Joe Vincent Passmedicine Psychiatry Flashcards
Theme: Overdose and poisoning: management
A. N-acetylcysteine B. Urinary alkalinization C. Naloxone D. Haemodialysis E. Vitamin K F. Fomepizole G. Beta-blockers H. IV bicarbonate I. Flumazenil J. Desferrioxamine
For each of the following scenarios please select the most appropriate treatment:
A 16-year-old girl presents after ingesting 32 paracetamol tablets
A. N-acetylcysteine
Overdose and poisoning: management
The table below outlines the main management for common overdoses:
Paracetamol - Management = activated charcoal if ingested
Theme: Overdose and poisoning: management
A. N-acetylcysteine B. Urinary alkalinization C. Naloxone D. Haemodialysis E. Vitamin K F. Fomepizole G. Beta-blockers H. IV bicarbonate I. Flumazenil J. Desferrioxamine
For each of the following scenarios please select the most appropriate treatment:
A 72-year-old woman who takes warfarin for atrial fibrillation is taken to the Emergency Department due to rectal bleeding
E. Vitamin K
Overdose and poisoning: management
The table below outlines the main management for common overdoses:
Paracetamol - Management = activated charcoal if ingested
Theme: Overdose and poisoning: management
A. N-acetylcysteine B. Urinary alkalinization C. Naloxone D. Haemodialysis E. Vitamin K F. Fomepizole G. Beta-blockers H. IV bicarbonate I. Flumazenil J. Desferrioxamine
For each of the following scenarios please select the most appropriate treatment:
A 40-year-old man presents after taking an overdose of amitriptyline. His ECG on arrival shows widening of the QRS complex
H. IV Bicarbonate
Overdose and poisoning: management
The table below outlines the main management for common overdoses:
Paracetamol - Management = activated charcoal if ingested
Which one of the following is not a first-rank symptom of schizophrenia?
A. Thought broadcasting B. Visual hallucinations C. Thought withdrawal E. Delusional perceptions F. Auditory hallucinations
B. Visual hallucinations
Schizophrenia: features
Schneider’s first rank symptoms may be divided into auditory hallucinations, thought disorders, passivity phenomena and delusional perceptions:
Auditory hallucinations of a specific type:
two or more voices discussing the patient in the third person
thought echo
voices commenting on the patient’s behaviour
Thought disorder*:
thought insertion
thought withdrawal
thought broadcasting
Passivity phenomena:
bodily sensations being controlled by external influence
actions/impulses/feelings - experiences which are imposed on the individual or influenced by others
Delusional perceptions
a two stage process where first a normal object is perceived then secondly there is a sudden intense delusional insight into the objects meaning for the patient e.g. ‘The traffic light is green therefore I am the King’.
Other features of schizophrenia include
impaired insight
incongruity/blunting of affect (inappropriate emotion for circumstances)
decreased speech
neologisms: made-up words
catatonia
negative symptoms: incongruity/blunting of affect, anhedonia (inability to derive pleasure), alogia (poverty of speech), avolition (poor motivation)
*occasionally referred to as thought alienation
A 24-year-old male is admitted to the Emergency Department complaining of severe abdominal pain. On examination he is shivering and rolling around the trolley. He has previously been investigated for abdominal pain and no cause has been found. He states that unless he is given morphine for the pain he will kill himself. This is an example of:
A. Hypochondrial disorder B. Conversion disorder C. Malingering D. Munchausen's syndrome E. Somatisation disorder
C. Malingering -This is difficult as the patient may well be an opiate abuser who is withdrawing. However, given the above options the most appropriate term to use is malingering as the patient is reporting symptoms with the deliberate intention of getting morphine
Unexplained symptoms
There are a wide variety of psychiatric terms for patients who have symptoms for which no organic cause can be found:
Somatisation disorder
multiple physical SYMPTOMS present for at least 2 years
patient refuses to accept reassurance or negative test results
Hypochondrial disorder
persistent belief in the presence of an underlying serious DISEASE, e.g. cancer
patient again refuses to accept reassurance or negative test results
Conversion disorder
typically involves loss of motor or sensory function
the patient doesn’t consciously feign the symptoms (factitious disorder) or seek material gain (malingering)
patients may be indifferent to their apparent disorder - la belle indifference - although this has not been backed up by some studies
Dissociative disorder
dissociation is a process of ‘separating off’ certain memories from normal consciousness
in contrast to conversion disorder involves psychiatric symptoms e.g. Amnesia, fugue, stupor
dissociative identity disorder (DID) is the new term for multiple personality disorder as is the most severe form of dissociative disorder
Munchausen’s syndrome
also known as factitious disorder
the intentional production of physical or psychological symptoms
Malingering
fraudulent simulation or exaggeration of symptoms with the intention of financial or other gain
A 23-year-old man presents to his GP surgery asking to be referred to a plastic surgeon. He is concerned that his ears are too big in proportion to his face. He now seldom leaves the house because of this and has lost his job. On examination his ears appear to be within normal limits. What is the most appropriate description of this behaviour?
A. Hypochondriasis B. Generalised anxiety disorder C. Somatisation D. Malingering E. Dysmorphophobia
E. Dysmorphophobia
Body dysmorphic disorder
Body dysmorphic disorder (sometimes referred to as dysmorphophobia) is a mental disorder where patients have a significantly distorted body image
Diagnostic and Statistical Manual (DSM) IV criteria:
Preoccupation with an imagined defect in appearance. If a slight physical anomaly is present, the person’s concern is markedly excessive
The preoccupation causes clinically significant distress or impairment in social, occupational, or other important areas of functioning
The preoccupation is not better accounted for by another mental disorder (e.g., dissatisfaction with body shape and size in Anorexia Nervosa)
A woman who gave birth 6 weeks ago presents to her local GP surgery with her husband. She describes ‘crying all the time’ and ‘not bonding’ with her baby. Which one of the following screening tools is it most appropriate to detect postnatal depression?
A. Hamilton Depression Rating Scale B. Patient Health Questionnaire-2 C. Beck Depression Inventory D. Patient Health Questionnaire-9 E. Edinburgh Scale
E. Edinburgh Scale
Post-partum mental health problems
Post-partum mental health problems range from the ‘baby-blues’ to puerperal psychosis.
The Edinburgh Postnatal Depression Scale may be used to screen for depression:
10-item questionnaire, with a maximum score of 30
indicates how the mother has felt over the previous week
score > 13 indicates a ‘depressive illness of varying severity’
sensitivity and specificity > 90%
includes a question about self-harm
