Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Phase 2 > Mental Health > Flashcards

Mental Health Flashcards

1
Q

What are the 3 Cardinal symptoms of depression?

A

Low mood
Loss of interest/enjoyment
Reduced energy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the additional symptoms of depression?

A 
Reduced concentration
Low self-esteem/confidence
Ideas or acts of self harm
Early morning wakening
Reduced appetite
Ideas of guilt and unworthiness
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What specific things do you need to ask about in history of presenting complaint?

A

Depression
Anxiety
Psychosis
Deliberate self-harm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the categories of anxiety symptoms?

A

Biological
Psychological
Avoidance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the components of a mental state examination?

A 
Appearance and Behaviour
Speech
Mood/Affect
Thought
Perception
Cognition
Insight
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What aspects of appearance and behaviour should you comment on?

A

Description
Psychomotor activity
Rapport
Other abnormal behaviours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What should you comment on regarding speech?

A 
Rate
Rhythm
Content
Tone
Formal thought disorder
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the aspects of mood?

A

Subjective
Objective

Affect

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How does affect relate to mood?

A

Mood is the season, affect is the weather

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What parts of thought should you comment on?

A

Form
Content
Suicidal ideation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What aspects of perception should you comment on?

A

Hallucinatory experience
Modalities
Illusions
Pseudo hallucinations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How do you assess insight?

A

Do they think they’re ill?
Do they think they need treatment?
Do they think treatment is useful?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the mnemonic for cognitive assessment?

A

GOAL-CRAMP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the components of cognitive assessment?

A 
General
Orientation
Attention and concentration
Language
Calculation
Right hemisphere function
Abstraction
Memory
Praxia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Define psychosis

A

Any condition where reality judgement is significantly disturbed. The individual is unable to distinguish between their own subjective experience and external reality

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the psychotic symptoms?

A

Hallucinations
Delusions
Thought disorder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Define a hallucination

A

A perception occurring in the absence of an external stimulus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the most common type of hallucination?

A

Auditory

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Define an illusion

A

A misperception of an external stimulus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is a pseudo hallucination?

A

A perception in the absence of an external stimulus (as for hallucination), but the perception is located in the internal (subjective) space
E.g. The patient is aware that the voice is in their own head

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Define a delusion

A

A false, unshakable belief which is out of keeping with the person’s cultural and religious background

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is the most common type of delusion?

A

Paranoid (persecutory) - patient feels they are being persecuted and the persecutor is trying to cause harm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What are delusions of reference?

A

Things happening in the external environment are targeted at them

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What types of delusions are commonly seen in schizophrenia?

A

Paranoid
Delusions of reference
Passivity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What are passivity delusions?

A

Belief that another agency is controlling the patient’s mind

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What are grandiose delusions?

A

Special beliefs/powers

Belief that other people are below them

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What are nihilistic delusions?

A

Everything’s going downhill

World’s going to end

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What’s a common nihilistic delusion in elderly patients?

A

That their bowels aren’t working

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What is an important differential for delusions?

A

Overvalued ideas

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What are overvalued ideas?

A

Ideas which tend to occupy the person and may affect their actions. They are shakable, and may be understandable culturally

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What is form of thought?

A

The way someone orders their thoughts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What are the 3 components of consent?

A

Informed
Competent
Voluntary

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Define capacity

A

The ability to make a specific decision

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What are the 4 components of testing capacity?

A
  1. Can they understand the information?
  2. Retain the information
  3. Use/weight it up
  4. Communicate the decision
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What are DOLS?

A

Deprivation of Liberty Safeguards

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

When can DOLS be used?

A

In hospital or care homes when the patient lacks capacity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Define mental disorder

A

Any disorder or disability of the mind

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Who can use section 5(4)?

A

Registered Mental health Nurses, to detain patients for up to 6 hours for assessment by a doctor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Who can use section 5(2)?

A

RMO/junior on call

Detain patient for up to 72 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Who does a section 2 need to be completed?

A

2 doctors - at least one section 12(2) approved

1 AMHP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

What does a section 2 allow?

A

Max 28 days detainment for assessment and treatment of a mental disorder
Can appeal within 1st 14 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Who does a section 3 require to be completed?

A

2 doctors - at least one section 12(2) approved

1 AMHP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

What does a section 3 allow?

A

Detainment for max 6 months for treatment of mental disorder

Treatment can only be forced for 3 months, then capacity must be assessed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

What is a section 137?

A

Police power to remove to a place of safety from a public place, for an assessment by an AMHP and a doctor
Can be held for up to 72 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

What is a section 17?

A

While detained in hospital under S2 or 3, a patient may leave under S17

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

What is a CTO?

A

Community Treatment Order

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Give some examples of static risk factors that increase a person’s risk

A

Male
Age
Comorbid diagnosis eg MS
History of recurrent major depressive disorder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Give some examples of dynamic risk factors for risk

A

Currently depressed
Use of alcohol or drugs as coping strategy
Recently unemployed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

What are the 5 dimensions of risk that need to be assessed?

A 
What is the risk?
Severity of risk
Frequency of risk
Imminence of risk
Who is at risk?
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Define suicide

A

Verdict or category recorded by a coroner where death was unnatural and a result of the victim’s own actions, with the intent to kill themselves

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Define para-suicide

A

For whatever reason the victim survived the suicide attempt

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

In what group are suicide rates highest?

A

Men aged 40-44

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

What risk factors make an inpatient more likely to commit suicide?

A 
Forensic history
Previous suicidal behaviour
Violence to property
Recent bereavement
Presence of delusions
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

What are post-discharge risk factors for suicide?

A

Unplanned discharge
Lack of continuity of care
Suicidal prior to admission

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

What are the general risk factors for suicide?

A 
Male
Living alone
Unemployment
Drug/alcohol misuse
Mental illness
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

What is the lifetime suicide risk for depression?

A

15% higher than general population

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

What is the lifetime risk of suicide in alcohol abuse?

A

2-4 % increase on general population

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

What increases risk of suicide in schizophrenia?

A 
Positive psychotic symptoms
Post-psychotic depression
Young and male
1st decade of illness
Relapsing pattern of illness
Recent hospital discharge
Social isolation
Good insight into illness
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

What type of personality disorder leads to highest suicide risk?

A

Borderline (emotionally unstable)

Due to accidental death after self harm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

What are the 2 main types of deliberate self harm?

A

Self-poisoning

Self-injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

Why is alcohol use at the time of deliberate self harm dangerous?

