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Facts from Passmed/ Quesmed Flashcards

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1
Q

What is the mechanism of Mirtazapine?

A

Noradrenergic and specific serotonergic antidepressant (NaSSA)

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2
Q

When is Mirtazapine generally used?

A

As 2nd line when SSRI is inappropriate eg. risk of bleeding in elderly people taking anticoagulants

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3
Q

When might Mirtazapine be preferred?

A

When there are concerns over weight loss (SE increased appetite) or issues getting to sleep (lightly sedative - usually taken in evening)

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4
Q

Which area of the brain is responsible for the fight or flight response?

A

Amygdala (forms part of the limbic system)

Direct connections to the hypothalamus and brainstem

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5
Q

Which part of the brain is larger in patients with anxiety disorders?

A

Left amygdala

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6
Q

What is logoclonia?

A

A phenomenon in Parkinson’s disease where a patient gets stuck on a word in a sentence and repeats it over again

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7
Q

What is Ekbom syndrome?

A

The patient has a sensation that they’re being infected by parasites

As opposed to delusional parasitosis where there is a fixed belief that they’re infested with parasites

Organic cause: vitamin B12 deficiency

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8
Q

What is Capgras delusion?

A

Patient believes someone close to them has been replaced by a clone

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9
Q

What is Fregoli delusion?

A

Patient believes everyone they meet is the same person in different disguises

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10
Q

Injuries to which parts of the brain are associated with Fregoli delusion?

A

Right frontal area, left temporoparietal areas and fusiform gyrus

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11
Q

Which healthcare professionals are required for a section 3?

A

An approved mental health professional (AMPH) and two doctors

Both doctors must have seen the patient in the past 24 hours. One doctor must be section 12 approved and the other is a registered practitioner (usually who knows the patient eg. GP).

AMPH must have seen the patient within 14 days

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12
Q

How long does a section 3 mental health act last?

A

Up to 6 months

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13
Q

What is a section 5(2)?

A

Emergency holding order that can be implemented by a hospital doctor (>=FY2) to keep a patient in hospital when they are trying to leave

Lasts up to 72 hours (after patient can leave or act can be converted to section 2/3)

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14
Q

What can’t happen to a patient under a section 5(2)?

A

They can’t be medicated against their will

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15
Q

What is alogia?

A

Paucity of speech (common negative symptom of schizophrenia)

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16
Q

Which neurotransmitter is most affected in patients with anhedonia?

A

Dopamine (the reward system is affected)

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17
Q

What is a motivational interview?

A

Patient-centred care that can be employed in the primary care setting and has been proven to increase compliance with medication

4 principles:
R- resisting to employ a didactic course of action
U- understanding the reasons for the change in behaviour
L - listening to the patient’s ideas, concerns and expectations
E- empowering the patient to understand they can change their behaviour

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18
Q

What is the medical management for a patient presenting with schizophrenia?

A

Atypical antipsychotic eg. olanzapine
Anticholinergic eg. procyclidine (to reduce EPSEs)
Short acting benzodiazepine eg. lorazepam (antipsychotics can take up to 10 days to take effect, so further sedation might be required)

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19
Q

How is the diagnosis of substance dependance made?

A

If 3 or more of the following have been present together at some time during the previous year:
- Strong desire/ compulsion
- Difficulty controlling substance-taking behaviour in terms of onset, termination or levels of use
- Physiological withdrawal state
- Evidence of tolerance
- Progressive neglect of alrernative pleasures or interests
- Persistance of substance use despite evidence of harmful consequences
- Social impairment
- Time spent on substance use (obtaining, using and recovering)

Patient consent before their details are entered into the National Drug Treatment Monitoring System

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20
Q

What is displacement?

A

Taking feelings out on a neutral person eg. shouting at the reception staff when the doctor doesn’t give them what they want

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21
Q

What is projection?

A

Where a person assumes that an innocent, neutral character is responsible for the patient’s actions eg. someone who cheated in an exam might accuse an innocent person of doing the same thing

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22
Q

What is network therapy?

A

An intervention that prevents relapse in substance abusers

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23
Q

What is the next step in managing a patient who has not taken their clozapine for >48 hours?

A

Restart at 12.5mg (but can be titrated up more quickly than for a clozapine-naive patient)

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24
Q

What is essential to review before initiating antipsychotic medication?

A
  • Weight
  • Waist circumference
  • Pulse
  • Blood pressure
  • HbA1c
  • Fasting glucose
  • Lipid levels
  • Prolactin levels
  • Diet
  • Exercise
  • Movement disorders
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25
Q

What is gamophobia?

A

Fear of getting married

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26
Q

What is algophobia?

A

Fear of pain

27
Q

What is acrophobia?

A

Fear of heights

28
Q

What is regression?

A

An ego defence where people revert to immature behaviour in the setting of stress

29
Q

What is reaction formation?

A

Unacceptable emotions are unconsciously repressed and replaced by their exact opposite.

Immature defence mechanism.

Eg. man with homoerotic desires champions anti-homosexual public policy

30
Q

What is idenitification?

A

When someone models the behaviour of another more powerful type.

Eg. when a victim of child abuse becomes a child abuser

31
Q

How long can a patient be restricted under urgent Deprivation of Liberty Safeguards authorisiation?

