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Oishi's 5th year flashcards > Hard to recall Psych > Flashcards

Hard to recall Psych Flashcards

1
Q

How many units of alcohol in a pint?

A

2

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2
Q

How many units of alcohol in a small glass of wine (175ml)

A

1.5

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3
Q

Which section allows police to detain someone in a public place?

A

136

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4
Q

Which section allows police to detain someone in their own home?

A

135

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5
Q

How long must psychotic symptoms last to consider a diagnosis of schizophrenia?

A

At least 1 month

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6
Q

List some drugs which cause erectile dysfunction

A 
TCAs
BDZs
SSRIs
Beta-blockers
Anti-histamines
Anti-parkinsonians
Statins
Oestrogens
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7
Q

Indications for ECT?

A

Severe depression
Puerperal depression
Mania
Catatonic schizophrenia

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8
Q

Absolute contra-indications for ECT?

A

Raised ICP

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9
Q

Relative contra-indications for ECT?

A

High anaesthetic risk

Known cerebral aneurysm

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10
Q

Action of typical antipsychotics on which pathway improves psychotic symptoms?

A

Mesolimbic

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11
Q

Action of typical antipsychotics on which pathway worsens negative symptoms?

A

Mesocortical

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12
Q

Action of typical antipsychotics on which pathway causes hyperprolactinaemia?

A

Tuberoinfundibular

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13
Q

Action of typical antipsychotics on which pathway causes extrapyramidal symptoms?

A

Nigrostriatal

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14
Q

What are the anticholinergic side effects of typical antipsychotics?

A

Increased QT interval
Arrhythmias
Cardiac arrest

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15
Q

Name some specific side effects of chlorpromazine

A

Greying of skin in response to sunlight

Reduced seizure threshold

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16
Q

6 Key features of Lewy body dementia?

A 
Day to day fluctuation of cognitive function
Visual hallucinations
Sleep disturbance
Transient loss of consciousness
Recurrent falls
Parkinsonian features
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17
Q

5 hallmarks of Parkinson’s?

A 
Tremor
Shuffling gait
Bradykinesia
Rigidity
Postural instability
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18
Q

Schneider’s first rank symptoms?

A

Delusional perception
Auditory hallucination (3rd person)
Passivity
Thought disorder (broadcasting, insertion, withdrawal)

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19
Q

Positive symptoms of schizophrenia?

A

Hallucinations
Delusions
Thought disorder

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20
Q

Negative symptoms of schizophrenia

A

Blunted affect
Anhedonia
Loss of interest in others or initiative
Reduced speech

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21
Q

Lifetime prevalence of depression in women?

A

20-25%

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22
Q

Lifetime prevalence of depression in men?

A

7-12%

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23
Q

Population prevalence of schizophrenia?

A

1%

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24
Q

Lifetime prevalence of schizophrenia?

A

1.45%

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25
Q

A score above what is considered normal cognitive function on MMSE?

A

> 27

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26
Q

What is considered mild, moderate and severe cognitive impairment on MMSE?

A

Mild: 21-24
Moderate: 10-20
Severe: <10

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27
Q

3 features of stupor?

A

Unresponsive
Akinetic
Mute

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28
Q

What is Amok?

A

Dissociative disorder typically in South East Asia esp. Malaysia
Acquisition of a weapon and frenzied killing
Followed by stupor/sleep for 1 day
Amnesia of events

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29
Q

What is Koro?

A

Chinese

Fear that penis is retracting into abdomen

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30
Q

What is Dhat?

A

Indian
Anxiety and belief semen is being lost in urine
Guilt about masturbation

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31
Q

What is Latah?

A

North African
Exaggerated startle response with echolalia or obeying commands
Frequently followed by amnesia

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32
Q

What is Susto?

A

South America

Depression after traumatic event - similar to acute stress reaction

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33
Q

Criteria for mood stabilisers in bipolar?

A

More than 1 episode of mania

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34
Q

Which section allows a doctor to hold a patient who is an inpatient?

A

5.2

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35
Q

How long is a 5.2 valid?

A

72 hours

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36
Q

Symptoms of neuroleptic malignant syndrome?

A

Pyrexia
Fluctuating consciousness
Muscle rigidity
Autonomic instability

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37
Q

Blood results with neuroleptic malignant syndrome?

A

Raised creatine kinase
Raised WCC
Deranged LFTs

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38
Q

Mx of neuroleptic malignant syndrome?

A
  1. Stop precipitating anti-psychotic
  2. BDZs
  3. Supportive measures - lower body temp, oxygen, fluids
  4. IV sodium bicarb - rhabdomyolysis
  5. Dantrolene - malignant hyperthermia
  6. lorazapam - reduce rigidity and agitation
  7. Bromocriptine - reverse dopamine blockade
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39
Q

What syndrome describes someone being able to disguise themselves to look like many people?

A

Fregoli syndrome

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40
Q

What syndrome describes someone of higher status being in love with them?

A

De Clerambault’s

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41
Q

What syndrome describes men experiencing symptoms of pregnancy around the time of their child’s birth?

A

Couvade syndrome

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42
Q

What syndrome describes someone being replaced by a doppleganger?

A

Capgras syndrome

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43
Q

Risk factors for PTSD?

A 
Low education
Low social class
Afro-caribbean/Hispanic
Female
Low self-esteem
Personal or family history of psych problems
Prior trauma
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44
Q

What characterises hebephrenic schizophrenia?

A

Disorganised speech and thoughts
Flat affect
Shallow and inappropriate emotional responses

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45
Q

What characterises simple schizophrenia?

A

Gradual decline in functioning

Negative symptoms without positive symptoms

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46
Q

Symptoms of serotonin syndrome?

A 
Severe HTN
Tachycardia
High pyrexia
Myoclonus
Sweating
Hyperreflexia
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47
Q

What drugs may contribute to serotonin syndrome?

A 
SSRIs
MAOIs
Opioids
Cocaine/meth
Lithium
Metoclopramide
St John's Wort
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48
Q

What is logoclonia?

A

Repeating the last syllable of a word

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49
Q

What is palilalia?

A

Repeating a whole word

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50
Q

What is perserveration?

A

When mental operations are continued beyond when they are relevant
Examples include palilalia and logoclonia

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51
Q

What is Rett syndrome?

A

Neurodevelopmental disorder similar to autism

Normal development followed by decline after 1-2 years old

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52
Q

Behaviour in Rett syndrome?

A 
Screaming attacks
Avoidant eye contact
Poor social interaction
Loss of fine motor skills
Stereotyped hand movements
Ataxia
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53
Q

After an act of self-harm what is the risk of completed suicide within the next year?

A

1%

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54
Q

Risk factors for suicide?

A 
Male
Age>45
Divorced, single, widowed
Unemployed
High or low social class
Psychiatric illness
Previous self-harm
Chronic physical illness
Recent adverse life events
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55
Q

What section can an A&E doctor use and how long is it valid?

A

Section 4

72 hours

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56
Q

What is piblokto?

A

Inuit women
Sudden hysteria and bizarre behaviour
May be due to Vit A toxicity

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57
Q

What is windigo?

A

North American tribes
Believe body is possessed by spirit which craves human flesh
Obsessions and compulsions about cannibalism

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58
Q

What drug is preferable to treat delirium tremens in patients with hepatic failure?

A

Lorazepam

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59
Q

Which SSRI is most likely to lead to QT prolongation and Torsades de Pointes

A

Citalopram

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60
Q

What risks do SSRIs pose in first trimester and third trimester of pregnancy?

A 
First = congenital heart defects
Third = persistent pulmonary hypertension of the newborn
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61
Q

What does paroxetine increase the risk of in the first trimester?

A

Increased risk of congenital cardiac malformations

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62
Q

What electrolyte abnormality are SSRIs associated with?

A

Hyponatraemia

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63
Q

What type of incontinence do TCAs cause?

A

Overflow incontinence due to anticholinergic effect

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64
Q

What is an affect illusion?

A

one in which a perception is altered depending on the mood state

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65
Q

What is a complete illusion?

A

when there is a lack of attention, and a perception is ‘incorrectly’ interpreted

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66
Q

What is a paraidolic illusion?

A

consist of shapes being seen in other objects

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67
Q

What is an extracampine hallucination?

A

one which occurs beyond the usual

range of sensation

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68
Q

What is a functional hallucination?

A

when a hallucination is experienced only when

an external stimulus is present in the same modality

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69
Q

What is a hypnagogic hallucination?

A

Occurs on falling asleep

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70
Q

What is a hypnopompic hallucination?

A

Occurs on waking up

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71
Q

What is a reflex hallucination?

A

similar to functional hallucinations but

the stimulus is in a different modality to the hallucination

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72
Q

What is a delusional atmosphere?

A

AKA delusional mood
the state of perplexity or bewilderment in which sufferers feel that something is ‘going on’ but without being able to state exactly what

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73
Q

What are the 4 features of Gerstmann’s syndrome? And which lobe is affected?

A
  1. ‘Left-right’ disorientation
  2. Dyscalculia (inability to perform arithmetical tasks)
  3. Finger agnosia (inability to distinguish the fingers on the hand)
  4. Agraphia (inability to write).
    Parietal lobe injury
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74
Q

Where would tumours with symptoms of confabulation and amnesia most likely be?

A

Wall/floor of third ventricle

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75
Q

What is pellagra?

A

Niacin deficiency

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76
Q

Symptoms of pellagra?

A

GI - diarrhoea, gastritis, anorexia

Psych - apathy, depression, irritability

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77
Q

What is temporal lobe epilepsy associated with?

A

psychological and psychiatric symptoms such as aura, sensory disturbances and depersonalization or derealization

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78
Q

What might precipitate an attack of acute intermittent porphyria?

A

menstruation
alcohol
poor nutrition
ocp

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79
Q

Side effects of aripiprazole?

A

Nausea

Insomnia

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80
Q

How can a diagnosis of schizoaffective disorder be made?

A

Symptoms of psychosis and mood symptoms present at the same time

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81
Q

Define dysthymia?

A

Chronic low grade mood disorder

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82
Q

How is brucellosis transmitted?

A

unpasteurized goat’s milk or contact with infected animals

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83
Q

What drug class is mirtazapine?

A

NaSSA

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84
Q

Incidence of OCD in men vs women?

A

1:1

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85
Q

MRI findings in Alzheimer’s

A

Loss of volume in hippocampus
generalized cerebral atrophy
enlarged ventricles
prominent sulci

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86
Q

Triad in Lewy Body dementia?

A

visual hallucinations
fluctuating cognitive impairment
parkinsonism.

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87
Q

In older people what type of drugs increase in their duration of action and why?

A

BDZs

Higher body fat proportion increases volume of distribution

88
Q

Drugs which cause priapism?

A

Trazodone

Chlorpromazine

89
Q

Define frotteurism

A

the paraphilic activity of touching and

rubbing against another person’s body for sexual pleasure

90
Q

Define Kleine–Levin syndrome

A

characterized by distinct periods of extreme

somnolence and excessive hunger

91
Q

Define Time zone change syndrome

A

characterized by difficulty initiating

and maintaining sleep as well as daytime fatigue

92
Q

How long must substance misuse go on to claassify as harmful use?

A

1 month

93
Q

Wernicke’s encephalopathy triad?

A

ataxia, confusion and ophthalmoplegia

94
Q

Define Marchiafava–Bignami disease

A

a progressive neurological condition characterized by corpus callosum demyelination associated with chronic alcoholism

95
Q

Acute psychological effects of cocaine?

A

increased alertness, formication, euphoria, irritability, delusions and hallucinations.

96
Q

Similarities and differences between autism and aspergers?

A 
Similarities:
Intense interest in restricted things
Abnormal social interaction
Motor clumsiness
Differences:
Aspergers has no language delay or cognitive difficulties
97
Q

IQ classifications for learning disabilities?

A

Mild 50-70
Moderate 35-49
Severe 20-34
Profound <20

98
Q

What therapy is good for depression resulting from loss?

A

Interpersonal therapy

99
Q

Incidence of baby blues?

A

50-75%

100
Q

AUDIT score cut offs?

A 
1-7 = low risk consumption
8-14 = hazardous or harmful alcohol consumption 
15+ = alcohol dependence
101
Q

Neuroleptic malignant syndrome Tx?

A

Dantrolene

102
Q

List some symptoms of SSRI discontinuation syndrome

A 
increased mood change
restlessness
difficulty sleeping
unsteadiness
sweating
gastrointestinal symptoms: pain, cramping, diarrhoea, vomiting
paraesthesia
103
Q

Signs of opioid withdrawal?

A 
Dilated pupils
Yawning
Rhinorrhoea
Epiphora
Agitation
Sweating
Piloerection
Vomiting
Shivering
Tachycardia
104
Q

Tx for amitriptyline OD?

A

Bicarbonate (causes metabolic acidosis)

105
Q

How does renewing a section 3 work?

