Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Yr 4 - Psychiatry > Corrections pt. 2 > Flashcards

Corrections pt. 2 Flashcards

1
Q

When do most cases of postnatal depression start?

When do they peak?

A

Most start within a month.

Most typically peak around 3 months.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Management of postnatal depression?

A
  • reassurance & support
  • CBT
  • SSRIs if symptoms are severe
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Which SSRI is typically recommended in postnatal depression? Why?

A

Paroxetine: because of the low milk/plasma ratio (safety in breastfeeding)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Which SSRI is typically avoided in postnatal depression? Why?

A

Fluoxetine: due to a long half life (safety in breastfeeding)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Most appropriate treatment option in acute episodes of mania/hypomania?

A

Antipsychotics e.g. olanzapine, quetiapine, risperidone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is ‘anankastic’ personality disorder also known as?

A

Obsessive compulsive personality disorder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

OCD vs OCPD?

A

OCD:
- recurrent, intrusive, unwanted thoughts and repetitive behaviours
- marked anxiety or distress due to symptoms
- symptoms can fluctuate with anxiety

OCPD:
- someone always wants to be in control
- does not experience anxiety or distress due to symptoms
- strict orderliness & perfectionism
- traits are persistent over time

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is conversion disorder?

A

Which a person experiences physical and sensory problems, such as paralysis, numbness, blindness, deafness or seizures, with no underlying neurologic pathology.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Symptoms of frontotemporal dementia?

A
  • behaviour and/or personality changes e.g. swearing, stealing, increased interest in sex, deterioration in personal hygiene habits
  • socially inappropriate, impulsive, or repetitive behaviors.
  • apathy
  • lack of empathy
  • language problems e.g. words in wrong order, using words incorrectly
  • memory problems (tend to occur later on compared to other forms of dementia)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What condition is associated with ventricular enlargement and cortical atrophy on a head CT?

A

Alzheimer’s dementia (also normal with aging).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

1st line medical management of Alzheimer’s disease?

A

Actetylcholinesterase inhibitors:
- donepezil
- galantamine
- rivastigmine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the 3 acetylcholinesterase inhibitors licensed for use in AD?

A

1) donepezil
2) galantamine
3) rivastigmine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

2nd line medical management of AD?

A

Memantine (an NMDA receptor antagonist)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Who is memantine reserved for in AD?

A

1) moderate Alzheimer’s who are intolerant of, or have a contraindication to, acetylcholinesterase inhibitors

2) as an add-on drug to acetylcholinesterase inhibitors for patients with moderate or severe Alzheimer’s

3) monotherapy in severe Alzheimer’s

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What class of drug is rivastigmine?

A

acetylcholinesterase inhibitor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the 5 stages of grief?

A

1) denial

2) anger

3) bargaining

4) depression

5) acceptance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is typically seen in the ‘denial’ stage of grief?

A
  • feeling of numbness
  • pseudohallucinations of the deceased (auditory and visual)
  • people may focus on physical objects that remind them of their loved one or even prepare meals for them
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Who are abnormal or atypical grief reactions more likely to occur in?

A
  • women
  • if death is sudden and unexpected
  • problematic relationship before death
  • if the patient has not much social support.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are some features of atypical grief reactions?

A
  • delayed grief: sometimes said to occur when more than 2 weeks passes before grieving begins
  • prolonged grief: difficult to define as normal grief reactions may take up to and beyond 12 months
  • suicidal thoughts
  • depression, deep sadness, guilt or self blame
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is acute intermittent prophyria (AIP)?

A

A rare autosomal dominant condition caused by a defect in porphobilinogen deaminase, an enzyme involved in the biosynthesis of haem.

This results in the toxic accumulation of delta aminolaevulinic acid and porphobilinogen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Which enzyme is defected in porphyria?

A

Porphobilinogen deaminase: an enzyme involved in the biosynthesis of haem

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What accumulates in porphyria?

A

Delta aminolaevulinic acid and porphobilinogen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

How does porphyria typically present?

A

Abdo & neuro symptoms in 20-40 years olds.

  • abdo: abdo pain & vomiting
  • neuro: motor neuropathy
  • psych: depression
  • HTN & tachycardia common
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is classical finding in porphyria?

A

Urine turns deep red on standing.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Investigations in porphyria?

A
  • urine turns deep red on standing
  • raised urinary porphobilinogen
  • assay of red cells for porphobilinogen deaminase
  • raised serum levels of delta aminolaevulinic acid and porphobilinogen
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Which drugs may precipitate an attack of porphyria?

A

barbiturates
halothane
benzodiazepines
alcohol
oral contraceptive pill
sulphonamides

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Which type of delusional disorder is characterised by the false absolute certainty of the infidelity of a partner?

A

Othello syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Dysthymia vs major depressive disorder?

A

Dysthymia (also called persistent depressive disorder) –> fewer symptoms but lasts longer (>2 years)

Depression –> more symptoms but can be diagnosed after 2 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What is dissociative fugue?

A

Individuals with dissociative disorders may embark on unexpected travels without any recollection of the journey or their original identity. They may adopt a new identity during the fugue state and only regain awareness of their primary identity upon resolution.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Somatic-type delusional condition vs hypochondriasis?

A

Somatic type: people are utterly convinced that the cause of their ailments is physical.

Hypochondriasis: can consider the possibility that the feared illness is not actually present.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

1st line management of phobias?

A

CBT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Management of manic episode in patient with bipolar disorder?

A

1st line: lithium

2nd line: sodium valproate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Why are SSRIs avoided in GI bleeding?

A

there is an increased risk of gastrointestinal bleeding in patients taking SSRIs.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Side effects of SSRIs?

A

1) GI symptoms (most common)

2) increased risk of GI bleeding: consider prescribing PPI if patient is also taking NSAID

3) hyponatraemia

4) potential for initial increase in agitation & anxiety

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

When should you consider prescribing a PPI for patients taking SSRIs?

A

If they are also taking NSAIDs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What are the most common substances that cause substance-induced psychotic disorder?

A
  • amphetamines
  • alcohol
  • cannabis
  • cocaine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Stepwise management of OCD?

A

1) CBT including exposure and response prevention (ERP)

2) SSRIs

3) Consider clomipramine (alternative 1st line to an SSRI)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What is an alternative to SSRIs in OCD?

A

Clomipramine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Describe dose & duration of SSRI in OCD vs depression

A

SSRI usually requires a higher dose and a longer duration of treatment in OCD.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

How long does it typically take for an initial response to SSRIs in OCD?

A

at least 12 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

What PHQ-9 score indicates ‘less severe’ depression?

A

<16

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

What PHQ-9 score indicates ‘more severe’ depression?

A

> /= 16

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

How can infections or inflammation predispose to clozapine toxicity?

A

Cloxapine is metabolised by the P450 enzymes. Downregulation of these enzymes by cytokines in infection/inflammation decreases the metabolism of clozapine, leading to a raised clozapine level.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Side effects of memantine?

A
  • sleepy/dizzy
  • headaches
  • constipation
  • SOB
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Side effects of acetylcholinesterase inhibitors (e.g. donepezil, rivastigmine)?

A
  • diarrhoea
  • N&V
  • bradycardia
  • increased salivary production
  • urinary incontinence
  • insomnia (donepezil)

Remember –> opposite of anticholinergics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

What is the delusional disorder in which the patient believes that someone close to them has been replaced by a clone?

A

Capgras delusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

What is the delusional disorder where a patient believes that everyone they meet is the same person but with different disguises?

A

Fregoli delusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

What characterises histrionic personality disorder?

A

Excessive displays of emotions and attention seeking behaviours
- may be sexually inappropriate
- may consider relationships more intimate than they really are

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Where in the digestive system is the majority of alcohol absorbed?

A

The proximal small intestine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

How long does a section 5(2) last up to?

A

72 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

What ECG finding is common in a patient with anorexia?

A

Prolonged QT interval (>450ms).

It is important to detect this as it can predispose to potentially fatal arrhythmias

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

What are the main side effects of sodium valproate?

Mneumonic: VALPROATE

A

V - vomiting

A - alopecia (hair loss)

L - liver toxicity

P - pacreatitis/panctyopenia

R - retention of fats (i.e. weight gain)

O - oedema

A - anorexia

T - tremor

E - enzyme inhibition

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

What investigation should you always do before starting patients on anti-cholinesterase inhibitors (e.g. donepezil)?

A

ECG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

Contraindications for anti-cholinesterase inhibitors (e.g. donepezil)?

A

1) QT prolongation
2) 2nd or 3rd degree heart block
3) sinus bradycardia <50 bpm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

1st line treatment of manic episodes?

A

Lithium, or atypical antipsychotics.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

What class of drug is clomipramine?

A

TCA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

How can tardive dyskinesia present?

A
  • chewing
  • pouting of jaw
  • excessive blinking
58
Q

What characterises acute dystonia?

A

Sustained often painful muscle contractions, leading to abnormal postures or movements.

59
Q

1st line management of acute alcohol withdrawal?

A

Chlordiazepoxide (or diazepam)

60
Q

If prescribing a patient an SSRI and an NSAID, what else should you give?

A

PPI

61
Q

Give the 3 indications for ECT

A

1) catatonia

2) life-threatening depression

3) prolonged or severe manic episode

62
Q

Which atypical antipsychotic reduces the seizure threshold?

A

Clozapine

63
Q

1st line for acute stress disorder?

A

Trauma focused CBT

64
Q

When stopping an SSRI, how long should the dose be reduced over?

A

Gradually over a 4 week period

65
Q

What drug is indicated in acute dystonia?

A

Procyclidine (an anticholinergic)

66
Q

What is the commonset electrolyte abnormality in anorexia nervosa?

A

Hypokalaemia

67
Q

How is cholesterol impacted in anorexia?

A

Typically high cholesterol levels

68
Q

Which hormones are increased in anorexia?

A

Cortisol & GH

69
Q

Which hormones are decreased in anorexia?

A

low FSH, LH, oestrogens and testosterone

70
Q

What should be monitored at initiation and dose titration of venlafaxine (and other SNRIs)?

A

BP –> SNRIs can cause HTN

71
Q

What are clang associations?

A

ideas related only by rhyme or being similar sounding

72
Q

After initiation of lithium or a change in dose, when should levels be taken?

A

a week later and then weekly until the levels are stable

73
Q

When can chronic insomnia be diagnosed?

A

if a person has trouble falling asleep or staying asleep at least three nights per week for 3 months or longer.

74
Q

How can lithium affect WBCs?

A

Lithium can precipitate a benign leucocytosis.

75
Q

What can the use of SSRIs in pregnancy result in?

a) first trimester
b) third trimester

A

a) congenital heart defects
b) persistent pulmonary hypertension of the newborn

76
Q

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

A

Paroxetine

77
Q

Symptoms of SSRI discontinuation syndrome?

A
  • increased mood change
  • restlessness
  • difficulty sleeping
  • unsteadiness
  • sweating
  • GI symptoms: pain, cramping, diarrhoea, vomiting
  • paraesthesia
78
Q

What is the phenomenon called where patients believe that someone familiar to them (eg friend or relative) has been replaced by an exact clone?

A

Capgras syndrome

79
Q

What is the 1st line treatment for autoimmune encephalitis?

A

Steroids & IV immunoglobulin

80
Q

Management of mild-moderate lithium toxicity caused by bendroflumethiazide?

A

Fluid resuscitation with saline

81
Q

Management of severe lithium toxicity?

A

Haemodialysis

82
Q

Which drug can be used in the treatment of anorexia?

A

Mirtazapine

83
Q

What is echopraxia?

A

In echopraxia, the patient involuntarily imitates another person’s movements.

84
Q

What class of drug is imipramine?

A

TCA

85
Q

What are the main side side effects of TCAs?

A

Antimuscarinic e.g. dry mouth, blurred vision etc

86
Q

What do antipsychotics increase the risk of in the elderly?

A

Cerebrovascular events e.g. stroke.

This increased risk is particularly relevant for those with dementia-related psychosis.

87
Q

What is management for more severe OCD or OCD that is unresponsive to CBT/exposure and response prevention?

A

CBT/ERP and add SSRI

88
Q

What medication may be used to treat moderate/severe tardive dyskinesia?

A

Tetrabenazine

89
Q

What class of drug is clomipramine?

A

TCA

90
Q

Which antipyschotic notably reduces the seizure threshold?

A

Clozapine

91
Q

1st line management of acute stress disorder?

A

Trauma focused CBT

92
Q

1st line antidepressant post MI?

A

Sertraline

93
Q

What foods should be avoided in patients taking MAOIs?

A

Tyramine containing foods e.g. cheese –> can cause a hypertensive crisis.

94
Q

What is the risk of developing schizophrenia if one monozygotic twin is affected?

A

50%

95
Q

What is tangentiality?

A

Wandering from a topic without returning to it.

Note - this differs from flight of ideas. FoI is usually associated with mania, pressured speech etc

96
Q

How can long term lithium use affect calcium?

A

Can result in hyperparathyroidism and resultant hypercalcaemia.

97
Q

Type 1 vs type 2 bipolar?

A

Type 1 –> associated with mania & depression

Type 2 –> associated with hypomania & depression

98
Q

Which personality disorder displays the negative symptoms of schizophrenia?

A

Schizoid personality disorder

99
Q

What are some risk factors for Charles-Bonnet symdrome?

A
  • Advanced age
  • Peripheral visual impairment
  • Social isolation
  • Sensory deprivation
  • Early cognitive impairment
100
Q

What is the persistent belief in the presence of an underlying serious disease, e.g. cancer called?

A

Illness anxiety disorder (hypochondriasis)

101
Q

For moderate/severe OCD, what may be used as an alternative to an SSRI?

A

Clomipramine

This is the only TCA licensed to manage OCD.

102
Q

What is the only TCA licensed to manage OCD?

A

Clomipramine

103
Q

What class of drug is mirtazapine?

A

noradrenergic and specific serotonergic antidepressant

104
Q

Knight’s 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.

105
Q

What is a normal MMSE score?

A

≥25

106
Q

What is the most effective antipsychotic for dealing with negative symptoms of schizophrenia?

A

Clozapine

107
Q

What are the negative symptoms suggestive of schizophrenia?

A
  • incongruity/blunting of affect
  • anhedonia (inability to derive pleasure)
  • alogia (poverty of speech)
  • avolition (poor motivation)
  • social withdrawal
108
Q

What is the most common ophthalmological condition associated with Charles Bonnet syndrome?

A

Age related macular degeneration

109
Q

How should antidepressants be adjusted prior to starting ECT?

A

Reduced to minimum dose but not stopped.

110
Q

How does akathisia typically present?

A

A subjective feeling of restlessness often accompanied by fidgeting movements or pacing around.

111
Q

What condition needs to be routienly checked for before diagnosing anxiety?

A

Thyroid disease

112
Q

ECG features of hypokalaemia?

A

1) Tall P waves
2) Flattened T waves
3) 1st degree heart block

113
Q

How can lithium use affect PTH?

A

Long term use can cause hyperparathyroidism –> resultant hypercalcaemia.

114
Q

What is the 2nd line drug for GAD?

A

Buspirone

115
Q

What are the 3 key traits seen in histrionic personality disorder?

A

1) Very emotional

2) Attention seeking

3) Sexually provocative

116
Q

What is the treatment of choice for delirium tremens?

A

Benzos

117
Q

What medication is given to patients on MAOI inhibitors that have eaten tyramine containing foods?

A

Phentolamine (alpha blocker)

118
Q

What 2 neurotransmitters are associated with ADHD?

A

Dopamine & norepinephrine

119
Q

What model of major depressive disorder specifies that a pre-existing vulnerability can be activated by stressful life events?

A

The diathesis-stress model

120
Q

What are 2 medications used in the treatment of severe Tourettes?

What is their mechanism?

A

1) Guanfacine
2) Clonidine

A2 agonists

121
Q

Length of time of schizophrenic symptoms in schizophrenia vs schizophreniform disorder?

A

Schizophrenia –> >6 months

Schizophreniform disorder –> >1 month but <6 months

122
Q

Which atypical antidepressant is used more commonly for insomnia?

A

Trazodone

123
Q

What term describes a phenomenon in Parkinson’s Disease where the patient gets ‘stuck’ on a particular word of a sentence and repeats it?

A

Logoclonia

124
Q

What is 1st line for managing the behavioural and psychological symptoms of frontotemporal dementia, including disinhibition, apathy, aggression, and impulsivity?

A

Non-pharmacological interventions, such as behavioural interventions and environmental modifications e.g. structured routines, physical activity, cognitive stimulation, socialisation, and caregiver education and support.

125
Q

1st line management of acute manic episode?

A

Antipsychotics

126
Q

What is there a risk of with chlorphenamine use in the elderly?

A

Acute delirium or other anti-cholinergic actions.

This is a H1 antagonist that is able to cross the BBB and can lead to anti-depressant/anxiety effects.

127
Q

1st line management of SEVERE Alzheimer’s?

A

Memantine

128
Q

MMSE scores for mild, moderate, moderately severe and severe Alzheimer’s?

A

Normal: >26
Mild: 21-16
Moderate: 10-20
Moderately severe: 10-14
Severe: <10

129
Q

What is the correct length and quantity of symptoms needed for a diagnosis of mild depression to be made according to the ICD-10?

A

Patient must have two of the first three symptoms (depressed mood, loss of interest in everyday activities, reduction in energy) plus at least two of the remaining seven symptoms over a duration of 2 weeks.

130
Q

Which is the SSRI of choice in people with unstable angina or recent MI?

A

Sertraline

131
Q

What is Hoover’s sign?

A

A quick and useful clinical tool to differentiate organic from non-organic leg paresis.

In non-organic paresis, pressure is felt under the paretic leg when lifting the non-paretic leg against pressure, this is due to involuntary contralateral hip extension.

132
Q

After how long can chronic insomnia be diagnosed?

A

After 3 months, if a person has trouble falling asleep or staying asleep at least 3 nights per week.

133
Q

What are some short term side effects of ECT?

A

1) headache
2) nausea
3) short term memory impairment
4) memory loss of events prior to ECT
5) cardiac arrhythmia

134
Q

What is a potential long term side effect of ECT?

A

some patients report impaired memory

135
Q

What class of drug is phenelzine?

A

MAOI

136
Q

When initiating lithium, when should levels first be checked?

A

1 week later, 12 hours after last dose

137
Q

Assisted withdrawal (e.g. with chlordiazepoxide) is recommended for patients who drink how many units of alcohol per day?

A

> 15

138
Q

1st line management for harmful drinkers and those with a mild alcohol dependence?

A

CBT

139
Q

What is the 1st line in managing a distressed patient with delirium?

A

Employ verbal and non-verbal de-escalation techniques

140
Q

What is derailment?

A

A type of formal thought disorder where the speech consists of a series of unrelated or reotely related ideas.

141
Q
A

Yr 4 - Psychiatry (17 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions