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1
Q

3 drugs used in the treatment of Alzheimer’s

A

Donepezil
Galantamine
Rivastigmine

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2
Q

4 Antimuscarinic side effects

A

Dry mouth
Constipation
Blurred vision
Urinary retention

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3
Q

What is neuroleptic malignant syndrome

A

In response to antipsychotics as a result of rapid fall in dopaminergic activity.

Muscle stiffness andrigidity, autonomic dysfunction(pyrexia, tachycardia, Labile BP)

Rhabdomyalysis leading to kidney failure

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4
Q

Side effects of benzodiazepines

A 
Withdrawal syndrome: 
Similar to alcohol withdrawal
Insomnia
Irritability
Anxiety
Tremor
Loss of appetite
Tinnitus
Perspiration
Perceptual disturbances
Seizures

May appear up to 3 weeks after stopping as some very long acting

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5
Q

Hypnagogic and hypnopompic

A

Before(usually with narcolepsy) and after sleeping

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6
Q

What is the time course for side effects in alcohol withdrawal

A

Symptoms - 6-12 hours
Seizures 36 hours
Delirium tremens 72 hrs

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7
Q

What medications are given in delirium tremens

A

Long acting benzodiazepines such as chlordiazepoxide

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8
Q

6 features of dependency

A

Tolerance
Strong compulsion to use
Difficulties controlling use
Withdrawal symptoms

Continue despite knowing the risk
Prioritise it over other things eg money to buy
(Reduced variability of habits and narrowing of repertpoire not in criteria but are a feature)

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9
Q

Triad of wernickes

A

Ataxia
Confusion
Opthalmaplegia

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10
Q

Types of dementia

A

Cortical - Alzheimer’s

Subcortical - Huntingtons

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11
Q

Key feature of normal pressure hydrocephalus

A

Urinary incontinence

Sub cortical dementia and ataxia

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12
Q

Features of HIV encephalitis

A

Early apathy and withdrawal

Ataxia
Tremors
Seizures
Myoclonus

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13
Q

Features of sporadic cjd

A

Rapid onset neurological and psychiatric symptoms
Occurs in 40-60 year olds
Triphasic sharp wave eeg.

Tonsillor biopsy?

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14
Q

What is amnesiac syndrome

A

Characterised by inability to lay down new memories and there may be some retrograde memory loss.
Korsakoffs is most common type

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15
Q

Triad in Parkinson’s

A

Pill rolling tremor
Rigidity
Bradykinesia

Stooped walk
Mask like face
Falls
Constipation

80% develop dementia first signs are bradyphrenia
50 % develop depression
40% get psychotic symptoms

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16
Q

MS

A

50 percent get depression

60 of late stage ms get dementia

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17
Q

Name 3 associations of restless leg syndrome

A

wittmack ekbom syndrome - associated with rheumatoid arthritis, uraemia, iron deficiency anaemia.

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18
Q

3 assocaitions of nocturnal leg cramps

A

diabetes, pregnancy, arthritis

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19
Q

what is adjustment sleep disorder

A

lack of sleep associated with stress conflict or environmental change - goes whenanxiety is diminished

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20
Q

what is limit setting sleep disorder

A

usually due to a stubborn child, where refusal to go to sleep when the time is set.

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21
Q

Describe othello syndrome

A

Commonly occurs in alcoholics and they devlop pathological or morbid jealousy in reference to their partner. they often adopt extreme measures to prove it

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22
Q

give an example of when Central pontine myelinolysis can occur

A

during fast recorrection of a hyponatraemia. often occurs in alcoholics. presents with quadriplegia.

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23
Q

what is kleine levin syndrome

A

associated with hypersomnia and binge eating, also sexual disinhibition

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24
Q

what is the IQ range of mild learning disability

A

50-69

moderate = 35-49
severe = 20-34
profound = <20
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25
Q

what is diagnostic overshadowing

A

tendency to explain someones current symtpoms with a preexisting diagnosis

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26
Q

causes of LD

A

antenatal: drugs, smoking, alcohol, medications, onfection

perinatal - hypoxia, hypoglycaemia, prematurity, trauma.

Postnatally - social deprivation, malnutrition, infection, head injury. lead posiing

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27
Q

What are the 4 types of delusions of diagnostic significance in schizophrenia?

A

perception - 2 stage process where interpret surroundings to mean something odd.
Passivity - controlled by others
Interference - thoughts under contol of someone else, they are being tampered with
formal though disorder - vagueness/loosening of association/poverty/word salad

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28
Q

What are the negative symptoms of schizophrenia and when do they occur?

A

more commonly in the chronic phase of the disorder

apathy
blunted affect
anhedonia
social withdrawal
poverty of thought and speech.

(may manifest as lack of attention to personal hygiene or limited repertoire of daily activities )

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29
Q

What are the different types of schizophrenia

A

PARANOID - stable paranoid delusions (catatonic sx relatively small)
CATATONIC - extremes of hyperkinesis and hypokinesis may have aggressive outbursts of excitement, resistance to passive movement, dream like state.
HEBEPHRENIC - erratic unpredictable, disorganised thought. negative symptoms come fast with loss of volition. normally in young adults. hallucinations are non predominant.
SIMPLE - just neg without any evidence of previous positives
RESIDUAL - just neg sx post hallucinations
POST SCHIZOPHRENIC DEPRESSION - some small residual features of schizophrenia but not gone or florid. depression is key element.

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30
Q

What are the disorders of psychoactive substance use?

A

ACUTE INTOXICATION
HARMFUL USE - repetetive use which is leading to damaging health effects, mental or physical.
DEPENDENCE SYNDROME - strong desire to use, struggles to regulate use, persistence despite knowledge of harmful conequences, increased tolerance, prioritise it.
WITHDRAWAL - time limited and specific to the substance
WITHDRAWAL WITH DELIRIUM - with disturbance of conciousness and attnetion, perception, thinking, memory, behaviour, emotion, sleep wake cycle.
PSYCHOTIC DISORDER - hallucination, persecutary or paranoid delusions, abnormal affect, psychomotor disturbance excitememnt or stupor)
AMNESIC SYNDROME - chronic impairment of recent and remote memory. recent is worst. difficulty learning new material, confabulation mmay be evident
LATE ONSET PSYCHOTIC DISORDER

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31
Q

What are the affective disorders?

A

MANIC EPISODE
BIPOLAR AFFECTIVE DISORDER
DEPRESSIVE EPISODE
RECURRENT DEPRESSIVE DISORDER with current episode: (essentially BPAD without the mania)
PERSISTENT MOOD DISORDER - cyclothymia/dysthmia

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32
Q

What are the core features of depression

A

anergia
anhedinia
low mood.

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33
Q

What are the other associated symptoms of depression which are used to determine severity?

A

COGNITIVE - wothlessness, guilty, poor concentration, slow thinking.
BIOLOGICAL altered sleep, appetite, weight, libido, ocnstipation, aches, pains.
PSYCHOTIC hallucination and delusions.

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34
Q

What makes a depressive episode severe?

A

usually suicidal thoughts or severe hopelessness with a large number of associated cognitive and biological symptoms which are marked and distressing.

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35
Q

What are the phobic anxiety disorders?

A

Agoraphobia
Social phobia
specific phobia

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36
Q

What are the other anxiety disorders?

A

Panic disorder
Generalised anxiety disorder
Mixed anxiety and depressive disorder

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37
Q

What is autobiographical memory

A

relating to onselef e.g grandchild, birthday.

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38
Q

what is procedural memory

A

act of doing things.

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39
Q

what is topographical memory

A

to orientate oneself - common in dememntia

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40
Q

When is ‘preservation’ seen most commonly

A

organic brain disease such as dementia

note it may not just be seen in word form - may be motor actions too

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41
Q

In what condition is deja vu commonly seen?

A

temporal lobe epilepsy

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42
Q

ganser syndrome

A

approximations despite understaning the question

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43
Q

What is jamais vu?

A

familiar event has never happened before

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44
Q

what is a pareidolic illusion?