A

First time you renew: 6 months

After that can extend by 1 year

106
Q

What constitutes a somatic syndrome of depression?

A 
At least 4 of the following 8 biological symptoms:
Anhedonia
Decreased emotional reactivity
Early morning wakening
Diurnal variation
Agitation
Decreased appetite
Weight loss >5% in one month
Reduced libido
107
Q

What is the proportion of people with completed suicide who have seen the GP in the last month?

A

66%

108
Q

What is the annual incidence of suicide?

A

1 in 10,000

109
Q

What is the annual incidence of self-harm?

A

3 in 1000

110
Q

What is Ganser’s syndrome?

A

Factitious disorder when people give approximate answers to questions to try and look psychotic e.g. how many legs does a donkey have? They say 12 rather than chicken wings

111
Q

Tx for akathisia?

A

Low dose propranolol or lorazepam

112
Q

When are Z drugs used?

A

Short term management of insomnia

113
Q

3 talking therapies adults with anorexia can be offered? What can be offered if all 3 are ineffective

A

eating disorder-focussed CBT
MANTRA
SSCM
Offer focal psychodynamic therapy

114
Q

Prescribing rules of MAOIs?

A

Only by a mental health specialist

2-week washout period beforehand

115
Q

What is excited delirium?

A 
Rare complication of cocaine/drug intoxication:
Profuse sweating
Delirium
Hallucinations
Super human strength
116
Q

Which antidepressants are most associated with discontinuation syndrome?

A

Paroxetine

Venlafaxine

117
Q

Features of BDZ withdrawal?

A 
Insomnia
Agitation
Anxiety
Tremor
Tinnitus
Sweating
118
Q

Preferred SSRI in OCD? If unsuccessful what should you try?

A

Fluoxetine

If after 12 weeks not working try another SSRI or clomipramine (TCA)

119
Q

2 paediatric iq tests?

A

Wechsler Preschool and Primaryn Scale of Intelligence (WPPSI) 2-7 years
Wechsler Intelligence Scale for Children (WISC) 6-16 years

120
Q

Which hypnotics are recommended for insomnia causing day time impairment?

A

Temazepam

Zopiclone

121
Q

Which screening tools can be used to assess severity of social phobia?

A

Social phobia inventory (SPIN)

Liebowitz social anxiety scale

122
Q

What scale is used to assess suicide risk?

A

SADPERSONs

123
Q

What falls under dissociative disorders?

A

disorders of physical functions under voluntary control

loss of sensation

124
Q

When should paracetamol level be measured in OD?

A

4 hours after ingestion

125
Q

4 subtypes of behaviours in conduct disorder?

How long and how many do you need for a diagnosis?

A 
Aggression to people and animals
Destruction of property
Deceitfulness or theft
Serious violations of rules
3 out of 4 needed for at least 12 months and impair functioning
126
Q

When can oppositional defiant disorder be a differential?

A

Age <11 years

127
Q

1st and 2nd line treatments for prevention of relapse in alcohol withdrawal?

A
  1. Acamprosate and naltrexone - anti-craving effect

2. Disulfiram - immediate hangover

128
Q

What to do if patient does not meet criteria for ADHD but it is suspected?

A

10 week watch and wait period

129
Q

Tx for assisted heroin withdrawal?

A

Oral methadone
Sublingual buprenorphine
Lofexidine (alpha-2 agonist)

130
Q

What do NICE recommend monitoring for patients starting on an SNRI and when should this be done?

A

BP (associated with HTN)

At initiation and after each dose titration

131
Q

What can some people starting SSRIs be at high risk of and when should it be monitored?

A

Hyponatraemia

U&Es before tx, 2-4 weeks after starting tx and every 3 months after

132
Q

What antidepressant do NICE recommend to people on warfarin/heparin?

A

Mirtazapine

133
Q

Which patients should be reviewed a week after starting antidepressants?
When should everyone else be reviewed?

A

Under 30 years old
High suicide risk
Everyone else after 2 weeks

134
Q

SEs of clozapine?

A

agranulocytosis (1%), neutropaenia (3%)
reduced seizure threshold - can induce seizures in up to 3% of patients
constipation
myocarditis: a baseline ECG should be taken before starting treatment
hypersalivation
PE

135
Q

Smoking cessation causes a rise in blood levels of which drug?

A

Clozapine

136
Q

Which SSRI specifically for body dysmorphic syndrome?

A

Fluoxetine

137
Q

How long should SSRI tx be continued in OCD if successful?

A

12 months

138
Q

When do fasting blood glucose and prolactin need to be monitored in patients on atypical antipsychotics?

A

at the start of therapy
at 6 months
annually

139
Q

When do lipids and weight need to be monitored in patients on atypical antipsychotics?

A

at the start of therapy
at 3 months
annually

140
Q

Which drugs increase lithium levels and therefore should be avoided?

A

NSAIDs
ACEi and thiazide diuretics
SSRIs
Anti psychotics

141
Q

Blood abnormalities with valproate and carbamazepine?

A

Leukopenia
Thrombocytopenia
Abnormal LFTs (valproate)

142
Q

Relative contraindications to AChEIs?

A

GI disease
Recent pancreatitis
CVS disease: bradycardia, sick sinus syndrome, AV block, asthma, COPD

143
Q

Mx of BPSD? How long can you give it for? What does it increase risk of?

A

Risperidone
12 weeks
Increased stroke risk x3

144
Q

What are neonates with mother’s on olanzapine during pregnancy monitored for?

A 
Agitation
Feeding problems
Resp distress
Tremor
Hyper/hypotonia
Drowsiness
145
Q

Antidepressants post-partum?

A
  1. SSRIs

2. TCAs

146
Q

1st line antipsychotics post-partum?

A

Olanzapine but must stop breast feeding

147
Q

Prolonged QTc in man and woman?

A

Men >440ms

Women >460ms

148
Q

New SNRI good for reducing sexual dysfunction side effects?

A

Reboxetine

149
Q

Psychological therapies for bipolar?

A

DBT

Mentalisation based therapy

150
Q

Risk factors for the development of GAD?

A

Aged 35- 54
Being divorced or separated
Living alone
Being a lone parent

151
Q

How should SSRIs be discontinued?

Which is an exception?

A

gradually reduced over a 4 week period

Fluoxetine due to longer half life

152
Q

Lack of which neurotransmitter causes anhedonia?

A

Dopamine

153
Q

Mnemonic for negative symptoms of schizo?

A

L Loss of volition, underactivity and social withdrawal
E Emotional flatness, lose normal modulation of mood
S Speech is reduced, monosyllabic if at all
S Slowness in thought and movement, psychomotor retardation may occur

154
Q

Mnemonic for positive symptoms of schizo?

A

T Thinking may become disturbed, neologism usage
H Hallucinations may occur, usually auditory
R Reduced contact with reality, the natural barrier between subjective and objective deteriorates
E Emotional control may be disturbed with inappropriate laughter or anger (incongruous affect)
A Arousal may lead to worsening of symptoms
D Delusions may occur

155
Q

Where can a DoLS be applied?

A

If a patient lives in a care home/is currently admitted to hospital

156
Q

Early symptoms of vascular dementia?

A

Gait disturbance
Urinary symptoms
Change in mood and concentration

157
Q

What is interpersonal therapy for?

A

To explore reasons/circumstances contributing to depression

158
Q

What is paroxetine licensed for use as?

A

SSRI in major depression

159
Q

What would be seen on PET scan of a patient with schizophrenia?

A

Hypoactivity of frontal lobes and enlarged cerebral ventricles

160
Q

Target lithium levels?

A
  1. 8-1.0mM/L (acute mania)

0. 6-1.0mM/L (prophylaxis)

161
Q

Lithium toxicity symptoms?

A 
Tremor
GI upset
Polyuria/polydipsia - feeling dry
Psoriasis
Weight gain
Hypothyroidism/DI long term
162
Q

Besides BPD when is lithium used?

A

Augmentation therapy in tx-resistant depression

163
Q

ICD 10 classifications for depression severity

A

Mild: 4
Moderate: 5-6
Severe: 7+

164
Q

Exception to EMDR in PTSD?

A

Combat related trauma

165
Q

Which of clozapine’s side effects is dose dependent?

A

Seizure threshold

166
Q

What is ekbom syndrome?

A

Delusion that you are infested with parasites

167
Q

Metabolic/physiological derangements in anorexia?

A 
hypokalaemia
low FSH, LH, oestrogens and testosterone
raised cortisol and growth hormone
impaired glucose tolerance
hypercholesterolaemia
hypercarotinaemia
low T3
168
Q

Time frames for adjustment disorder?

A

starts within 3 months of event

duration <6 months

169
Q

What is seen on MRI of a patient with vascular dementia?

A

Lacunar lesions

170
Q

Features of friedrich’s ataxia? Age of presentation?

A 
Ataxia
Dysarthria/dysphagia
Talipes/MSK problems
HOCM
DM
Presents in childhood/adolescence
171
Q

Risk of schizo if family member affected?

A

1st degree relative is 1/10

twin is 50%)

172
Q

Assisted alcohol withdrawal - where and what?

A

Mild dependence: not needed
Moderate dependence: community assisted
Severe dependence: inpatient
Fixed dose reducing regimen of chlordiazepoxide

173
Q

Exceptions to community assisted withdrawal in moderate alcohol dependence?

A

high risk of developing alcohol withdrawal seizures or delirium tremens
decompensated liver disease

174
Q

Symptoms of frontotemporal degeneration?

A 
personality and behaviour changes 
language problems 
problems with mental abilities 
memory problems 
physical problems: slow/stiff movements, loss of bladder or bowel control, muscle weakness or difficulty swallowing
175
Q

When does frontotemporal degeneration present?

A

Age 45-60

176
Q

Difference between korsakov’s and wernicke’s encephalopathy?

A

Korsakov’s: short term memory loss + confabulation

Wernicke’s: confusion + nystagmus + 6th nerve palsy

177
Q

How long must symptoms have lasted for a diagnosis of somatisation syndrome?

A

2 years

178
Q

What should you do if a person with known BPD on antidepressants and antipsychotics becomes manic?

A

Stop the antidepressants immediately

179
Q

Risks of lithium in pregnancy?

A

Ebstein’s anomaly

Wolf parkinson white

180
Q

3 psychopathological hallmarks of autism?

A

Difficulties with reciprocal social interactions
Difficulties with speech and communication
Restricted stereotyped, repetitive behaviours

181
Q

Extrapyramidal side effects of antipsychotics? Tx for them?

A

Dystonia - procyclidine
Akathisia - beta blocker
Parkinsonism
Tardive dyskinesia - tetrabenazine

182
Q

4 rating scales used to assess alcohol use/dependence?

A

AUDIT to identify use disorder
SADQ to determine severity of dependence
CIWA-Ar for severity of withdrawal
APQ to assess then nature of problems arising from alcohol

183
Q

FRAMES structure for motivational interview?

What should be covered?

A

feedback, responsibility, advice, menu, empathy, self-efficacy
Cover potential harm caused by their level of drinking and reasons for changing the behaviour (inc health/wellbeing benefits)
Identify barriers to change
Outline practical strategies to help reduce alcohol consumption (to address ‘menu’ component of FRAMES)
Lead to a set of goals

184
Q

ICD10 criteria for alcohol dependence? How many do you need?

A
  1. Compulsion/strong desire to drink
  2. hard to control consumption
  3. Withdrawal symptoms on stopping
  4. Tolerance
  5. Neglecting other activities
  6. Persisting despite clear evidence of harmful consequences

At least 3 at once during the past year needed for diagnosis

185
Q

NICE recommended cognitive tools in dementia?

A

10-point Cognitive Screener (10-CS)
6-item Cognitive Impairment Test (6CIT)
Memory Impairment Screener (MIS)
Mini-Cog

186
Q

Which class of drug inhibits serotonin re-uptake at pre-synaptic terminals only?

A

SSRIs

187
Q

Which class of drug inhibits serotonin and norepinephrine re-uptake?

A

SNRIs

188
Q

Which class of drug competitively inhibits MAO receptors?

A

MAOIs

189
Q

Which class of drug inhibits serotonin re-uptake at pre-synaptic terminals and acts as a serotonin antagonist?

A

Serotonin modulators (trazodone)

190
Q

Which class of drug inhibits dopamine re-uptake at pre-synaptic terminals and has a weak effect on norepinephrine?

A

Dopamine and norepinephrine reuptake inhibitors (bupropion)

191
Q

Which class of drug blocks presynaptics alpha-2-adrenergic receptors thus leading to an increase in NA and serotonin? What other action do they have?

A

NaSSA

Also block post synaptic 5HT2 and 5HT3 receptors

192
Q

Which class of drugs inhibit NA and serotonin reuptake in presynaptic terminals?

A

TCAs

193
Q

What to do in paracetamol overdose?

A

If ingestion less than 1 hour ago + dose >150mg/kg: Activated charcoal
If staggered overdose or ingestion >15 hours ago: Start N-acetylcysteine immediately
If ingestion <4 hours ago: Wait until 4 hours to take a level and treat with N-acetylcysteine based on level
If ingestion 4-15 hours ago: Take immediate level and treat based on level

194
Q

Symptoms of refeeding syndrome? What do you see on initial bloods?

A

Oedema, confusion and tachycardia

Hypophosphataemia

195
Q

Triad in normal pressure hydrocephalus?

What would you see on CT head?

A

Urinary incontinence
Gait dysfunction
Dementia
Enlarged ventricles and absent sulci

196
Q

Delirium mnemonic?

A

D - Drugs and Alcohol (Anti-cholinergics, opiates, anti-convulsants, recreational)
E - Eyes, ears and emotional
L - Low Output state (MI, ARDS, PE, CHF, COPD)
I - Infection
R - Retention (of urine or stool)
I - Ictal
U - Under-hydration/Under-nutrition
M - Metabolic (Electrolyte imbalance, thyroid, wernickes
(S) - Subdural, Sleep deprivation

197
Q

Which hay fever drug can cause delirium in elderly?

A

Chlorphenamine (1st gen H1 antagonist + anticholinergic activity)

198
Q

Good prognostic indicators in schizophrenia?

A 
High IQ/education level
Sudden onset
Obvious precipitating factor such as a traumatic life event
A strong support network
Positive symptoms predominant
199
Q

1st line Tx for alzheimer’s if mild, moderate and severe?

A

Mild - moderate: donepezil or rivastigmine

Moderate - severe: memantine

200
Q

MMSE score and AD severity?

A

mild AD: MMSE 21–26
moderate AD: MMSE 10–20
moderately severe AD: MMSE 10–14
severe AD: MMSE less than 10.

201
Q

Alpha-synuclein cytoplasmic inclusions?

A

Lewy body dementia

202
Q

Spongiotic changes and neuronal death

A

sporadic CJD

203
Q

SEs of anticholinesterase drugs?

A 
Diarrhoea
N&V
bradycardia
increased saliva
urinary incontinence
204
Q

3 hallmarks of anorexia in DSM5?

A
  1. Restriction of energy intake relative to requirements leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health.
  2. Intense fear of gaining weight or becoming fat, even though underweight.
  3. Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight.
205
Q

DSM 5 criteria for bulimia?

A

Recurrent episodes of binge eating (eating an amount of food that is definitely larger than most people would eat during a similar period of time and circumstances)
A sense of lack of control over eating during the episode
Recurrent inappropriate compensatory behaviour in order to prevent weight gain, such as self-induced vomiting, misuse of laxatives, diuretics, or other medications, fasting, or excessive exercise.
The binge eating and compensatory behaviours both occur, on average, at least once a week for three months.
self-evaluation is unduly influenced by body shape and weight.
The disturbance does not occur exclusively during episodes of anorexia nervosa

206
Q

What are the 4 main diagnostic criteria of anorexia in ICD10?

A
  1. BMI <17.5
  2. Deliberate weight loss
  3. Distorted body image
  4. Endocrine dysfunction
207
Q

Questionnaire for eating disorders? What are the qs?

A

SCOFF questionnaire:
Do you make yourself Sick because you feel uncomfortably full?
Do you worry you have lost Control over how much you eat?
Have you recently lost more than One stone in a 3 month period?
Do you believe yourself to be Fat when others say you are too thin?
Would you say that Food dominates your life?

208
Q

Electrolyte imbalance in refeeding?

A

low phosphate, potassium and magnesium - KPMG

209
Q

Charity to recommend for eating disorders?

A

BEAT

210
Q

How to withdraw from benzos?

A

In steps of 1/8th daily dose every fortnight

211
Q

Questionnaire for childhood depression?

A

Childhood depression index

212
Q

Which childhood syndromes cause learning difficulties?

A

Fragile X
Cri du Chat
William’s
Down’s

213
Q

List 3 educational/behavioural interventions that might be useful in ASD?

A

Applied behavioural analysis (young children)
Early start denver model
More than words (Hanen programme)

214
Q

3 features of ED-CBT

A

Control
Low self-esteem
Perfectionism
40 sessions over 40 weeks

215
Q

What medication can be given short term to a LD patient with challenging behaviour?

A

Risperidone

Oishi's 5th year flashcards (8 decks)

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