A

Up to 7 days

32
Q

What is a section 12 approved doctor?

A

Section 12 approved doctors are those approved by the Secretary of State under section 12(2) Mental Health Act 1983 (MHA), where they are described ‘as having special experience in the diagnosis or treatment of mental disorder’.

33
Q

What is the management of methanol toxicity?

A

Fomepizole

34
Q

What would methanol toxicity show on ABG?

A

Raised anion gap metabolic acidosis (anion gap >=30)

35
Q

What is the mechanism of methanol toxicity?

A

Methanol metabolised to formaldehyde before being oxidised via alcohol dehydrogenase to become formic acid

Fomepizole competitively inhibits alcohol dehydrogenase (no toxic metabolites formed)

36
Q

What is a section 135?

A

The police can use 135 to move a person from private property to an area of safety where they can be assessed by a trained doctor or medical personnel

37
Q

Why is melatonin the drug of choice to help with insomnia in service users with learning disabilities?

A

SUs often have chronic sleep-wake cycle disruption

Melatonin can regulate natural sleep-wake cycles

38
Q

Which SUs is melatonin not licensed for treatment in?

A

<55 years old (but can be taken if recommended by a specialist)

Should be prescribed by a psychiatrist with expertise in sleep disturbance in learning disability

39
Q

At what age does the MCA apply?

A

> =16

Before this Gilick’s competence can be used

40
Q

What are the 5 fundamental principles of the MCA?

A
  • Presumption of capacity
  • Support to individuals to make their own decisions
  • Inidivduals have the right to make decisions that may be perceived as unwise without assuming lack of capacity
  • Decisions made whilst the individual lacks capacity should be in their best interests
  • Least restrictive option should be chosen when acting on their behalf
41
Q

What is DSM V criteria for oppositional defiance disorder?

A

Persistent pattern, lasting at least 6 months, of:
- Anger
- Irritability
- Argumentative behaviour
- Defiance
- Vindictiveness

42
Q

What are learning difficulties?

A

Specific challenges in certain areas of learning eg. dyslexia

43
Q

How is ASD characterised by the DSMV?

A

Persistent difficulties with social communication and interaction and restrictive and repetitive patterns of behaviour, activities or interests

44
Q

What is sublimation?

A

The diversion of unacceptable impulses into acceptable outlets

45
Q

What is the correct protocol for switching from fluoxetine to sertraline?

A

Reduce fluoxetine (if dose >20mg) gradually over two weeks, wait 4-7 days after stopping before starting sertraline

Fluoxetine has a long half life therefore wash out period is recommended

46
Q

What is the cause of muscle spasms shortly after starting antipsychotics?

A

Acute dystonia

Occurs within the first few hours of starting antipsychotics (eg. Haloperidol) and is treated by antimuscarinics

47
Q

What is the first line drug treatment for PTSD?

A

SSRI or venlafaxine

48
Q

What is the first line psychological therapy for PTSD?

A

Trauma focussed CBT

49
Q

What is the cardinal difference between OCD and OCPD?

A

Absence of distress over the obsessions

50
Q

Which age group is methyphenidate not approved for?

A

<6 years old

51
Q

What is the PHQ-9 used for?

A

To monitor the severity of depression and response to interventions

52
Q

Which drugs should not be used in patients with Lewy Body Dementia?

A

First generation antipsychotics eg. haloperidol

53
Q

What is the guidance for BPAD patients presenting with mania?

A

Check lithium levels and consider adding an antipsychotic

54
Q

What are static and dynamic risk factors for suicide?

A

Static (cannot be changed):
- Age
- Sex
- Previous self harm

Dynamic (can be changed):
- Drug use
- Plans for self-harm/ current self-harm
- Employment status

55
Q

What is pain disorder?

A

Intense, long standing pain without a somatic explanation

56
Q

What is conversion disorder?

A

Neurological deficit (paralysis, pseudoseizure and numbness) without a somatic cause

57
Q

What is adjustment disorder?

A

Suffering a recent stress and having trouble adjusting to the new environment

  • Symptoms present within 3 months of stress
  • Symptoms last <6 months
  • Can manifest with depressive or anxious symptoms
58
Q

What is the presentation of depressive stupor?

A
  • Mutism
  • Akinesis
  • Depression + severe psychomotor retardation (warrants immediate treatment to avoid dehydration and bed sores)
59
Q

What is the presentation of brucellosis?

A
  • Fevers
  • Headaches
  • Fatigue
  • Pain
  • Depression
60
Q

What are the side effects of Methydopa?

A
  • Depression
  • Suicidal ideation
  • Nightmares
61
Q

What is the presentation of lyme disease?

A
  • Fever
  • Headache
  • Low mood
  • Erythema chronicum migrans
62
Q

What is Korsakoff’s amnesia?

A

Severe deficiency in B1 results in bilateral losses of mamillary bodies in the brain

  • Anterograde amnesia
  • Confabulation
  • History of alcoholism
63
Q

What is the difference between anterograde and retrograde amnesia?

A

Anterograde: can remember before the amnesia, but can’t remember after

Retrograde: can remember after the amnesia, but not before

64
Q

What are the sexual side effects of SSRIs?

A
  • Anorgasmia
  • Reduced libido
  • Delayed ejaculation

Psych (13 decks)

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