A

where shapes are found wihtin other objects such as shapes in the sky. one which becomes more real with concentration

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45
Q

what is a complete illuion

A

one which occurs due to not concentrating. incorrect interpretation

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46
Q

What is an extracampine hallucination

A

one which arises outside the usual range of senstion as apposed to a functional hallucination which may occur as a reulst of a specific external symptom(that is of the same modality)

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47
Q

What is a reflex hallucaination

A

one which happens as a result of a stimulus of a different modaility

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48
Q

What is a delusional atmosphere

A

idea that there are ‘goings on’ which often cant be explained. often occurs before a delusion forms

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49
Q

What is deulsional memory

A

reinterpretation of past events with a delusion

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50
Q

Knights move or derailment is what?

A

losening of association and is a formal thought disorder.

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51
Q

At what intervals do blood tests need to be taken for clozapine?

A

weekly for 18 weeks
2 weekly til end of year 1
then monthly

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52
Q

What is the traffic light system for clozapine?

A

GREEN -
WBC>3.5 neut>2

AMBER
WBC 3< x <3.5 and neut 1.5< x > 2.0

RED WBC <3 neut <1.5

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53
Q

What are the risks in pregancy of SSRI’s

A

first trimester use can increase loss, persistent pulmonary hypertension of the newborn and congenital heart disease

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54
Q

what is formication

A

feeling of insects under skin

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55
Q

what is micropsia

A

seeing things smaller than they are

macropsia - bigger

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56
Q

what is pelopsia

A

seeing things closer than they are

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57
Q

mechanism of action for amphetamines and cocaine

A

dopamine increased by reducing removal from synapse

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58
Q

MOA of caffeine

A

blocks inhibitoy receptor of adenosine causing neurostimulation. increased glutamate activity.

also increases serotonin and norepinephrine.

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59
Q

MOA nicotine

A

act at nicotinic recepters causing dopamine rise in the MCLP

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60
Q

ketamine

A

NMDA blockade - glutamine

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61
Q

What ahppens to the brain as it gets older?

A

reduces in size and loss of grey matter.

ventricle size increases

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62
Q

how long do PTSD symptoms need to persevere for diagnosis?

A

1 month

increased arousal
exposure to life threatening event
reexperiencing the evnt.

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63
Q

what is an adjustment disorder

A

inability to cope with daily tasks due to adjustment to new surroundings or circumstances. it has symptoms of depression and anxiety.

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64
Q

how long may an acute stress reaction persist for?

A

hours or days.

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65
Q

What is the cat sat on my hat sack and ate the bait to wait in hate? an example of?

A

clanging - not a symptom of catatonia

66
Q

what is cataLEPSY?

A

state of rigidity and they can be moved

67
Q

what is cataplexy?

A

loss of muscle tone sudden and transient

68
Q

what is negativism

A

doing exactl the oppostie of what they are being told to do. resisting.
often seen in catatonia

69
Q

what is nominal dysphasia

A

being able to describe what something is for but unable to say the name. common in dementia

70
Q

what is circumstentiality

A

talking in a roundabout manour before ever getting to the answer. too much additional info. mania

71
Q

what is the difference between loosening of assocaition and flight of ideas?

A

flight of ideas still shows some association which is logical between ideas however the objective changes. derailment however there is no association between the words they are disjointed.

72
Q

What things are associated with frontal lobe malfunction?

A 
hyperphagia
hypersexuality
childishness
mood swings
forced utilization
73
Q

what do keiser fleisher rings look like?

A

brown or greenish golden rings in the eye.

They can also occur in PBC

74
Q

What features would a tumour around the third ventricle produce

A

amnesia and confabulation

near the hypothalamus and thalamus which is likely to cause increase in eating and drinking and sleeping. and temperature dysregulation

75
Q

vitamin b 3 deficiency?

A

pellagra - niacin deficiency - GI upset, bullous skin disease on sun exposed areas, depression/apathy/irritability. - may be a differential fr dementia

76
Q

what is the correlation between epilepsy and psychiatric conditions?

A

associated with increase in psychotic symptoms aswell as depression

77
Q

what vitamin is b1

A

thiamine

78
Q

what symptoms might someone with post concussion syndrome have?

A

cognitive: poor concentration and memory
mood: anxiety depression irritability.
somatic: headaches dizziness fatigue, insomnia

79
Q

What percentage of parkinsons suffferers get psychotic symptoms?

A

40% visual hallucinations are common of people or animals

may result from use of dopaminergic drugs too. is a strong predictor of home placement.

80
Q

what part is demyelinated in MS

A

white matter of the CNS.

81
Q

What psychiatric illnesses are often seen in MS?

A

memory and concentration problems
dementia (60% of late stage)
depression and suicide
mania

82
Q

What are the 7 organic causes of a depression

A 
Addisons
b12 deficiency
corticosteroids
cushings syndrome
hypothyroidism
hypo/hyperparathyroidism
SLE
83
Q

what are the organic causes of mania

A

corticosteroids
cushings
hypothyroid

84
Q

what are the 5 organic causes of psychosis?

A 
Acute porphyria
corticosteroids
cushings
hypothyroid
SLE
85
Q

What are the 5 organic causes of anxiety

A 
arythmias
caffeine
hypoglycaemia
hyperthyroid
phaeo
86
Q

What are the 6 organic causes of dementia?

A 
Addisons disease
b12 deficiency
cushings
folate deficiency
hypothyroid
hypo/hyper parathyroidism.
87
Q

What is autoprosopagnosia

A

inability to recognise onselef in the mirror

88
Q

what is sun downing and who gets it?

A

worseing of confusion as evening draws in - dementia

89
Q

what is the most important feature in diagnosing dementia

A

interfereance with ADLs.

small mistakes in ADLs become more and more frequent.

90
Q

What is found in alzheimers plaques?

A

beta amyloid core with surrounding dystrophic neuritis with hyperphosphylated tau protein. this also forms intercellular neurofibrillary tangles (NFTs)

91
Q

what is prosopagnosia

A

inability to recognise faces

92
Q

what are the 4A’s of alzheimers presentation?

A

Amnesia - recent mems go first
Aphasia - word finding problems with speach becoming muddled
Agnosia - inability to interpret things and recognise.
Apraxia - inability to carry out skilled tasks despite normal motor function.

93
Q

what is the pathology of alzhgeimers

A 
neuronal loss (mainly cholinergic pathways) leading to brain shrinkage
dysfunction related to loss and deposition of beta amyloid and hyperphosphorylated tau protein
these also create neurofibrillary tanges which further abet neuronal death.
94
Q

what is strategic infarct demantia

A

one single stroke which leads to dementia - may be associated with vascular dementia or a stroke. the symptoms reflect the site of the lesion

95
Q

what is a lewy body maed up of?

A

lewy bodies are eosinophilic intracytoplasmic neuronal structures made up of alpha synuclein and ubiquitin

96
Q

where are lewy bodies found in parkinsons and lewy body dementia

A

PD: brainstem

DLB: cingulate gyrus and the neocortex

97
Q

why should you avoid antipsychotics in DLB?

A

increases mortality

98
Q

What are the risk factors for alzheimers?

A

Age
FHx
low IQ and poor education
head injury and vsascular risk factors

99
Q

What are the genes involved in Alzheimer susceptibility

A

EARLY ONSET:
presenilin 1 and 2
beta amyloid precursor protein (APP)

LATE ONSET:
apolipoprtein allele E4 - also assocaited with arteriosclerosis.

100
Q

What are the additional features of DLB

A

syncope
autonomic instability
recurrent falls
neuroleptic sensitivity

101
Q

what is pseudodementia?

A

sever depression which can cause dementia like symptoms - often the patient is very worried about their memory loss as they retain a level of insight tht demtia patients do not. it is more likely in the elderly population. and is a result of poor concentration and attention that this memory loss occurs.

102
Q

what is an obsession

A

recurrent unwanted intrusive thought which is recognised as ones own often making them feel very uncomfortable or anxious. the anxiety and tension of obsessions are often relieved by compulsions.

103
Q

what is a compulsion

A

activity carried out repeatedly which neutralises anxiety. they are purposeful rituals that the patient feels they must carry out. they are often irrational and lack any link to the obsession.

104
Q

What are the features exhibited in PTSD

A

re-experiencing: daydreams, flashbacks, nightmares
avoidance: avoid reminding of the event
hyperarousal: irritability, quick to startle, insomnia, poor concentration, cant relax or sleep. hypervigilant
Others: emotional detachment, decreased interest in acxtivites

105
Q

what are the expected time frames of adjustment disorder

A

1 month to 6 months - support is all that is needed

106
Q

who is more at risk of experiecning medically unexplained symptoms?

A

women, shorter duration of formal education. adverse events in childhood

107
Q

what is ME?

A

myalgic encephalomyelitis or chronic fatigue syndrome.

extreme fatigue
aches and pains

mx = cbt and exercise

108
Q

what is malingering?

A

feigning symptoms to gain external reward. e.g getting out of military servce

109
Q

how do you distinguish picks disease with fronto temporal dementia?

A

tau present in picks

FTLD - ubiquinated inclusions which are tau negative similar to those in motor neurone disease.

These diseases come on much earlier than normal dementias in 40-60 year olds and have a strong inherited assocaition. around 40% are thought to be autosomal. death usually occurs within 5-10 years.

110
Q

factors of poor prognosis in schizophrenia?

A

slow/gradual onset
male
young age at onset
lack of mood symptoms

111
Q

what are the long term consequences of a raised prolactin

A

osteoporosis

112
Q

what is a metonym

A

an existing word used in an unusual way

113
Q

How do you distinguish hypomania?

A

affects daily life but not assocaited with psychotic symptoms or SEVERE disruption

114
Q

hwo would agitated depression present?

A

irritable and anxioous but not with elevated or manic symptoms

115
Q

risk factors for suicide?

A

have they tried before
male
unemployment

OCD is apparently protective. age is not a factor as is equal accross the board.

116
Q

what is nihilism

A

nihilism is a psychological feature of depression characterized by
an overwhelming feeling of hopelessness and negativity which may
amount to delusional intensity

117
Q

what is dysthmia

A

chronic depression of mood which is not severe enough to diagnose depressive episode. often may have small episodes which are not individually lasting long enough to diagnose depressive episode or recurrent depressive disorder. they must have the core symptoms for that.

118
Q

biological treatment in OCD

A

SSRI

119
Q

what are conversion disorders also known as

A

dissociative disorders

they have much better outcomes compared to somatiform dsorders.

internal conlict becomes unconsciously converted into neurological symptoms such as collapse or paralysis.

acute specific and dramatic presentations

Broadly speaking, dissociation refers
to a loss of integration between consciousness, memory, perception,
identity and bodily movements

120
Q

What are the theories behind anxious disorders?

A

attachment: those who are insecurely attached as children go on to become anxious

Cognitive theory: automatic worrying thoughts repeatedly induce and maintain the anxiety

Negative reinforcement: running away for example helps the anxiety and does not allow for habituation.

121
Q

triad of DLB?

A

parkinsonism
fluctuating conciousness and cognition
hallucinations

(greater risk of falls)

122
Q

What are the contraindications to ECT

A

RELATIVE CONTRAINDICATIONS:
Heart disease
Riased ICP
High anaesthetic risk

123
Q

what are you at risk of with chronic kidney disease

A

Depression and therefore diabetes is a risk too

124
Q

What is very late onset schizphrenia like psychosis

A

condition of the elderly where partition delusions occur usually (where objects become permeable to people or substances)

they are often eldery and isolated individuals.

125
Q

periventricular white matter lesions?

A

vascular dememntia

126
Q

What is the difference between denial and repression?

A

Denial is the refusal to accept the reality depite logical evidence.

Repression is hiding of a memory in order to protect yourself from the feelings which that memory elicits.

127
Q

what is systemic therapy also known as

A

family therapy - it aims to explore the interactions and relationships between people as apposed to the individuals inner world

subtypes include:
narrative therapy
solutionfocused therapy
strategic family therapy

128
Q

Who is affected more by eating disorders

A

women that are WHITE!

if they were abused as a child this can manifest in this way. or any family which was overprotective or enmeshed.

129
Q

what is the most common eating disorder

A

Binge eating disorder 2.8% (lifetime)
BN:1%
AN0.6%

130
Q

what is the genetic component in anorexia

A

58% heretability.

131
Q

You are more likely to get AN if you are :

A

a perfectionist
have low self esteem

In this domain if you lose weight it enhances your sense of achievement and gives you a chance to be autonomaous and a perfectionist

132
Q

What are the 4 main diagnostic criteria for AN?

A

BMI less than 17.5
endocrine dysfunction
intended weight loss and disorted body image.

133
Q

when would you admit anorexia

A 
BMI less than 13
weight loss >1kg per week
hypothermia <34.5
purpuric rash
cold peripheries
brady <40
K <2.5
cant stand up
134
Q

What should be paid more attention when investigating BN

A

electrolyte changes - because they are vomiting

135
Q

what are the 4 features of BN?

A

BMI>17.5
binge eating
purging
distorted body image - usually of a reasonably normal weight with maintained menses

136
Q

What is thrombocytosis?

A

lack of platelets and is common in AN

137
Q

What is the treatment for eating disrders

A

SSRI
treat comorbid conditions such as depression or self harm
CBT

138
Q

What is motivational interviewing?

A

empowering an individual to see the change required and give them the ocnfidence to undertake it.

139
Q

Wjhat are the baby blues

A

50-75% of mothers get it and feel down day 3 doesnt usually last more than a week.

140
Q

What percentage of mothers get postnatal depression

A

10%
commonly relate to the baby
use paroxitine becuase lower amount in milk

they are increased risk of PND but not depression

141
Q

Who gets peurperal psychosis

A

0.1% of births around 2 weeks post. admission required. those with a family history of BPAD or PND.
treat with antipsychotics, antidepressants and even lithium if needed. can give benzos too in short term to calm

142
Q

What is the prognosis of puerperal psychosis?

A

patients recover in 6-12 weeks and there is a 1 in 3 chance of recurrance

143
Q

What does adhd frequently coexist with?

A

conduct disorder

144
Q

how many points on the MMSE would you expect someone to lose a year in dementia?

A

2/3 per year.

7 years is the median survival

145
Q

What do you need to diagnose GAD

A

4 clincal features of(with atleast 1 autonomic):
autonomic arousal: sweating palp, shaking
physical symptoms: breathing dif, choking, chest pain/discomfort
mental state symptoms
General symptoms: numbness tingling
Tension symptoms: muscle aches, restlessness
Other: startle, concentration difficulties, sleep difficulty

146
Q

Why should you aska forensic history in an alcohol station?

A

because they may have been done for drink driving or for violence when drunk.

147
Q

What is pathalogical drunkness

A

when an alcoholic dependant gets liver damage and so gets drunk really easily now rather than exhibitng the tolerance he once had

148
Q

Why shouldnt you give IV dextrose in wernickes?

A

can cause brain odema without the b1. give oral afterwards

149
Q

What monitoring does one neeed on lithium

A

once stabilised 3/6 monthly depending on reliability of paitent. thyroid and U+Es

150
Q

signs of refeeding syndrome

A

low BP with an increase in heart rate

2 pints of milk helps with phosphate intake

151
Q

feeding too quickly on a slowly digesting stomach does what?

A

causes gastric ischemia

152
Q

important things to avoid refeeding syndrome

A

too much fluid
too much volume (6 meals)
too hard to digest
high phophate diet

153
Q

What do you need to think about before diagnosing someone

A

Time line

Symptoms

154
Q

What can you not give in first line treatment for schizophrenia?

A

injectables should not be given as a firt line. if you are having trouble getting them to take it, atypical antipsychotics come in a liquid or disolvable tab form

155
Q

What are the main side effects of SSRI’s

A

nausea vomiting, insomnia, irritability, anxiety

156
Q

Which EPSEs should you treat with procyclidine?

A

acute dystonias and you can use them in parkinsons too. they should not be used in tardive dyskinesias

157
Q

What would you expect to see in huntingtons disease?

A

chorea
athetosis (involuntary writhing movements)
dementia
depression

affects women and men equally
Autosomal dominant

more likely to get younger in

158
Q

What condition has a better prognosis in the developing world?

A

schizophrenia

159
Q

What disease has a 60-70 percent monozygotic concordance rate?

A

schizophrenia

160
Q

peak age of onset of depression?

A

late 30’s

161
Q

which disorder confers no inheritability?

A

agoraphobia

Joshua's Psych (4 decks)

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