A

Alcohol increases toxicity of psychotropic drugs

Unconsciousness can delay time to treatment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

How do mood disorders affect risk to others?

A

No increase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

In psychotic disorders, what increases risk of harm to others?

A

Specific persecutory delusions or hallucinations

Command auditory hallucinations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

Name 3 specific toxic syndromes relating to psychiatric drugs

A

Prolonged QTc
Serotonin syndrome
Neuroleptic malignant syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

What is the mono amine hypothesis of depression?

A

Reduced levels of serotonin and noradrenaline lead to depression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

How do TCAs work?

A

Non-specific reuptake inhibitors for both serotonin and noradrenaline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

How do SNRIs work?

A

Serotonin and noradrenaline reuptake inhibitors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

How does trazodone work?

A

Similar to TCA, complex serotonin action

Sedative effect

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

When is prophylaxis indicated for depression?

A

2 or more depressive episodes in 5 years

Continue antidepressants for 2 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

In which antidepressants is discontinuation syndrome more common?

A

Shorter-acting antidepressants

Paroxetine and venlafaxine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

Give two examples of TCAs

A

Amitriptyline

Imipramine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

What is the safest and least cardio toxic TCA?

A

Lofepramine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

What are the anticholinergic side effects of TCAs?

A 
Dry mouth
Blurred vision
Urinary retention
Constipation
Worsening of glaucoma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

What are the other side effects of TCAs?

A 
Drowsiness and weight gain
CVS - tachycardia, hypotension, prolonged QT
Fine tremor, poor coordination, headache
Lowered seizure threshold
Allergic skin rashes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

What SSRI has a longer half-life?

A

Fluoxetine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

What SSRIs can cause prolonged QTc?

A

Citalopram

Escitalopram

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

How do SSRIs affect other drugs?

A

CYP enzyme inhibitors, so reduce metabolism and increase plasma drug levels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

What are the side effects of SSRIs?

A 
GI: nausea, loss of appetite, dyspepsia, bloating, diarrhoea, constipation
Headache
Sweating
Sexual dysfunction
Increased risk of bleeding
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

Give 2 examples of SNRIs

A

Venlafaxine

Duloxetine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

What are the side effects of SNRIs?

A 
Nausea
Dry mouth
Headache
Dizziness
Sexual dysfunction
Hypo or hypertension
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

How do monoamine oxidase inhibitors work?

A

Block intracellular breakdown of dopamine, serotonin, noradrenaline and tayra mine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

Why are there diet restrictions with MAOIs?

A

‘Cheese reaction’ can cause hypertensive crisis

These drugs block breakdown of dietary tyramine, found in foods such as cheese

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

What is serotonin syndrome?

A

Too much serotonin, causing…

Restlessness, excess sweating, tremor, shivering, myoclonus, confusion, convulsions, death

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

What drugs can cause serotonin syndrome?

A

Antidepressants
Tramadol
Amitryptiline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

What are the indications for antipsychotics?

A

Psychotic symptoms (delusions and hallucinations)
Mania
Acute behavioural disturbance
Antidepressant augmentation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

How do antipsychotics work?

A

Dopamine antagonists at D2 receptors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

Name 3 dopamine pathways in the brain

A

Mesolimbic
Nigrostriatal
Pituitary temporofundibular

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

On which dopamine pathway do antipsychotics have their therapeutic effect?

A

Mesolimbic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
89
Q

What side effects are caused by antipsychotics taking effect on the nigrostriatal pathway?

A

Extra-pyramidal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
90
Q

What side effect is caused by antipsychotics taking effect on the pituitary temporofundibular pathway?

A

Hyperprolactinaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
91
Q

Name 3 typical antipsychotics

A

Haloperidol
Chlorpromazine
Sulpiride

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
92
Q

What are the 4 types of extra pyramidal side effects?

A

Parkinsonism
Akathasia
Dystonia
Tardive dyskinesia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
93
Q

What are the signs of Parkinsonism?

A

Tremor
Cogwheel rigidity
Bradykinesia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
94
Q

How is Parkinsonism treated?

A

Anticholinergics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
95
Q

What is akathisia?

A

Subjective restlessness

Doesn’t respond to anticholinergic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
96
Q

What is dystonia?

A

Serious muscle spasm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
97
Q

What is tardive dyskinesia?

A

Serious long-term involuntary choreo-athetoid orofacial movements

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
98
Q

Give 5 examples of atypical antipsychotics

A 
Olanzapine
Quetiapine
Risperidone
Aripiprazole
Clozapine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
99
Q

What are the side effects of atypical antipsychotics?

A

Hyperprolactinaemia
Anti-adrenergic eg sedation and postural hypotension
Anticholinergic
Cardiac arrhythmias

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
100
Q

What monitoring is required for clozapine?

A

FBC initially weekly then monthly

Due to 0.5% risk of agranulocytosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
101
Q

Give an example of a Depot antipsychotic injection

A

Haldol - haloperidol decanoate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
102
Q

What is neuroleptic malignant syndrome?

A

Rare response to antipsychotics
Extra pyramidal side effects
Autonomic dysfunction
Creatine kinase increased

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
103
Q

What are the indications for mood stabilisers?

A

Bipolar affective disorder
Hypomania, mania, depression or mixed
Treatment and prophylaxis of mood episodes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
104
Q

What classes of drugs can be used as mood stabilisers?

A

Antipsychotics
Lithium
Anticonvulsants

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
105
Q

What are the indications for lithium?

A

Mania
Prevention of manic and depressive episodes
Treatment-resistant depression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
106
Q

What are the main causes of lithium toxicity?

A

Overdose
Dehydration
Drug interactions: NSAIDs, diuretics, ACEi

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
107
Q

What are the side effects of lithium?

A 
Polydipsia and polyuria
Nausea, GI disturbance, weight gain, oedema
Fine tremor
Mild renal impairment
Metallic taste in mouth
Teratogenic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
108
Q

What are the signs of lithium toxicity?

A 
Coarse tremor
Ataxia
Dysarthria
Reduced consciousness
Convulsions
Coma
Death
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
109
Q

How may lithium effect the ECG?

A

T wave flattening

Widened QRS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
110
Q

What are the side effects of sodium valproate?

A 
Tremor
Sedation
Headache
GI disturbance
Hyperammonaemia, thrombocytopenia, hair loss
Teratogenic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
111
Q

What are the potential drug interactions of sodium valproate?

A

CYP inhibitors and inducers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
112
Q

What is the mechanism of action of carbamazepine?

