT interval
110
Q

Which personality disorder can be rigid with respect to morals, ethics and values and often are reluctant to surrender work to others?

A

Obsessive compulsive personality

111
Q

Initial management of OCD?

A

Exposure and response prevention

112
Q

First line management of alcohol withdrawal?

A

Chlordiazepoxide

113
Q

The introduction of antidepressants can trigger a manic episode. What is the management of mania/hypomania in patients taking antidepressants?

A

consider stopping the antidepressant and start antipsychotic therapy

114
Q

What class of drug is duloxetine?

A

SNRI

115
Q

In GAD, if a first line SSRI such as sertraline is ineffective or not tolerated, what should be tried next?

A

Try another SSRI or an SNRI

116
Q

What is Charles-bonnet syndrome?

A

Characterised by visual hallucinations associated with eye disease.

Most common visual hallucinations are faces, children and wild animals.

117
Q

What investigation should be done in patients presenting with new sudden onset psychosis?

A

Brain imaging to rule out organic causes such as tumour, stroke –> CT head scan, brain MRI

(especially in the elderly)

118
Q

In which disorder is there the presence of a delusion that a famous is in love with them, with the absence of other psychotic symptoms?

A

Erotomania (De Clerambault’s syndrome)

119
Q

When is the peak incidence of seizures following alcohol withdrawal?

A

36 hours

120
Q

In what conditions is ECT indicated?

A
  • Treatment-resistant depression
  • Catatonic schizophrenia
  • Severe mania
  • An episode of moderate depression know to respond to ECT in the past
121
Q

Short term side effects of ECT?

A
  • Headache
  • Nausea
  • Memory impairment
  • Cardiac arrhythmias

Long term, there are very few effects noted, though rarely patients have long term memory issues.

122
Q

What class of dtug is clomipramine?

A

Tricyclic antidepressants

123
Q

What is the mechanism of action of metoclopramide?

A

Dopamine receptor antagonist

124
Q

What can metoclopramide induce when taken with antipsychotics?

A

Acute dystonic reaction

125
Q

What can be used in the management of an acute dystonic reaction?

A

Anticholinergics –> these help decrease muscle stiffness, sweating, and the production of saliva, and helps improve walking ability in people with Parkinson’s disease

E.g. procyclidine

126
Q

How can a somatisation disorder be distinguised from Munchausen’s syndrome?

A

Somatisation disorder –> recurrent presentation of physical symptoms e.g. nausea, headaches, and palpitations in the absence of a detectable organic cause. These symptoms are NOT intentionally produced or feigned. The patient may have multiple admissions over years due to these unexplained symptoms, which can cause significant distress and impairment in their daily life.

Munchausen’s (factitious disorder) –> involves individuals deliberately producing or feigning physical or psychological symptoms to assume the sick role.

127
Q

Following the 2011 NICE guidelines on the management of panic disorder, what is the most appropriate first-line drug treatment?

A

SSRI

128
Q

Features of PTSD?

A
  • re-experiencing e.g. flashbacks, nightmares
  • avoidance e.g. avoiding people or situations
  • hyperarousal e.g.hypervigilance, sleep problems
129
Q

Difference between flight of ideas and Knight’s move?

A

Knight’s move –> there are illogical leaps from one idea to another

Fligt of ideas –> there are discernible links between ideas

130
Q

What are clang associations?

A

Ideas related only by rhyme or being similar sounding

E.g. ‘How do I feel? Like a wheel that’s rolling away, and I stay and I sway with the breeze’

131
Q

What class of drug is paroxetine?

A

SSRI

132
Q

How can bulimia nervosa affect an ECG?

A

Can casuse hypokalaemia, leading to palpitations, first-degree heart block, tall P-waves and flattened T-waves

133
Q

Which atypical antipsychotic drug notably reduces the seizure threshold?

A

Clozapine

134
Q

What is the first-line pharmacological therapy for generalised anxiety disorder?

A

SSRIs

135
Q

If a patient is establised on an NSAID and are then prescribed an SSRI, what else should they be prescribed?

A

A proton pump inhibitor (PPI)

SSRI + NSAID = GI bleeding risk –> give a PPI

136
Q

What tool is used by GP’s to characterise a patient’s severity of depression?

A

Patient health questionnaire-9 (PHQ-9)

137
Q

Describe the different categories of depression in the PHQ-9

A

0-4 –> No depression identified

5-9 –> Mild depression

10-14 –> Moderate depression

15-19 –> Moderately severe depression

20-27 –> Severe depression

138
Q

What are some useful side effects of Mirtazapine?

A

Sedation
Increased appetite
Improved mood

139
Q

What are the symptoms of SSRI discontinuation syndrome?

A
  • increased mood change (e.g. anxiety)
  • restlessness
  • difficulty sleeping
  • unsteadiness/dizziness
  • sweating
  • gastrointestinal symptoms: pain, cramping, diarrhoea, vomiting
  • paraesthesia (electric shock sensations)
140
Q

What is SSRI discontinuation syndrome?

A

Can occur when suddenly stopping or reducing SSRIs

141
Q

What are the 5 stages of grief?

A
  1. Denial - this may include a feeling of numbness and also pseudohallucinations of the deceased, both auditory and visual (people may focus on physical objects that remind them of their loved one or even prepare meals for them)
  2. Anger - this is commonly directed against other family members and medical professionals
  3. Bargaining
  4. Depression
  5. Acceptance

It should be noted that many patients will NOT go through all 5 stages.

142
Q

What are some features of an atypical grief reaction?

A

Delayed grief: sometimes said to occur when more than 2 weeks passes before grieving begins.

Prolonged grief: difficult to define. Normal grief reactions may take up to and beyond 12 months.

143
Q

When are abnormal, or atypical, grief reactions more likely to occur?

A

More likely to occur in women and if the death is sudden and unexpected.

Other risk factors include a problematic relationship before death or if the patient has not much social support.

144
Q

Hypochondriasis vs somatisation disorder?

A

Hypochondriasis (or illness anxiety disorder):
- Describes a persistent belief in the presence of an underlying serious disease.
- A helpful way of remembering this is hypochondriasis is worrying about cancer (as they both contain the letter C and it is an example of a serious underlying disease).

Somatisation disorder:
- This is characterised by the persistent belief of multiple physical symptoms lasting for at least 2 years despite being given reassurance and negative test results.
- SomatiSation disorder is worrying about multiple physical Symptoms (as they both contain the letter S).

145
Q

What is the form of thought disorder where the patient repeats someone else’s speech including the questions being asked?

A

Echolalia

146
Q

How can tardive dyskinesia present?

A

Tardive kinesia can present as chewing, jaw pouting or excessive blinking due to late onset abnormal involuntary choreoathetoid movements in patients on conventional antipsychotics

147
Q

What is an appropriate non-pharmalogical treatment for borderline personality disorder/EUPD?

A

Dialectical behaviour therapy (DBT)

This is a targeted therapy that is based CBT, but has been adapted to help people who experience emotions very intensely.

148
Q

How can atypical antipsychotics affect blood glucose levels?

A

Can cause dysglycaemia (e.g. raised gasting blood glucose)

As well as other metabolic side effects e.g. dyslipidaemia, diabetes mellitus

149
Q

What is catatonia?

A

Stopping of voluntary movement or staying still in an unusual position

150
Q

Pharmacological management of acute dystonia secondary to antipsychotics?

A

Procyclidine

151
Q

For insomnia to be classed as ‘chronic’, how long must it be present for?

A

At least 3 months

BUT it only needs to be present for 3 out of 7 nights in the week.

152
Q

At what age can a diagnosis of a personality disorder be made?

A

18 and over

153
Q

Mechanism of mertazapine?

A

Mirtazapine is an atypical antidepressant and is used primarily for the treatment of a major depressive disorder.

Mirtazapine is in a group of tetracyclic antidepressants (TeCA).

Mirtazapine inhibits the central presynaptic alpha-2-adrenergic receptors, which causes an increased release of serotonin and norepinephrine.

154
Q

What age group is a risk factor for the development of GAD?

A

35-54

155
Q

Give some risk factors for the development of GAD

A

Aged 35- 54
Being divorced or separated
Living alone
Being a lone parent

156
Q

What type of urinary incontinence is the most associated with amitriptyline?

