Gap Deck - Psych

Question 1

What’s an oculogyric crisis

Answer 1

an acute dystonic reaction characterized by a prolonged involuntary upward deviation of the eyes.

can occur as part of the spectrum of EPSEs of antipsychotics. 90% reactions happen within first 4 days of initiation/dose increase

Question 2

EPSE more common with

Answer 2

first gen antipsychotics (haloperiodl, chlorpromazine)

Question 3

Treatment of acute dystonia

Answer 3

Procyclidine [Anticholinergic ]

Then reduce dose of antipsychotic

Question 4

what is Somatisation disorder

Answer 4

multiple physical SYMPTOMS present for at least 2 years

patient refuses to accept reassurance or negative test results

Question 5

What is Illness anxiety disorder (hypochondriasis)

Answer 5

persistent belief in the presence of an underlying serious DISEASE, e.g. cancer
patient again refuses to accept reassurance or negative test results

Question 6

What is Conversion disorder

Answer 6

typically involves loss of motor or sensory function. May be caused by stress

the patient doesn’t consciously feign the symptoms (factitious disorder) or seek material gain (malingering)
patients may be indifferent to their apparent disorder - la belle indifference - although this has not been backed up by some studies

Question 7

What is Dissociative disorder

Answer 7

dissociation is a process of ‘separating off’ certain memories from normal consciousness
in contrast to conversion disorder involves psychiatric symptoms e.g. Amnesia, fugue, stupor
dissociative identity disorder (DID) is the new term for multiple personality disorder as is the most severe form of dissociative disorder

Question 8

What is Factitious disorder

also known as Munchausen’s syndrome

Answer 8

the intentional production of physical or psychological symptoms

Question 9

What is Malingering

Answer 9

fraudulent simulation or exaggeration of symptoms with the intention of financial or other gain

Question 10

Schneider’s first rank symptoms for schizophrenia

Answer 10

Auditory hallucinations of a specific type:
two or more voices discussing the patient in the third person
thought echo
voices commenting on the patient’s behaviour

Thought disorder*:
thought insertion
thought withdrawal
thought broadcasting

Passivity phenomena:
bodily sensations being controlled by external influence
actions/impulses/feelings - experiences which are imposed on the individual or influenced by others

Delusional perceptions
a two stage process) where first a normal object is perceived then secondly there is a sudden intense delusional insight into the objects meaning for the patient e.g. ‘The traffic light is green therefore I am the King’.

Question 11

What is therapeutic range of lithium

Answer 11

0.4-1mmol/L

Question 12

Lithium is associated with which defect in neonates

Answer 12

Ebstein’s anomaly, a serious cardiac anomaly.

Question 13

BZD are associated with what malformation in neonates

Answer 13

Cleft Lip

First trimester exposure to benzodiazepines has been associated with increased risk of cleft lip,

Question 14

What is circumstantiality

Answer 14

inability to answer a Q without giving excessive unnecessary detail

Question 15

What is knight’s move thinking/loosening of associations and when is it seen

Answer 15

schizophrenia → no clear links between successive thoughts

Question 16

What is flight of ideas and when may it be seen

Answer 16

• Flight of ideas: feature of mania, not psychosis → jumping thoughts with links between successive thoughts

Question 17

What is tangentiality

Answer 17

wandering from a topic without returning to it

Question 18

What is perserveration

Answer 18

repetition of ideas/words despite an attempt to change the topic

Question 19

What are clang associations

Answer 19

when ideas related to each other only by the fact they sound similar/rhyme

Question 20

What is word salad

Answer 20

incoherent speech where real words strung together into nonsense sentence

Question 21

What is echolalia

Answer 21

repetition of someone else’s speech, including question asked

Question 22

What is De Clerambault’s syndrome (Erotomania )

Answer 22

presence of a delusion that a famous is in love with them, with the absence of other psychotic symptoms

Question 23

What is Capgras syndrome

Answer 23

delusion that a person closely related to the patient has been replaced by an impostor.

Question 24

What is Othello syndrome

Answer 24

delusion of sexual infidelity on the part of a sexual partner.

Question 25

What is Ekbom syndrome

Answer 25

delusional parasitosis and describes the delusion of infestation.

Question 26

Tx of alcohol withdrawal

Answer 26

first-line: long-acting benzodiazepines e.g. chlordiazepoxide or diazepam. Lorazepam may be preferable in patients with hepatic failure. Typically given as part of a reducing dose protocol

carbamazepine also effective in treatment of alcohol withdrawal

Question 27

When is the peak incidence of delirium tremens following alcohol withdrawal?

Answer 27

72hrs (3 days)

Question 28

When is the peak incidence of seizures following alcohol withdrawal?

Answer 28

36hrs

Question 29

Which SSRI is most likely to have caused the cardiac abnormality: QT prolongation & torsades de pointes?

Answer 29

Citalopram

Question 30

Long-term lithium use can result in hyperparathyroidism and resultant ____

Answer 30

hypercalcaemia.

The signs and symptoms presented are indicative of hypercalcaemia. Remember the mnemonic: ‘stones, bones, abdominal moans, and psychic groans’.

Long-term lithium use can result in hyperparathyroidism and resultant hypercalcaemia. This is postulated to occur by altering the homeostatic regulation of calcium, leading to parathyroid hyperplasia. A urea and electrolyte panel (U&Es), alongside parathyroid hormone levels (PTH), are useful investigations to establish the diagnosis.