A

Sodium channel blocker

Affects glutamate, dopamine and NA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
113
Q

What are the side effects of carbamazepine?

A 
Dizziness, drowsiness, ataxia, headache, visual disturbance
Hyponatraemia and oedema
GI: anorexia, nausea, constipation
Leukopenia (rare)
Teratogenic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
114
Q

How does carbamazepine affect other drugs?

A

CYP inducer - decreases drug levels in plasma eg OCP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
115
Q

What class of drug is lamotrigine?

A

Anticonvulsant

Used in bipolar depression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
116
Q

What are the side effects of lamotrigine?

A

GI: nausea, vomiting, diarrhoea
Dizziness, tremor, ataxia
Serious skin reactions eg Stevens Johnson syndrome
Bone marrow failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
117
Q

When are anxiolytics used?

A

2nd line for anxiety disorders eg GAD, panic disorder, OCD, PTSD, phobias

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
118
Q

Give 4 examples of anxiolytics

A

Benzodiazepines
Antidepressants
Buspirone
Pregabalin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
119
Q

How do benzodiazepines work?

A

Act on GABA-A receptors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
120
Q

Name a fast-acting benzodiazepine

A

Lorazepam

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
121
Q

Name a long acting benzodiazepine

A

Diazepam

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
122
Q

What is the effect of acute withdrawal of benzodiazepines?

A

Anxiety
Insomnia
Seizures
Potential death

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
123
Q

What are the side effects of benzodiazepines?

A 
Drowsiness
Light-headedness
Ataxia
Confusion
Amnesia
Paradoxical agitation
Disinhibition
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
124
Q

What are the effects of benzodiazepine overdose?

A 
Ataxia
Dysarthria
Nystagmus
Coma
Respiratory depression
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
125
Q

Name 5 hypnotic drugs

A

Benzodiazepines eg temazepam and diazepam
Zopiclone
Zolpidem
Zalepon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
126
Q

When are hypnotics used?

A

As 2nd line to sleep hygiene measures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
127
Q

How does alcohol withdrawal syndrome present?

A

Anxiety
Insomnia
Agitation
Risk of convulsions and death

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
128
Q

What is the pharmacological management of alcohol detox?

A

Chlordiazepoxide - long-acting BZD

Multivitamins and pabrinex

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
129
Q

What drugs are used to maintain abstinence from alcohol?

A

Acamposate/naltrexone to reduce craving

Disulfiram

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
130
Q

How does disulfiram work?

A

Disrupts alcohol metabolism by inhibiting acetaldehyde dehydrogenase
Causes acetaldehyde to build up causing an unpleasant reaction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
131
Q

Name 2 drugs used to treat opioid dependence

A

Methadone

Buprenorphine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
132
Q

Name 3 acetylcholinesterase inhibitors

A

Donepezil
Rivastigmine
Galantamine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
133
Q

What are the side effects of acetylcholinesterase inhibitors?

A 
Nausea and vomiting
Anorexia
Diarrhoea
Fatigue
Insomnia
Headaches
Muscle cramps
Bradycardia and syncope
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
134
Q

What is the mechanism of action of memantine?

A

Partial glutamate agonist

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
135
Q

What is the indication for memantine?

A

Behavioural disturbance in dementia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
136
Q

What are the side effects of memantine?

A 
Constipation
Dyspnoea
Headache
Dizziness
Drowsiness
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
137
Q

What type of drug is used for ADHD?

A

Central nervous system stimulants

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
138
Q

Give 2 examples of drugs used in ADHD

A

Methylphenidate

Dexamphetamine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
139
Q

What is ECT?

A

Passage of small electrical current through the brain

View to inducing a generalised fit which is therapeutic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
140
Q

What are the indications for ECT?

A

Severe depressive illness
Uncontrolled mania
Catatonia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
141
Q

What are the side effects of ECT?

A 
Risks of anaesthesia
Confusion
Headache
Status epilepticus
Stroke
Arrhythmias
Bleeding ulcers
PE
Broken teeth
Memory - depends on total energy and site
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
142
Q

What are the absolute contraindications to ECT?

A

Raised intracranial pressure
Cerebral aneurysm
History of cerebral haemorrhage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
143
Q

Define psychosis

A

Any condition where reality judgement is significantly disturbed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
144
Q

What are the psychotic symptoms?

A

Hallucinations
Delusions
Thought disorder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
145
Q

Define hallucination

A

A perception occurring in the absence of an external stimulus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
146
Q

Define an illusion

A

A misperception of an external stimulus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
147
Q

Define a delusion

A

A false, unshakable belief which is out of keeping with the person’s cultural and religious background

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
148
Q

Name 2 conditions in which there may be a formal thought disorder

A

Schizophrenia

Mania

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
149
Q

What are the different types of formal thought disorder?

A

Flight of ideas
Loosening of associations
Neologisms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
150
Q

What is flight of ideas?

A

Ideas follow each other rapidly

Connection between ideas appears to be due to chance, usually understood by cues in the patient’s language

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
151
Q

What is loosening of associations?

A

Complete loss of normal structure of thinking

Transition from one topic to another either between sentences or mid-sentence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
152
Q

What are neologisms?

A

Words or phrases constructed (not consciously) by the patient and used with meaning in their conversation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
153
Q

What are the aspects of insight?

A

Understand they are unwell
Understand they need treatment
Accept treatment or make rational decisions about their treatment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
154
Q

What are the positive symptoms of schizophrenia?

A

Thought disorder
Hallucinations
Delusions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
155
Q

What are the negative symptoms of schizophrenia?

A 
Loss of/not doing the activities they would normally have engaged with
Apathy
Social withdrawal
Loss of motivation
Neglect
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
156
Q

What is the most common type of schizophrenia?

A

Paranoid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
157
Q

What are the likely symptoms of paranoid schizophrenia?

A

Delusions
Hallucinations
Loss of insight
Possible formal thought disorder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
158
Q

What are schneider’s first rank symptoms? Name the categories

A 
Group of symptoms rarely thought to be found in disorders other than schizophrenia
3 hallucinations
3 thought possession delusions
3 'made' phenomena/delusions
Delusional perception
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
159
Q

What 3 hallucinations are commonly seen in paranoid schizophrenia?

A

Running commentary
3rd person hallucinations
Thought echo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
160
Q

What 3 thought possession delusions are commonly seen in paranoid schizophrenia?

A

Thought withdrawal
Thought insertion
Thought broadcast

161
Q

What is the prevalence of schizophrenia?

A

1 in 100

162
Q

When is the peak incidence of schizophrenia?

A

Late teens/early 20s in males

Late 20s in females

163
Q

How does the environment influence development of schizophrenia?

A

Obstetric complications
Migration
Drug use - cannabis

164
Q

What is the neurotransmitter abnormality in schizophrenia?

A

Excess dopamine causes positive symptoms

165
Q

What are the differential diagnoses for schizophrenia?

A 
Drug-induced psychosis
Mania/depression with psychosis
Delusional disorder
Organic disorders eg delirium or SOL
Personality disorder
166
Q

How is schizophrenia managed?

A

Bio: antipsychotics
Psycho: CBT, family therapy
Social: OT, POC with CPN, employment/financial support

167
Q

What is delusional disorder?

A

Single or set of related delusions present for 3 months
Other schizophrenic symptoms not present
Usually presents in older patients

168
Q

How can you distinguish between schizophrenia and psychosis in mood disorders?

A

In mood disorders, symptoms are congruent with mood

169
Q

What is psychosis typically like in mania?

A

Grandiose delusions
Formal thought disorder - flight of ideas
Auditory hallucinations

170
Q

What is psychosis typically like in depression?

A 
Delusions of guilt, nihilism or poverty
Auditory hallucinations (often saying negative things in 2nd person)
171
Q

How may psychosis present in the non-psychiatric environment?

A 
Delirium
Drug-induced psychosis
Steroid-induced
Neurosyphilis
Epilepsy
Mental illness
172
Q

Define delirium

A

Clouding of consciousness with reduced levels of alertness, attention and perception of the environment

173
Q

What are the core symptoms of depression?

A

Continuous low mood for 2 weeks or more
Lack of energy
Anhedonia

174
Q

What are the somatic symptoms of depression?

A 
Early morning wakening
Reduced appetite
Weight loss
Psychomotor agitation or retardation
Loss of libido
175
Q

What are depressive cognitions?

A 
Low self-esteem
Guilt and self-blame
Hopelessness
Hypochondriacal thoughts
Poor concentration and attention
Suicidal thoughts
176
Q

Define mild depression

A

2 core symptoms + 2 others

177
Q

Define moderate depression

A

2 core symptoms + 3-4 others

178
Q

Define severe depression

A

3 core symptoms + at least 4 others

179
Q

What is the lifetime prevalence of depression?

A

10-20%

180
Q

What are the features of atypical depression?

A 
Variably depressed mood
Overeating
Oversleeping
Extreme fatigue and heaviness in the limbs
Pronounced anxiety
181
Q

What type of delusions are commonly seen in depression?

A

Hypochondriacal
Guilt
Nihilistic
Poverty

182
Q

What are the risk factors for postnatal depression?

A 
Personal or family history
Older age
Single mother
Unwanted pregnancy
Poor social support
183
Q

How do you diagnose a manic episode?

A

Elevated, expansive or irritable mood + 3 more symptoms

184
Q

What are the additional symptoms of mania?

A 
Increased energy or activity
Grandiosity or increased self-esteem
Pressure of speech
Flight of ideas
Distractible
Reduced need for sleep
Increased libido
Social inhibitions lost
185
Q

What is hypo mania?

A

3 or more characteristic symptoms of mania for at least 4 days, but not severe enough to interfere with social or occupational functioning

186
Q

Define bipolar I

A

1 or more manic/mixed episodes

And/or 1 or mor depressive episodes

187
Q

Define bipolar II

A

1 or more depressive episodes with at least 1 hypomanic episode

188
Q

What does ICD10 diagnosis of bipolar require?

A

At least 2 episodes, one of which must be hypomanic, manic or mixed

189
Q

What is the prevalence of bipolar disorder?

A

0.3-1.5%

190
Q

What is the median age of onset of bipolar disorder?

A

25

191
Q

How is the suicide rate affected in bipolar disorder?

A

20x increased

192
Q

What are the differential diagnoses of mood disorders?

A 
Normal fluctuations in mood
Adjustment disorder/bereavement
Dementia or other brain disorders
Underlying physical illness
Personality disorders
Anxiety disorders
193
Q

Give examples of predisposing factors for mood disorders

A

Genetic factors

Childhood experiences

194
Q

Give some examples of precipitating factors for mood disorders

A

Life events
Substance use
Change in routine
Iatrogenic

195
Q

Why should antidepressants be avoided in bipolar disorder?

A

Risk of manic switch

196
Q

What are the possible psychological interventions for mood disorders?

A

Psychoeducation about illness, relapse signs, medication
CBT
IPT

197
Q

How long should antidepressants be used for following a 1st depressive episode?

A

At least 6 months

198
Q

What percentage of people suffering a depressive episode will experience another?

A

80%

199
Q

How long should antidepressants be continued for if a patient suffers multiple episodes?

A

2 years

200
Q

What are the poor prognostic factors for bipolar disorder?

A

Severe episodes
Early onset
Cognitive deficits

201
Q

What is dysthymia?

A

Neurotic/chronic depression

Same cognitive and physical symptoms as depression, but less severe and longer lasting

202
Q

Define neurosis

A

Persistent, inappropriate anxiety and worries

Not due to an organic brain disease, psychosis or personality disorder

203
Q

Name the different types of neurotic disorder

A

Anxiety disorders: phobic anxiety, panic disorder, GAD
OCD
Dissociative disorders
Neurasthenia - chronic fatigue syndrome
Depersonalisation-de realisation syndrome

204
Q

What are somatoform disorders?

A

Somatic symptoms unexplained by a medical or other psychiatric disease
Eg hypochondriasis, dysmorphophobia

205
Q

What are stress-related disorders?

A

A major external stressor appears to explain the symptoms of neurosis
Eg acute stress reaction, adjustment disorders, PTSD

206
Q

What are the features of normal (physiological) anxiety?

A

Adaptive
Signals and alerts to real threat
Causes cognitive and somatic symptoms

207
Q

What is pathological anxiety?

A

Excessive
Impairs functioning
Persists in absence of a real threat

208
Q

What are the cognitive symptoms of pathological anxiety?

A

Worry
Recurrent morbid or fear-inducing thoughts/impending doom
Inability to concentrate
Over-arousal (hyper-vigilance and sleep disturbance)
Irritability

209
Q

What are the physical symptoms of anxiety?

A

Muscle tension

Autonomic arousal: sweating, headache, stomach disturbance, racing heart, hyperventilation

210
Q

What may anxiety disorder be secondary to?

A

Substance use or disorder
Medical condition or medication
Other psychiatric disorder
Psychosocial stressors eg adjustment disorder

211
Q

What are the different types of primary anxiety disorders?

A 
Panic disorder
Agoraphobia
Generalised anxiety disorder
Social phobia
Specific phobia
OCD
PTSD
212
Q

Describe panic attacks

A

Recurrent unexpected urges of severe anxiety
Discreet episodes of intense fear/discomfort
Accompanied by at least 4 physical/psychological symptoms of anxiety
Usually lasts between 30 mins and 2 hours

213
Q

What proportion of people with panic disorder develop agoraphobia?

A

2/3

214
Q

When do panic attacks become panic disorder?

A

At least 1 of the attacks are followed by at least 1 month of…
Persistent concern about further attacks
Worry about the consequences of a further attack
Significant change in behaviour related to the attack

215
Q

What is agoraphobia?

A

Fear in places or situations from which escape might be difficult, or in which help might not be available

216
Q

What situations do people with agoraphobia commonly avoid?

A

Crowds
Going outside the home
Using public transport

217
Q

What is required for ICD 10 diagnosis of agoraphobia?

A

2 situations causing distress + avoidance at some stage

218
Q

What is the treatment for agoraphobia?

A

Pharmacological + CBT

May involve gradual exposure therapy

219
Q

What is generalised anxiety disorder?

A

Persistent, excessive, inappropriate worry lasting at least 6 months
Not related to any specific situation
Person finds it difficult to control

220
Q

What are the main features of generalised anxiety disorder?

A 
WATCHERS:
Worry
Anxiety
Tension in muscles
Concentration difficulty
Hyper-arousal
Energy loss
Restlessness
Sleep disturbance
221
Q

What is the treatment for generalised anxiety disorder?

A

Some SSRIs eg Escitalopram, paroextine, sertraline
Diazepam short-term
CBT

222
Q

What is social phobia?

A

Marked, persistent and unreasonable fear of being observed or evaluated negatively by other people in social or performance situations

223
Q

Define a specific phobia

A

Excessive or unreasonable fear of specific people, animals, objects of situations
This is then avoided, or endured with significant personal distress

224
Q

What is the 1st line treatment for specific phobias?

A

Exposure techniques

225
Q

What are obsessions?

A

Recurrent, persistent thoughts, impulses or images

226
Q

What are compulsions?

A

Repetitive behaviours or mental acts (eg counting, praying etc)
They feel driven to perform these in response to an obsession or according to rules they must follow rigidly

227
Q

Name some common obsessions in OCD

A

Contamination
Accidents
Religious or sexual matters

228
Q

Name some common rituals in OCD

A 
Washing
Checking
Cleaning
Counting
Touching
229
Q

What is the treatment for OCD?

A

SSRIs
Clomipramine (TCA)
Exposure therapy and CBT

230
Q

What are the stages of PTSD?

A

Exposure to trauma
Re-experiencing
Avoidance
Hype-arousal

231
Q

What does the PTSD mnemonic TRAUMA stand for?

A 
Traumatic event
Recurrent recollections
Avoidance
Unable to function
Month long symptoms
Arousal increased: insomnia, irritable
232
Q

What psychological interventions are used for PTSD?

A

Trauma-focussed CBT to prevent chronic PTSD

EMDR - eye movement desensitisation and reprocessing

233
Q

What is adjustment disorder?

A

Psychological reactions arising in relation to adapting to new circumstances

234
Q

What are the symptoms of adjustment disorder?

A 
Anxiety
Worry
Poor concentration
Depression
Irritability
Physical symptoms caused by autonomic arousal eg palpitations, tremor
235
Q

What are the time scales related to adjustment disorder?

A

Disorder must start within 3 months (usually within 1 month)
Reaction is understandably related and in proportion to the stressful experience
Most last several months, a few persist for years

236
Q

Define bereavement

A

Loss through death of a loved one

237
Q

Define grief

A

Involuntary emotional and behavioural response to bereavement

238
Q

Define mourning

A

Voluntary expression of behaviours and rituals that are socially sanctioned responses to bereavement

239
Q

What are the 5 stages of grief?

A 
Denial
Anger
Bargaining
Depression
Acceptance
240
Q

When is grief considered to be abnormal?

A 
Unusually intense
Unusually prolonged
Delayed
Inhibited
Distorted
241
Q

When is abnormal grief more likely?

A

Sudden, unexpected death
Very close/dependent relationship with the deceased
Previous psychiatric disorder
Having to care for dependent children

242
Q

What is an abnormal duration for a grief reaction?

A

Longer than 6 months

243
Q

What weight is considered anorexic?

A

Refusal to maintain/achieve normal body weight
85% of normal
BMI

244
Q

What are the 2 types of bulimia nervosa?

A

Purging type

Non-purging type

245
Q

What is the main feature of bulimia nervosa?

A

Recurrent binge episodes + inappropriate compensatory behaviour

246
Q

What is a binge?

A

Eating much more than someone around you would think is normal, in a short amount of time
Loss of control of eating

247
Q

Why may people with bulimia nervosa not be so obvious?

A

They may be normal weight and able to carry on working etc

248
Q

What compensatory mechanisms do people with bulimia use?

A

Self-induced vomiting
Drugs eg laxatives, diuretics, thyroxine
Excessive exercise
Omission/reduction in insulin dose

249
Q

What is EDNOS?

A

Eating disorder not otherwise specified

Full criteria of AN or BN not met, mainly due to frequency of symptoms

250
Q

What is binge eating disorder?

A

Binge eat, but don’t engage in compensatory behaviours

251
Q

What proportion of patients with anorexia die?

A

10% of total
50% from consequences of illness
50% from suicide

252
Q

What are the physical complications of anorexia?

A 
CVS
GI, especially IBS
Electrolyte disturbances
Nutritional deficiencies
Endocrine and reproductive
Blood and bone marrow
MSK
253
Q

What is the most important complication of bulimia nervosa?

A

Hypokalaemia

254
Q

What are the other potential complications of bulimia nervosa?

A 
Other electrolyte disturbances
Malory-Weiss tear
Dental erosion
Parotid enlargement
Calluses on back of hand
255
Q

What treatments are recommended for anorexia?

A

CBT
IPT
Focal psychodynamic therapy
Family intervention for adolescents

256
Q

What are the indications for admission in anorexia?

A 
Patient wants to change
Not progressing with outpatient treatment
Home life not conducive to OP treatment
Patient in immediate danger
Complex cases eg comorbidities
257
Q

What percentage of dementias are Alzheimer’s disease?

A

60%

258
Q

What are the reversible types of dementia?

A 
Chronic alcohol abuse
Vitamin deficiencies
Normal pressure hydrocephalus
Infection
Metabolic and endocrine
Neoplastic eg frontal lobe tumours
259
Q

What are the risk factors for dementia?

A

Genetic - apoE4 allele

Vascular risk factors for vascular dementia

260
Q

What are the protective factors for developing dementia?

A

Diet rich in antioxidants, vit C&E, fish, veg, fruits
Physical activity
Mental activity
More complex work

261
Q

What are the executive functions?

A 
Problem solving
Abstraction
Reasoning
Decision making
Judgement
Planning
Organisation
Processing
262
Q

What are the signs someone’s visuospatial abilities are diminished?

A

Getting lost
Impaired driving
Copying figures

263
Q

What is apraxia?

A

Inability to carry out previously learned purposeful movements despite normal coordination and strength

264
Q

What is agnosia?

A

Impaired recognition of sensory stimuli not attributed to sensory loss or language disturbance

265
Q

What are the non-cognitive symptoms of dementia?

A

Disturbed perceptions - hallucinations
Disturbed Thought content - delusions
Disturbed emotion - depression and apathy
Disturbed behaviour - wandering, aggression, restlessness

266
Q

What are the pathological features of Alzheimer’s?

A

Shrunken brain
Wide Sulci
Large ventricles

267
Q

What are the pathological hallmarks of Alzheimer’s?

A

Beta amyloid deposition - plaques
Neurofibrillary (Tau) tangles
Neuronal loss

268
Q

What are the Parieto-temporal symptoms of dementia?

A

Aphasia
Agnosia
Apraxia
Apathy

269
Q

What are the frontal lobe symptoms of dementia?

A

Irritability

Disinhibition

270
Q

What are the symptoms of advanced dementia?

A

Parkinsonian symptoms
Logoclonia
Seizures

271
Q

What is the average duration of Alzheimer’s disease from diagnosis to death?

A

Less than 10 years

272
Q

What are the features of mild Alzheimer’s disease?

A

Forgetfulness and recent memory deficit

Normal activities of daily living

273
Q

What are the features of moderate Alzheimer’s disease?

A

Significant memory loss with personality and behavioural changes
Difficulties in orientation and language start
Impairment in activities of daily living

274
Q

What are the features of advanced Alzheimer’s disease?

A 
Dysphasia with disordered and fragmented speech
Aggression, restlessness and wandering
Hallucinations and delusions
Incontinence
Immobility, rigidity and falls
275
Q

What percentage of people suffering a single stroke develop dementia?

A

10%

276
Q

What are the features of vascular dementia?

A

Memory and cognitive impairment
Emotional and behavioural disturbances
Uneven distribution of deficits

277
Q

What are the common features of Lewy body dementia?

A

Fluctuating memory and cognitive impairment
Visual hallucinations
Parkinsonism

278
Q

What is required for ICD 10 classification of dementia?

A

6 months or more of
Decline in memory
Decline in other cognitive abilities
Preserved awareness of the environment (no clouding of consciousness)
Decline in emotional control, motivation, changes in social behaviour

279
Q

What is pseudodementia?

A

Symptoms of poor concentration and impaired memory due to depression

280
Q

How do you distinguish between dementia and depression in an elderly person?

A

Did low mood or poor memory come first?

Is the failure to answer questions due to lack of ability or lack of motivation?

281
Q

What extra symptoms may depression present with in an older patient?

A

Apathy
Anxiety
Irritability
Forgetfulness

282
Q

What are the other differentials for dementia?

A 
Depression
Delirium
Deafness
Other psychiatric disorders
Transient global ischaemia
Epilepsy
Drug-effects
283
Q

What is mild cognitive impairment?

A

Isolated memory loss with preserved activities of daily living
Don’t meet the criteria for dementia but do have evidence of decline in cognitive function

284
Q

What proportion of mild cognitive impairment cases progress to dementia?

A

30%

285
Q

What is the purpose of tertiary prevention in dementia?

A

Reduce functional disability and improve quality of life

286
Q

What is the purpose of secondary prevention in dementia?

A

Try to identify the pre-clinical stage of Alzheimer’s disease, for early diagnosis and intervention

287
Q

What aspects of tertiary prevention are used in dementia?

A 
Cognitive training
Psychosocial support for patient and carer
Acetylcholinesterase inhibitors
NMDA receptor antagonists
Antidepressants
288
Q

Give 3 examples of acetylcholinesterase inhibitors

A

Donepezil
Rivastigmine
Galantamine

289
Q

Give an example of an NMDA antagonist

A

Memantine

290
Q

What factors may exacerbate dementia symptoms?

A

Constipation
Pain
Infection
Dehydration

291
Q

What are the potential complications of dementia?

A

Depression
Disturbed sleep
Aggression

292
Q

What are the prominent signs/symptoms of vascular dementia?

A

Early gait disturbance
Personality change, labile mood
Early urinary symptoms
Preserved insight

293
Q

How does vascular dementia progress?

A

Stepwise

294
Q

How do antipsychotics affect Lewy body dementia?

A

Worsen condition

295
Q

What are the prominent signs/symptoms of huntington’s disease?

A

Schizophrenia-like psychosis
Choreiform movements
Depression and irritability
Dementia occurs later

296
Q

What is delirium also known as?

A

Acute confusional state
Acute brain syndrome
Encephalopathy

297
Q

What proportion of elderly patients in hospital experience an episode of delirium?

A

A third

298
Q

What are the features of delirium?

A

Global impairment of cognition
Disturbances of attention and conscious level
Abnormal psychomotor behaviour and affect
Disturbed sleep-wake cycle

299
Q

What psychotic symptoms may be present in delirium?

A

Hallucinations - usually visual

Delusions

300
Q

What is clouding of consciousness?

A

Drowsiness
Decreased awareness of surroundings
Disorientation in time and place
Distractability

301
Q

What are the differential diagnoses of delirium?

A

Dementia
Psychosis
Depression

302
Q

How do you distinguish between dementia and delirium?

A

Delirium acute onset, with fluctuating course
Attention poor in delirium
Delusions are common in delirium

303
Q

What drugs commonly cause delirium?

A 
Antidepressants 
Antipsychotics
Benzodiazepines
Antiparkinsonians
Anticholinergics
Opiates
Diuretics
304
Q

What are the common medical causes of delirium?

A 
Hypoxia
Infection
Organ failure
Hypoglycaemia
Dehydration
Constipation
305
Q

What neurological conditions cause delirium?

A

Epilepsy
Head injury
Space occupying lesion
Encephalitis

306
Q

What proportion of cases of delirium are caused by medication?

A

A third

307
Q

What are the risk factors for delirium?

A 
Elderly
Male
Dementia or cognitive impairment
Current hip fracture
Previous episode of delirium
Sensory impairment
308
Q

What are the environmental components of management of delirium?

A

Quiet surroundings with low lighting, clock, calendar etc.
Regular routine, prevent transfer
Clear simple communications with limited staff
Involve family
Avoid unnecessary procedures

309
Q

What are the medical components of management of delirium?

A

Monitor vital signs
Investigate and treat underlying cause
Consider use of meds if agitation and behaviour places patient or others at risk
Lorazepam OR haloperidol 1st line

310
Q

What is the prognosis for delirium?

A

Depends on cause, but most recover in days or weeks. Can persist for several months
Increases mortality - only 45% patients still alive 2-4 years after the episode

311
Q

What is the link between delirium and dementia?

A

No evidence that delirium progresses to dementia

But pre-existing dementia is a risk factor for delirium

312
Q

What is psychoeducation?

A

Giving people information to help them understand and cope with the illness

313
Q

What is counselling?

A

Loosely-defined activity where people are helped to understand and cope with life’s problems

314
Q

What is supportive psychotherapy?

A

Formalised version of what a good friend might provide

315
Q

What is problem-solving therapy?

A

Structured mix of counselling and CBT

Specify problem, select an option to tackle it and try out solutions/review effect

316
Q

What is the focus of psychodynamic psychotherapy?

A

Unconscious phenomena from the past

317
Q

What are the main indications for psychodynamic psychotherapy?

A

Difficulties with relationships

Some personality disorders

318
Q

What is the aim of CBT?

A

Direct, practice-driven change in behaviour and/or cognitions

319
Q

What are the main indications for CBT?

A

Depressive disorders
Neuroses and somatoform disorders
Eating disorders

320
Q

What is transference?

A

The patient’s pattern of previous relationships is evidenced most directly by the way they interact with the therapist

321
Q

In whom should psychodynamic psychotherapy be avoided?

A

People with paranoid or antisocial personality disorder

Psychosis

322
Q

How is exposure used in behavioural therapy?

A

Patient is re-exposed to a situation or behaviour that they have come to avoid, and learn to stop an inappropriate, excessive response
Usually graded

323
Q

What is flooding?

A

Sudden and prolonged exposure to a feared or avoided situation

324
Q

How does graded exposure work?

A

Patient finds that each extra exposure increases anxiety, but it then subsides and hence they are desensitised to the stimulus

325
Q

What are the aims of CBT?

A

Correct inaccurate/unhelpful ways of thinking

Aim is to improve mood, reduce anxiety and allow return to normal behaviour

326
Q

What are cluster A personality disorders?

A

‘Mad’
Paranoid
Schizoid

327
Q

What are cluster B personality disorders?

A

‘Bad’
Dissocial
Emotionally unstable (borderline)
Histrionic

328
Q

What are cluster C personality disorders?

A

‘Sad’
Anankastic
Anxious
Dependent

329
Q

Define personality disorder

A

Enduring maladaptive patterns of behaviour, cognition and inner experience
Exhibited across many contexts
Deviates markedly from those accepted in individual’s culture

330
Q

What are the key aspects of emotionally unstable personality disorder?

A

Impulsivity and emotional instability
High self-harm rates
Association with childhood sexual abuse, PTSD and bulimia nervosa

331
Q

In what group is EUPD most common in?

A

Young females

332
Q

What is the management for medically unexplained symptoms (MUS)?

A

Normalise
Minimise investigations and treatment
Treat possible underlying condition eg antidepressants
Consider referral to CBT/psych services

333
Q

Where is Broca’s area?

A

Frontal lobe

334
Q

Where is wernicke’s area?

A

Parietal lobe

335
Q

What is the function of the precentral gyrus?

A

Motor cortex

336
Q

What is the function of the postcentral gyrus?

A

Somatosensory

337
Q

What is the pyramidal system?

A

Upper motoneurones originating in the motor cerebral cortex

Lateral and ventral corticospinal tracts

338
Q

Name 4 extra pyramidal tracts

A

Rubrospinal
Tectospinal
Vestibulospinal
Reticulospinal

339
Q

What is the function of the extra pyramidal system?

A

Responsible for constant descending inhibition of lower motoneurones
Don’t originate in cortex (mainly from brainstem)

340
Q

What are the extra pyramidal signs?

A 
Spastic paralysis
Pill rolling
Shuffling gait
Choreoforms
Tics
341
Q

What amino acid neurotransmitters are found in the CNS?

A

Glutamate
GABA
Glycine

342
Q

What biogenic amine neurotransmitters are found in the CNS?

A 
Acetylcholine
Noradrenaline
Dopamine
Serotonin
Histamine
343
Q

What is the function of glutamate synapses?

A

Excitatory

344
Q

What type of receptors are NMDA receptors?

A

Ionotropic glutamate receptors

345
Q

What is the main inhibitory transmitter in the brain?

A

GABA

346
Q

How do GABA receptors work?

A

Receptors have integral chloride channels

Opening of these channels leads to hyperpolarisation, and decreased action potential firing

347
Q

What drugs target GABA receptors?

A

Barbiturates

Benzodiazepines

348
Q

What are the functions of cholinergic pathways in the CNS?

A

Arousal
Learning and memory
Motor control

349
Q

What are the functions of dopamine receptors in the brain?

A

Motor control
Mood
Arousal
Reward

350
Q

What is the neurotransmitter abnormality in schizophrenia?

A

Too much dopamine

351
Q

How do amphetamines affect the brain?

A

Release dopamine and noradrenaline, producing schizophrenia-like behaviour

352
Q

Why is vomiting a common side effect of SSRIs?

A

Serotonin receptors also found in vomiting centre of brain

353
Q

What are the signs of cerebellar dysfunction?

A 
Ataxia
Dysmetria
Dysarthria
Disequilibrium
Hypotonia
Nystagmus
Dydiadochokinesia
354
Q

What is the function of the basal ganglia?

A

Regulate amplitude and velocity of planned movement

Especially in relation to use of proprioceptive information

355
Q

What is the triad of findings in Parkinson’s disease?

A

Tremor at rest
Increased tone
Bradykinesia

356
Q

What are the psychiatric manifestations of Parkinson’s and why?

A

Depression and apathy

Degeneration of dopaminergic neurones also elsewhere in brain

357
Q

Name one drug that can induce Parkinsonism

A

Haloperidol

358
Q

What is wernicke’s aphasia?

A

Fluent but unintelligible speech

Receptive/sensory aphasia

359
Q

What is Broca’s aphasia?

A

Poorly constructed sentences and disjointed speech

Comprehension is fine

360
Q

What is the role of senile plaques in Alzheimer’s disease?

A

Amyloid deposition in the centre of the plaque

Genetic link - mutations of genes on chr. 21

361
Q

How do voltage-gated sodium channel blockers work in epilepsy?

A

Bind to internal surface of inactivated Na+ channel
Act preferentially on neurones causing high-frequency discharge that occurs in a fit - depolarisation increases proportion of sodium channels in inactivated state

362
Q

How does carbamazepine work?

A

Voltage-gated sodium channel blocker, prolonging inactivated state

363
Q

How is the half-life of carbamazepine affected by long-term use?

A

T1/2 decreases because carbamazepine is a strong CYP inducer and increases its own metabolism

364
Q

What are the side effects of carbamazepine?

A 
CNS: dizziness, drowsiness, ataxia, numbness, tingling
GI: vomiting
CVS: BP variation
Rashes
Hyponatraemia
365
Q

What drugs does carbamazepine interact with?

A

Any metabolised by CYP (enzyme inducer)

E.g. Phenytoin, warfarin, steroids, OCP

366
Q

What is the mechanism of action of phenytoin?

A

Voltage-gated Sodium channel blocker

367
Q

How does lamotrigine work?

A

Voltage-gated sodium channel blocker

? Also calcium channel blocker

368
Q

What are the potential drug interactions of lamotrigine?

A

OCP reduces plasma levels of lamotrigine

Valproate increases lamotrigine levels by competitive binding

369
Q

What are the side effects of lamotrigine?

A

Less marked CNS dizziness, ataxia, somnolence, nausea than other AEDs

370
Q

Name 2 agonists at GABA receptors

A

Benzodiazepine

Barbiturate

371
Q

How do GABA agonists act as anti epileptics?

A 
Bind to GABA
Increase chloride current into neurone
Hyper polarises neurone
Increases threshold for activation
Reduced likelihood of epileptic neuronal hyper-activity
372
Q

How does Sodium Valproate work?

A

Inhibition of GABA inactivation enzymes
Stimulates GABA synthesising enzymes
Voltage-gated sodium channel blocker
Calcium channel blocker

373
Q

What are the side effects of sodium valproate?

A

CNS: sedation, ataxia, tremor, weight gain

Increases transaminases

374
Q

What are the potential drug interactions of valproate?

A

Antidepressants inhibit valproate action
Antipsychotics antagonise valproate by lowering seizure threshold
Aspirin: competitive binding increases valproate levels in plasma

375
Q

What are the side effects of benzodiazepines?

A 
Sedation
Tolerance with chronic use
Confusion
Impaired coordination
Aggression
Abrupt withdrawal seizure trigger
Respiratory and CNS depression
376
Q

What is the antidote to benzodiazepine overdose?

A

IV flumazenil

377
Q

What enzymes are involved in dopamine degradation?

A

Monoamine oxidase

COMT enzyme

378
Q

Why can’t you give dopamine to treat deficiency in the brain?

A

Can’t cross BBB

Causes peripheral effects

379
Q

What are the antimuscarinic side effects?

A 
Miosis + SSLUDGE
Salivation
Sweating
Lacrimation
Urinary incontinence
Diarrhoea
GI upset and hypermotility
Emesis
380
Q

Give 4 examples of SSRIs

A

Fluoxetine
Citalopram
Paroxetine
Sertraline

381
Q

Give 3 side effects of SSRIs

A

Anorexia
Nausea
Diarrhoea

382
Q

How do TCAs work?

A

Block reuptake of serotonin and noradrenaline at pre synaptic membrane

383
Q

What is the effect of TCA overdose?

A

Lethal

Cardio toxic can cause sudden cardiac death

384
Q

Name 2 SNRIs

A

Venlafaxine

Duloxetine

385
Q

How are SNRIs dose dependent?

A

Lower doses - serotonin action

Higher doses - noradrenaline action

386
Q

What are the actions of antipsychotics?

A

Sedation within hours
Tranquilisation within hours
Antipsychotic within several days/weeks

387
Q

Name 2 typical antipsychotics

A

Haloperidol

Chlorpromazine

388
Q

What is the mechanism of action of antipsychotics?

A

D2 receptor antagonists

389
Q

Which antipsychotic causes weight gain?

A

Olanzipine

390
Q

Name 5 mood stabilisers

A 
Lithium
Sodium valproate
Carbamazepine
Lamotrigine
Antipsychotics
391
Q

What are the side effects of lithium?

A 
Memory problems
Thirst
Polyuria
Tremor
Drowsiness
Weight gain
392
Q

How do you treat lithium toxicity?

A

Supportive
Anticonvulsant
Increase fluid intake/IV fluids
Harmonica lysis

393
Q

How do you differentiate between schizophrenia and amphetamine effects?

A

Amphetamines only cause positive symptoms, not the negative symptoms of schizophrenia

394
Q

Give 3 examples of acetylcholinesterase inhibitors

A

Donepezil
Rivastigmine
Galantamine

395
Q

How do acetylcholinesterase inhibitors affect prognosis of Alzheimer’s?

A

Slows progression - extra year of independent living

396
Q

What are the side effects of acetylcholinesterase inhibitors?

A 
N & V, anorexia, diarrhoea
Fatigue, insomnia, headache
Bradycardia
Worsening of COPD
Gastric/duodenal ulcers
397
Q

What is memantine?

A

NMDA receptor antagonist

398
Q

What are the differential diagnoses for depression?

A

Normal sadness
Anxiety disorders
Schizophrenia
Organic brain syndromes

399
Q

What are the differential diagnoses for mania?

A

Schizophrenia
Organic brain disease involving frontal lobes
Amphetamines or other illicit drugs

Phase 2 (21 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions