High Yield Psychiatry Flashcards
A 19-year-old female visits her GP with low mood. This has been present for multiple months, with reduced concentration and tiredness. However, she also finds herself waking early each morning and
being unable to get back to sleep. She feels hopeless about the future and no longer enjoys seeing her friends. Her largest concern is that the symptoms significantly affect her university work.
She denies any thoughts of suicide and there are no psychotic features on examination. She does not use drugs, alcohol or smoke.
What would be the most appropriate treatment?
A. Trial amitriptyline
B. Trial fluoxetine with high intensity psychological intervention C. Refer for individual guided self-help
D. Same day referral to mental health services
E. Watch and wait for 2 weeks
Trial fluoxetine combined with psychological intervention
A 19-year-old female visits her GP with low mood. This has been present for multiple months, with reduced concentration and tiredness. However, she also finds herself waking early each morning and
being unable to get back to sleep. She feels hopeless about the future and no longer enjoys seeing her friends. Her largest concern is that the symptoms significantly affect her university work.
She denies any thoughts of suicide and there are no psychotic features on examination. She does not use drugs, alcohol or smoke.
What would be the most appropriate treatment?
A. Trial amitriptyline
B. Trial fluoxetine with high intensity psychological intervention C. Refer for individual guided self-help
D. Same day referral to mental health services
E. Watch and wait for 2 weeks
Trial fluoxetine combined with psychological intervention
mild, mod, severe depression
medication for depressio
Sarah Jones is a 27-year-old woman with a known history of depressive disorder. You are working with the community mental health team when she presents with her wife. You find out that Sarah hasn’t been sleeping for the last week since she has been ‘working on a cure for COVID-19’ in her basement. Her speech is pressured and she appears very active, running around the room performing star jumps. Her wife says that she has been like this for 7 days. She is currently on sertraline after a previous depressive episode 5 months ago. History does not reveal any risk to self or others.
What’s the likely diagnosis and most appropriate first step in management?
A. Schizotypal personality disorder refer to the home treatment team.
B. Schizophrenia refer to the emergency department.
C. Bipolar - stop sertraline
D. Schizophrenia begin an antipsychotic
E. Mania urgent referral to the community mental health team.
Bipolar - stop sertraline
medication for depressio
Sarah Jones is a 27-year-old woman with a known history of depressive disorder. You are working with the community mental health team when she presents with her wife. You find out that Sarah hasn’t been sleeping for the last week since she has been ‘working on a cure for COVID-19’ in her basement. Her speech is pressured and she appears very active, running around the room performing star jumps. Her wife says that she has been like this for 7 days. She is currently on sertraline after a previous depressive episode 5 months ago. History does not reveal any risk to self or others.
What’s the likely diagnosis and most appropriate first step in management?
A. Schizotypal personality disorder refer to the home treatment team.
B. Schizophrenia refer to the emergency department.
C. Bipolar - stop sertraline
D. Schizophrenia begin an antipsychotic
E. Mania urgent referral to the community mental health team.
Bipolar - stop sertraline
Mania vs hypomania
Mania is abnormally elevated mood or irritability, with severe functional impairment or psychotic symptoms for 7 days or more.
Hypomania
describes decreased or increased function for 4 days or more.
Mania management
Consider stopping antidepressant if the patient takes one; antipsychotic therapy e.g. olanzapine or haloperidol
Sarah Jones is a 27-year-old woman with a known history of depressive disorder. You are working with the community mental health team when she presents with her wife. You find out that Sarah hasn’t been sleeping for the last week since she has been ‘working on a cure for COVID-19’ in her basement. Her speech is pressured and she appears very active, running around the room performing star jumps. Her wife says that she has been like this for 7 days. She is currently on sertraline after a previous depressive episode 5 months ago. History does not reveal any risk to self or others.
What’s the likely diagnosis and most appropriate first step in management?
A. Schizotypal personality disorder refer to the home treatment team.
B. Schizophrenia refer to the emergency department.
C. Bipolar - stop sertraline
D. Schizophrenia begin an antipsychotic
E. Mania urgent referral to the community mental health team.
Bipolar - stop sertraline
Mania vs hypomania
Mania is abnormally elevated mood or irritability, with severe functional impairment or psychotic symptoms for 7 days or more.