A

Overflow incontinence

TCAs have anticholinergic effects which may lead to urinary retention, leading to frequent leaking.

157
Q

What is a brief psychotic disorder?

A

This describes an episode of psychosis lasting less than a month with a subsequent return to baseline functioning.

158
Q

What conditions is dialectical behaviour therapy indicated in?

A

generally used in the management of personality disorders

159
Q

What is the 1st line management in OCD with MILD impairment?

A

CBT including exposure and response prevention (ERP)

160
Q

Is CBT indicated in schizophrenia?

A

Yes - CBT is recommended for all people with schizophrenia.

This form of therapy helps patients deal with their symptoms by changing the way they think and behave. It can reduce the severity of symptoms and improve quality of life.

161
Q

What is a potential risk of fluoxetine when used in the third trimester of pregnancy?

A

Persistent pulmonary hypertension

162
Q

What is the most appropriate first-line treatment in PTSD?

A

Trauma-focused CBT or eye movement desensitisation and reprocessing therapy (EMDR)

163
Q

How can concordance with antipsychotics be improved?

A

With depot medication

164
Q

What is sleep paralysis?

A

Sleep paralysis is a condition characterized by the inability to move or speak when transitioning between sleep and wakefulness, either when falling asleep or upon awakening.

It can be accompanied by vivid hallucinations, which may explain the patient’s description of seeing another person in the room.

Sleep paralysis is generally harmless but can cause significant anxiety for those who experience it.

165
Q

What is Hoover’s sign?

A

Hoover’s sign is a quick and useful clinical tool to differentiate organic from non-organic leg paresis.

With the patient in the supine position, ask them to raise their right leg against resistance whilst keeping it straight. Places your hand under the left heel as they do this.

Positive test –> pressure felt under the paretic leg when lifting the non-paretic leg against pressure due to involuntary contralateral hip extension.

If this test is positive, could indicate a conversion disorder (i.e. no organic cause).

166
Q

Mania vs hypomania?

A

Hypomania is characterised by elevated mood, pressured speech and flight of ideas but without psychotic symptoms

Patients with hypomania can experience disinhibition such as increased sexuality, increased spending or taking risks that they wouldn’t normally.

Features that differentiate this presentation from that of mania include the time frame (less than 7 days) and the lack of psychotic symptoms (hallucinations).

167
Q

What medication is most suitable for treating tardive dyskinesia (as a result of long-term antipsychotics)?

A

Tetrabenazine

168
Q

What electrolyte abnormality can SSRIs cause?

A

Hyponatraemia

169
Q

If an SSRI and NSAID are prescribed together, what else should be prescribed?

A

PPI e.g. omeprazole

170
Q

What class of drug is mefenamic acid?

A

NSAID

171
Q

Which NSAID can be taken to help alleviate heavy bleeding in periods?

A

Mefenamic acid

172
Q

Side effects of zopiclone?

A
  • Agitation
  • Bitter taste in mouth
  • Constipation
  • Decreased muscle tone
  • Dizziness
  • Dry mouth
  • Increased risk of falls (especially in the elderly)
173
Q

Tangentiality vs flight of ideas?

A

Flight of ideas –> where patients jump from one topic to the next with discernible links between them. Speech at fast rate.

Although tangentiality also has this feature, in flight of ideas the question would’ve first been answered, then the patient would have jumped to the next topic. In flight of ideas the speech would also be at a faster rate.

Tangentiality –> where patients wander away from a topic without returning to it, usually with loosely discernible links.

174
Q

Memory loss in severe depression vs demenita?

A

Dementia –> memory loss of recent events

Depression –> global memory loss (pseudodementia)

175
Q

Before starting venlafaxine, what should be monitored at initiation and dose titration of this medication?

A

Blood pressure –> SNRIs are associated with the development of hypertension

176
Q

What investigation is needed prior to starting citalopram or escitalopram?

A

ECG –> QT prolongation, and/or ventricular arrhythmias including torsade de pointes have been reported in people taking citalopram or escitalopram

177
Q

A 75-year-old woman presents to the emergency department with new onset confusion.

She is taking sertraline.

What blood test would you want?

A

U&Es –> risk of hyponatraemia

178
Q

Knights move vs flight of ideas?

A

Knight’s move thinking there are illogical leaps from one idea to another, flight of ideas there are discernible links between ideas

179
Q

What are the features of post-concussion syndrome?

A

headache
fatigue
anxiety/depression
dizziness

180
Q

Who do patients with schizotypal personality disorder often maintain close relationships with?

A

Family members

181
Q

A 45-year-old man describes successful abstinence from alcohol for the past six months following inpatient detoxification. During his admission, he was started on a ‘deterrent’ medication. He takes this medication daily and reports that if he consumes alcohol he will ‘violently vomit’.

Which medication is the patient describing?

A

Disulfiram

182
Q

What is an ‘anti-craving medication’ in alcohol detoxification?

A

Acamprosate

183
Q

In GAD, if a first line SSRI such as sertraline is ineffective or not tolerated, what should be tried next?

A

SNRI e.g. duloxetine

184
Q

If clozapine doses are missed for more than 48 hours, what should be done?

A

The dose will need to be restarted again slowly (i.e. retitrated)

185
Q

For moderate/severe OCD, what drug may be used as an alternative first-line drug treatment to an SSRI?

A

Clomipramine (tricyclic antidepressant)

186
Q

Which antipsychotic is the most effective for dealing with negative symptoms?

A

Clozapine

187
Q

Suicide risk factors?

A
  • male sex (hazard ratio (HR) approximately 2.0)
  • history of deliberate self-harm (HR 1.7)
  • alcohol or drug misuse (HR 1.6)
  • history of mental illness
  • depression
  • schizophrenia: NICE estimates that 10% of people with schizophrenia will complete suicide
    history of chronic disease
  • advancing age
  • unemployment or social isolation/living alone
    being unmarried, divorced or widowed
188
Q

What class of drug is selegiline?

A

MAOI

189
Q

After a change in dose, how often should lithium levels be monitored?

A

One week after dose change and then weekly until levels are stable

190
Q

What class of drug is rasagiline?

A

MAOI

191
Q

What scoring system can be used to assess alcohol withdrawal severity?

A

Clinical Institute Withdrawal Assessment (CIWA-Ar)

192
Q

Which SSRI is the most likely to lead to QT prolongation and Torsades de pointes?

A

Citalopram

193
Q

What is the Alcohol Use Disorders Identification Test (AUDIT)?

A

A test to assess whether there is a need for a specialist evaluation concerning alcohol consumption.

194
Q

What is logoclonia?

A

A phenomenon in Parkinson’s disease where the patient gets ‘stuck’ on a particular word of a sentence and repeats it.

195
Q

What is a bizarre delusion?

A

Where a person is adament about a belief that is impossible, not understandable, and unrelated to normal life.

196
Q

Where is the majority of alcohol absorbed?

A

Up to 80% is absorbed through the proximal intestine

197
Q

What is transient global amnesia?

A

Transient global amnesia (TGA) is a temporary, abrupt neurological condition characterized by sudden memory loss, affecting both short and long term memory while leaving other cognitive functions intact.

198
Q

What are the key features of TGA?

A

Disorientation, inability to form new memories, and an unaffected sense of self-identity

  • Sudden onset of memory loss, affecting both the ability to recall past events (retrograde amnesia) and form new memories (anterograde amnesia)
  • Repetitive questioning due to memory loss
  • Confusion or feeling lost, even in familiar surroundings
  • Clear consciousness and preserved personal identity
  • Unaffected motor skills, allowing individuals to maintain their regular physical activities
  • Spontaneous resolution of symptoms, typically within 24 hours
199
Q

When should lithium be stopped in pregnancy? Why?

A

In the first trimester

Lithium is known for increasing the risk of developing Epstein’s abnormality

200
Q

What is Epstein’s abnormality?

A

The leaflets of the tricuspid valve are displaced, resulting in a large right atrium and a small right ventricle

201
Q

What is the 1st line non-pharmacological management for agitated patients?

A

Assign a 1-1 nurse and re-orientation

202
Q
A

Yr 4 - Psychiatry (17 decks)

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