General Flashcards
1
Q
3 drugs used in the treatment of Alzheimer’s
A
Donepezil
Galantamine
Rivastigmine
2
Q
4 Antimuscarinic side effects
A
Dry mouth
Constipation
Blurred vision
Urinary retention
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
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
5
Q
Hypnagogic and hypnopompic
A
Before(usually with narcolepsy) and after sleeping
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
7
Q
What medications are given in delirium tremens
A
Long acting benzodiazepines such as chlordiazepoxide
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)
9
Q
Triad of wernickes
A
Ataxia
Confusion
Opthalmaplegia
10
Q
Types of dementia
A
Cortical - Alzheimer’s
Subcortical - Huntingtons
11
Q
Key feature of normal pressure hydrocephalus
A
Urinary incontinence
Sub cortical dementia and ataxia
12
Q
Features of HIV encephalitis
A
Early apathy and withdrawal
Ataxia
Tremors
Seizures
Myoclonus
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?
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
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
16
Q
MS
A
50 percent get depression
60 of late stage ms get dementia
17
Q
Name 3 associations of restless leg syndrome
A
wittmack ekbom syndrome - associated with rheumatoid arthritis, uraemia, iron deficiency anaemia.
18
Q
3 assocaitions of nocturnal leg cramps
A
diabetes, pregnancy, arthritis
19
Q
what is adjustment sleep disorder
A
lack of sleep associated with stress conflict or environmental change - goes whenanxiety is diminished
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.
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
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.
23
Q
what is kleine levin syndrome
A
associated with hypersomnia and binge eating, also sexual disinhibition
24
Q
what is the IQ range of mild learning disability
A
50-69
moderate = 35-49 severe = 20-34 profound = <20
25
what is diagnostic overshadowing
tendency to explain someones current symtpoms with a preexisting diagnosis
26
causes of LD
antenatal: drugs, smoking, alcohol, medications, onfection
perinatal - hypoxia, hypoglycaemia, prematurity, trauma.
Postnatally - social deprivation, malnutrition, infection, head injury. lead posiing
27
What are the 4 types of delusions of diagnostic significance in schizophrenia?
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
28
What are the negative symptoms of schizophrenia and when do they occur?
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 )
29
What are the different types of schizophrenia
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.
30
What are the disorders of psychoactive substance use?
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
31
What are the affective disorders?
MANIC EPISODE
BIPOLAR AFFECTIVE DISORDER
DEPRESSIVE EPISODE
RECURRENT DEPRESSIVE DISORDER with current episode: (essentially BPAD without the mania)
PERSISTENT MOOD DISORDER - cyclothymia/dysthmia
32
What are the core features of depression
anergia
anhedinia
low mood.
33
What are the other associated symptoms of depression which are used to determine severity?
COGNITIVE - wothlessness, guilty, poor concentration, slow thinking.
BIOLOGICAL altered sleep, appetite, weight, libido, ocnstipation, aches, pains.
PSYCHOTIC hallucination and delusions.
34
What makes a depressive episode severe?
usually suicidal thoughts or severe hopelessness with a large number of associated cognitive and biological symptoms which are marked and distressing.
35
What are the phobic anxiety disorders?
Agoraphobia
Social phobia
specific phobia
36
What are the other anxiety disorders?
Panic disorder
Generalised anxiety disorder
Mixed anxiety and depressive disorder
37
What is autobiographical memory
relating to onselef e.g grandchild, birthday.
38
what is procedural memory
act of doing things.
39
what is topographical memory
to orientate oneself - common in dememntia
40
When is 'preservation' seen most commonly
organic brain disease such as dementia
note it may not just be seen in word form - may be motor actions too
41
In what condition is deja vu commonly seen?
temporal lobe epilepsy
42
ganser syndrome
approximations despite understaning the question
43
What is jamais vu?
familiar event has never happened before
44
what is a pareidolic illusion?
where shapes are found wihtin other objects such as shapes in the sky. one which becomes more real with concentration
45
what is a complete illuion
one which occurs due to not concentrating. incorrect interpretation
46
What is an extracampine hallucination
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)
47
What is a reflex hallucaination
one which happens as a result of a stimulus of a different modaility
48
What is a delusional atmosphere
idea that there are 'goings on' which often cant be explained. often occurs before a delusion forms
49
What is deulsional memory
reinterpretation of past events with a delusion
50
Knights move or derailment is what?
losening of association and is a formal thought disorder.
51
At what intervals do blood tests need to be taken for clozapine?
weekly for 18 weeks
2 weekly til end of year 1
then monthly
52
What is the traffic light system for clozapine?
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
53
What are the risks in pregancy of SSRI's
first trimester use can increase loss, persistent pulmonary hypertension of the newborn and congenital heart disease
54
what is formication
feeling of insects under skin
55
what is micropsia
seeing things smaller than they are
macropsia - bigger
56
what is pelopsia
seeing things closer than they are
57
mechanism of action for amphetamines and cocaine
dopamine increased by reducing removal from synapse
58
MOA of caffeine
blocks inhibitoy receptor of adenosine causing neurostimulation. increased glutamate activity.
also increases serotonin and norepinephrine.
59
MOA nicotine
act at nicotinic recepters causing dopamine rise in the MCLP
60
ketamine
NMDA blockade - glutamine
61
What ahppens to the brain as it gets older?
reduces in size and loss of grey matter.
| ventricle size increases
62
how long do PTSD symptoms need to persevere for diagnosis?
1 month
increased arousal
exposure to life threatening event
reexperiencing the evnt.
63
what is an adjustment disorder
inability to cope with daily tasks due to adjustment to new surroundings or circumstances. it has symptoms of depression and anxiety.
64
how long may an acute stress reaction persist for?
hours or days.
65
What is the cat sat on my hat sack and ate the bait to wait in hate? an example of?
clanging - not a symptom of catatonia
66
what is cataLEPSY?
state of rigidity and they can be moved
67
what is cataplexy?
loss of muscle tone sudden and transient
68
what is negativism
doing exactl the oppostie of what they are being told to do. resisting.
often seen in catatonia
69
what is nominal dysphasia
being able to describe what something is for but unable to say the name. common in dementia
70
what is circumstentiality
talking in a roundabout manour before ever getting to the answer. too much additional info. mania
71
what is the difference between loosening of assocaition and flight of ideas?
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
What things are associated with frontal lobe malfunction?
```
hyperphagia
hypersexuality
childishness
mood swings
forced utilization
```
73
what do keiser fleisher rings look like?
brown or greenish golden rings in the eye.
They can also occur in PBC
74
What features would a tumour around the third ventricle produce
amnesia and confabulation
near the hypothalamus and thalamus which is likely to cause increase in eating and drinking and sleeping. and temperature dysregulation
75
vitamin b 3 deficiency?
pellagra - niacin deficiency - GI upset, bullous skin disease on sun exposed areas, depression/apathy/irritability. - may be a differential fr dementia
76
what is the correlation between epilepsy and psychiatric conditions?
associated with increase in psychotic symptoms aswell as depression
77
what vitamin is b1
thiamine
78
what symptoms might someone with post concussion syndrome have?
cognitive: poor concentration and memory
mood: anxiety depression irritability.
somatic: headaches dizziness fatigue, insomnia
79
What percentage of parkinsons suffferers get psychotic symptoms?
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
what part is demyelinated in MS
white matter of the CNS.
81
What psychiatric illnesses are often seen in MS?
memory and concentration problems
dementia (60% of late stage)
depression and suicide
mania
82
What are the 7 organic causes of a depression
```
Addisons
b12 deficiency
corticosteroids
cushings syndrome
hypothyroidism
hypo/hyperparathyroidism
SLE
```
83
what are the organic causes of mania
corticosteroids
cushings
hypothyroid
84
what are the 5 organic causes of psychosis?
```
Acute porphyria
corticosteroids
cushings
hypothyroid
SLE
```
85
What are the 5 organic causes of anxiety
```
arythmias
caffeine
hypoglycaemia
hyperthyroid
phaeo
```
86
What are the 6 organic causes of dementia?
```
Addisons disease
b12 deficiency
cushings
folate deficiency
hypothyroid
hypo/hyper parathyroidism.
```
87
What is autoprosopagnosia
inability to recognise onselef in the mirror
88
what is sun downing and who gets it?
worseing of confusion as evening draws in - dementia
89
what is the most important feature in diagnosing dementia
interfereance with ADLs.
| small mistakes in ADLs become more and more frequent.
90
What is found in alzheimers plaques?
beta amyloid core with surrounding dystrophic neuritis with hyperphosphylated tau protein. this also forms intercellular neurofibrillary tangles (NFTs)
91
what is prosopagnosia
inability to recognise faces
92
what are the 4A's of alzheimers presentation?
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
what is the pathology of alzhgeimers
```
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
what is strategic infarct demantia
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
what is a lewy body maed up of?
lewy bodies are eosinophilic intracytoplasmic neuronal structures made up of alpha synuclein and ubiquitin
96
where are lewy bodies found in parkinsons and lewy body dementia
PD: brainstem
DLB: cingulate gyrus and the neocortex
97
why should you avoid antipsychotics in DLB?
increases mortality
98
What are the risk factors for alzheimers?
Age
FHx
low IQ and poor education
head injury and vsascular risk factors
99
What are the genes involved in Alzheimer susceptibility
EARLY ONSET:
presenilin 1 and 2
beta amyloid precursor protein (APP)
LATE ONSET:
apolipoprtein allele E4 - also assocaited with arteriosclerosis.
100
What are the additional features of DLB
syncope
autonomic instability
recurrent falls
neuroleptic sensitivity
101
what is pseudodementia?
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
what is an obsession
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
what is a compulsion
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
What are the features exhibited in PTSD
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
what are the expected time frames of adjustment disorder
1 month to 6 months - support is all that is needed
106
who is more at risk of experiecning medically unexplained symptoms?
women, shorter duration of formal education. adverse events in childhood
107
what is ME?
myalgic encephalomyelitis or chronic fatigue syndrome.
extreme fatigue
aches and pains
mx = cbt and exercise
108
what is malingering?
feigning symptoms to gain external reward. e.g getting out of military servce
109
how do you distinguish picks disease with fronto temporal dementia?
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
factors of poor prognosis in schizophrenia?
slow/gradual onset
male
young age at onset
lack of mood symptoms
111
what are the long term consequences of a raised prolactin
osteoporosis
112
what is a metonym
an existing word used in an unusual way
113
How do you distinguish hypomania?
affects daily life but not assocaited with psychotic symptoms or SEVERE disruption
114
hwo would agitated depression present?
irritable and anxioous but not with elevated or manic symptoms
115
risk factors for suicide?
have they tried before
male
unemployment
OCD is apparently protective. age is not a factor as is equal accross the board.
116
what is nihilism
nihilism is a psychological feature of depression characterized by
an overwhelming feeling of hopelessness and negativity which may
amount to delusional intensity
117
what is dysthmia
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
biological treatment in OCD
SSRI
119
what are conversion disorders also known as
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
What are the theories behind anxious disorders?
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
triad of DLB?
parkinsonism
fluctuating conciousness and cognition
hallucinations
(greater risk of falls)
122
What are the contraindications to ECT
RELATIVE CONTRAINDICATIONS:
Heart disease
Riased ICP
High anaesthetic risk
123
what are you at risk of with chronic kidney disease
Depression and therefore diabetes is a risk too
124
What is very late onset schizphrenia like psychosis
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
periventricular white matter lesions?
vascular dememntia
126
What is the difference between denial and repression?
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
what is systemic therapy also known as
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
Who is affected more by eating disorders
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
what is the most common eating disorder
Binge eating disorder 2.8% (lifetime)
BN:1%
AN0.6%
130
what is the genetic component in anorexia
58% heretability.
131
You are more likely to get AN if you are :
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
What are the 4 main diagnostic criteria for AN?
BMI less than 17.5
endocrine dysfunction
intended weight loss and disorted body image.
133
when would you admit anorexia
```
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
What should be paid more attention when investigating BN
electrolyte changes - because they are vomiting
135
what are the 4 features of BN?
BMI>17.5
binge eating
purging
distorted body image - usually of a reasonably normal weight with maintained menses
136
What is thrombocytosis?
lack of platelets and is common in AN
137
What is the treatment for eating disrders
SSRI
treat comorbid conditions such as depression or self harm
CBT
138
What is motivational interviewing?
empowering an individual to see the change required and give them the ocnfidence to undertake it.
139
Wjhat are the baby blues
50-75% of mothers get it and feel down day 3 doesnt usually last more than a week.
140
What percentage of mothers get postnatal depression
10%
commonly relate to the baby
use paroxitine becuase lower amount in milk
they are increased risk of PND but not depression
141
Who gets peurperal psychosis
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
What is the prognosis of puerperal psychosis?
patients recover in 6-12 weeks and there is a 1 in 3 chance of recurrance
143
What does adhd frequently coexist with?
conduct disorder
144
how many points on the MMSE would you expect someone to lose a year in dementia?
2/3 per year.
7 years is the median survival
145
What do you need to diagnose GAD
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
Why should you aska forensic history in an alcohol station?
because they may have been done for drink driving or for violence when drunk.
147
What is pathalogical drunkness
when an alcoholic dependant gets liver damage and so gets drunk really easily now rather than exhibitng the tolerance he once had
148
Why shouldnt you give IV dextrose in wernickes?
can cause brain odema without the b1. give oral afterwards
149
What monitoring does one neeed on lithium
once stabilised 3/6 monthly depending on reliability of paitent. thyroid and U+Es
150
signs of refeeding syndrome
low BP with an increase in heart rate
2 pints of milk helps with phosphate intake
151
feeding too quickly on a slowly digesting stomach does what?
causes gastric ischemia
152
important things to avoid refeeding syndrome
too much fluid
too much volume (6 meals)
too hard to digest
high phophate diet
153
What do you need to think about before diagnosing someone
Time line
| Symptoms
154
What can you not give in first line treatment for schizophrenia?
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
What are the main side effects of SSRI's
nausea vomiting, insomnia, irritability, anxiety
156
Which EPSEs should you treat with procyclidine?
acute dystonias and you can use them in parkinsons too. they should not be used in tardive dyskinesias
157
What would you expect to see in huntingtons disease?
chorea
athetosis (involuntary writhing movements)
dementia
depression
affects women and men equally
Autosomal dominant
more likely to get younger in
158
What condition has a better prognosis in the developing world?
schizophrenia
159
What disease has a 60-70 percent monozygotic concordance rate?
schizophrenia
160
peak age of onset of depression?
late 30's
161
which disorder confers no inheritability?
agoraphobia