Hypomania
describes decreased or increased function for 4 days or more.
Mania management
Consider stopping antidepressant if the patient takes one; antipsychotic therapy e.g. olanzapine or haloperidol
medication for depressio
Bipolar
Bipolar disorder is a chronic mental health disorder characterized by periods of mania/hypomania alongside episodes of depression.
Main treatment is lithium which is a mood stabilizer.
Lithium monitoring
- when checking lithium levels, the sample should be taken 12 hours post- dose
- after starting lithium levels should be performed weekly and after each dose change until concentrations are stable
- once established, lithium blood level should ‘normally’ be checked every 3 months
- after a change in dose, lithium levels should be taken a week later and weekly until the levels are stable.
- thyroid and renal function should be checked every 6 months
A 27 year old man has just been diagnosed with schizophrenia. He is worried about the prognosis of this condition and wants know if he has any poor prognostic indicator for schizophrenia.
Which of the following is not a poor prognostic indicator for schizophrenia?
A. High IQ
B. Lack of obvious precipitant
C. Family history
D. Socialwithdrawalpre-datingthediagnosis.
E. Gradual onset
A. High IQ
Psychotic features include:
- hallucinations (e.g. auditory)
- delusions
- thought disorganization
1) alogia: little information conveyed by speech
2) tangentiality:answersdivergefromtopic
3) clanging
4) word salad: linking real words incoherently→ nonsensical content
Schizophrenia
The ICD-10 suggest symptoms of psychosis must be present for 1 month to = schizophrenia
Schizophrenia: management
- Oral atypical antipsychotics are first-line
- Cognitive behavioral therapy should be offered to all patients
- Close attention should be paid to cardiovascular risk-factor modification due to the high rates of cardiovascular disease in schizophrenic patients (linked to antipsychotic medication and high smoking rates)
Schizophrenia: management
- Oral atypical antipsychotics are first-line
- Cognitive behavioral therapy should be offered to all patients
- Close attention should be paid to cardiovascular risk-factor modification due to the high rates of cardiovascular disease in schizophrenic patients (linked to antipsychotic medication and high smoking rates)
Schizophrenia
The ICD-10 suggest symptoms of psychosis must be present for 1 month to = schizophrenia
Clozapine
Only use if resistant to other antipsychotics
- 1% agranulocytosis
- 3% neutropaenia
- Must monitor FBC
- ECG at baseline as can cause myocarditis
A 23 year old woman attend the emergency department with her new housemate, with open wounds from deliberate self-harm. She states she doesn’t need to be here as she “does this all the time” it’s just her housemate making a fuss. She says she had a fight with her boyfriend because he was late for a date again. She said “he said it’s because his train was delayed but he should check that beforehand”.
Which personality disorder is this patient most likely to have?
A. Antisocial.
B. Dependent
C. Borderline
D. Narcissistic
E. Histrionic
Borderline
personality disorder
personality disorder
alcohol
A 15 year old girl attend with her mother to the GP practice as her mother is worried that she has not yet start her period. Her mother says “she is first in everything else, first of her friends to start walking and first in the class”, so is concerned about this perceived delay.
Which of the following factors might make you think that the girls amenorrhoea, is the result of her suffering from Anorexia Nervosa alone?
A. Russel’s sign
B. Hypokalemia
C. Mouth ulcers
D. The present of soft hairs across most of her body.
E. A normal body weight
Lanugo hair
The present of soft hairs across most of her body.
Refeeding syndrome
- occurs in those with extended period of nutritional deficit
- higher risk if BMI <20 and little to eat for 5 days or more
Biochemical triad of
* Hypomagnasaemia
* Hypokalaemia
* Hypophosphataemia
Risk of cardiac arrhythmias, heart failure and fluid overload
eating disorders
TLS
high uric acid
high phosphate
high potassium
low calcium
section 2 vs section 3
eating disorders
Refeeding syndrome
- occurs in those with extended period of nutritional deficit
- higher risk if BMI <20 and little to eat for 5 days or more
Biochemical triad of
* Hypomagnasaemia
* Hypokalaemia
* Hypophosphataemia
Risk of cardiac arrhythmias, heart failure and fluid overload
TLS
high uric acid
high phosphate
high potassium
low calcium
section 5
