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Year 4 TCDs > Mental Health Block > Flashcards

Mental Health Block Flashcards

1
Q

List the 10 components of a psychiatric history?

A
  1. Presenting complaint
  2. History of presenting complaint
  3. Past psychiatric history
  4. Past medical history
  5. Drug history
  6. Family history
  7. Personal and psychosexual history
  8. Social history
  9. Forensic history
  10. Pre morbid personality
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2
Q

What are the 7 components of the mental state exam?

A
  1. Appearance and behaviour
  2. Speech
  3. Mood
  4. Thought
  5. Perception
  6. Cognition
  7. Insight
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3
Q

What is a mnemonic to remind you of the possible categories of differential diagnoses for a psychiatric patient?

A

SAD MOPP

S-substance
A-anxiety
D-developmental

M-mood
O-organic
P-psychotic
P-personality

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4
Q

What are 5 medical conditions that should be asked about in PMH of a psychiatric history?

A
  1. Thyroid disease
  2. Epilepsy
  3. Previous head injury
  4. Cardiovascular risk (psychotropic medication)
  5. Diabetes (psychotropic medication)
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5
Q

Name 4 thought contents that are of special importance in the diagnosis of schizophrenia

A
  1. Thought insertion (someone else is putting thoughts in your head)
  2. Thought excision (someone is removing your thoughts)
  3. Delusions of control (feeling like a puppet)
  4. Delusions of reference (think they’re talking about you on tv/radio)
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6
Q

What are the 9 key symptoms of (major) depressive disorder (DSM classification)?

A
  1. Persistent low mood
  2. Loss of interest or pleasure (anhedonia)
  3. Fatigue/low energy
    (at least 1 of these must be present for a diagnosis and if so, then ask patients about the following)
  4. Disturbed sleep
  5. Poor concentration or indecisiveness
  6. Low self confidence/guilt
  7. Poor/increased appetite
  8. Suicidal thoughts/acts
  9. Agitation/slowing of movement
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7
Q

How is depressive disorder diagnosed?

A

A patient must have had at least 2 of the 10 symptoms of depressive disorder over a 2 week period

4 symptoms = mild depression
5-6 = moderate
7+ = severe

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8
Q

How is major depressive disorder diagnosed?

A

A patient must have had at least 5 of the 9 symptoms of major depressive disorder over a 2 week period

Patient must be clinically distressed or have impaired functioning

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9
Q

What 4 investigations would you consider for a patients suspected to have depression?

A
  1. BP + pulse
  2. FBC, U&E, TFT, LFT, HbA1C
  3. ECG
  4. BMI
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10
Q

What are 5 common side effects of sertraline (SSRI)?

A
  1. Dry mouth
  2. Drowsiness
  3. Mild nausea (resolve in 1-2wks)
  4. GI upset (resolve in 1-2wks)
  5. Decreased libido + impotence
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11
Q

Name 5 conditions where antidepressants are used

A
  1. Unipolar depression
  2. Organic mood disorder
  3. Schizoaffective disorder
  4. Anxiety disorder
  5. Premenstrual dysphoric disorder
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12
Q

How long does it take before antidepressants improve symptoms?

A

3-6 weeks

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13
Q

How long should an antidepressant be continued once symptoms improve?

A

At least 6 months

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14
Q

What are 2 examples of a tricyclic antidepressant (name 1 tertiary TCA and 1 secondary TCA)?

A

Amitriptyline = tertiary TCA (act primarily on serotonin receptors)

Nortriptyline = secondary TCA (act primarily on norepinephrine receptors)

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15
Q

Name 6 side effects of tricyclic antidepressants

A
  1. Lower seizure threshold
  2. Cardiotoxic (prolong QTc)
  3. Lethal in overdose
  4. Anticholinergic effects (dry mouth, blurred vision, constipation, urinary retention, confusion, cognitive/memory problems)
  5. Antiadrenergic effects (postural hypotension, sexual dysfunction, tachycardia)
  6. Antihistaminic effects (sedation, weight gain)
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16
Q

What is the most common class of antidepressant used?

A

SSRIs

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17
Q

List 5 common SSRIs

A
  1. Fluoxetine
  2. Sertraline
  3. Citalopram
  4. Escitalopram
  5. Paroxetine
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18
Q

If a patient doesn’t respond to SSRI treatment what drug class can you try?

A

SNRI

serotonine norepinephrine re-uptake inhibitor

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19
Q

Give 3 examples of SNRIs

A
  1. Duloxetine (used in diabetic neuropathy)
  2. Venlaxafine (used for menopausal symptoms)
  3. Mirtazapine
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20
Q

What is serotonin syndrome?

A

Autonomic dysfunction caused by increased/excessive serotonin (due to 1+ drugs or interactions)

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21
Q

What are the 5 symptoms of serotonin syndrome?

A
  1. Autonomic dysfunction (hyperthermia, hypertension, tachycardia)
  2. Abdo pain
  3. Myoclonus
  4. Delirium
  5. Cardiovascular shock
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22
Q

What are the 4 steps to treating serotonin syndrome?

A
  1. Discontinue medication
  2. Benzodiazepines for agitation
  3. Cyproheptadine (serotonin antagonist - if severe)
  4. Active cooling
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23
Q

Name 4 scenarios where urgent psychiatric referral is necessary

A
  1. Significant perceived risk of suicide, harm to others, self-neglect
  2. Psychotic symptoms
  3. History/suspicion of bipolar disorder
  4. All cases where a child/adolescent presents with major depression
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24
Q

Name 9 risk factors for suicide

A
  1. Age > 45
  2. Male
  3. Unemployment
  4. Divorced/widowed/single
  5. Psychiatric illness
  6. Physical illness
  7. Previous suicide attempts
  8. Substance abuse
  9. Family history of depression/substance abuse/suicide
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25
Q

Other than pharmacological treatment, what’s another treatment option for depression?

A

Cognitive-Behavioural Therapy (CBT)

- Up to 20 30-60min sessions

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26
Q

How should antidepressants be stopped?

A

Titrate down slowly (over a period of at least 4wks) to avoid withdrawal symptoms

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27
Q

What are 4 common and 4 rare antidepressant withdrawal symptoms?

A

Common:

  1. Dizziness
  2. Headache
  3. Nausea
  4. Lethargy

Rare:

  1. Ataxia
  2. Electric shock sensations (particularly scalp)
  3. Extrapyramidal symptoms (ie. muscle spasms, parkinsonisms)
  4. Hypomania/mania
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28
Q

What are symptoms of hypomania/mania? (8)

A

3 or more of the following symptoms lasting at least 4 consecutive days (for hypomania) or at least 1 week (for mania):

  1. Abnormally upbeat, jumpy, wired
  2. Increased activity, energy, agitation
  3. Exaggerated sense of well-being/self-confidence (euphoria)
  4. Decreased need for sleep
  5. Unusual talkativeness
  6. Racing thoughts
  7. Distractibility
  8. Poor decision making

Mania may require hospitalization while hypomania is a milder form

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29
Q

Mrs Banerjee has recently recovered from a major depressive episode on duloxetine 60mg orally daily. This was her third major depressive episode in the past four years. What is the best management advice to reduce her risk of relapse?

A

In high risk patients (e.g. >5 lifetime episodes and/or 2 episodes in the last few years) at least 2 years at the dose needed to get them well should be advised and long-term treatment should be considered for most

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30
Q

In a moderate to severe depressive episode, what is the most effective treatment option?

A

Antidepressant + high intensity CBT

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31
Q

What are 11 organic causes of psychosis?

A
  1. Acute confusion
  2. Dementia
  3. Temporal lobe epilepsy
  4. Infections of the nervous system (AIDS, neurosyphilis, encephalitis)
  5. Brain injury
  6. Brain tumours
  7. Huntington’s Disease
  8. Metabolic disorders (Vit B12 deficiency, porphyria)
  9. Endocrine disorders (Cushing’s, thyroid disease)
  10. Medication effects (high dose steroids)
  11. Autoimmune disorders (lupus, thyroid disease)
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32
Q

What are 2 initial investigations for a patient with psychosis?

A
  1. Bloods (FBC, U&E, TFTs, LFTs, bone profile)

2. MRI head

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33
Q

What is psychosis?

A

A severe mental disorder in which thought and emotions are so impaired that contact is lost with external reality

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34
Q

What are the 2 most common features of psychosis?

A
  1. Hallucinations

2. False beliefs

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35
Q

Name 5 mental health disorders that can cause psychosis

A
  1. Schizophrenia
  2. Severe depression (mood congruent psychotic symptoms)
  3. Drug induced psychosis
  4. Dementia
  5. Manic phase of a bipolar disorder (mood congruent)
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36
Q

Before starting an antipsychotic medication, what 7 baseline investigations must be performed?

A
  1. Weight (plotted on chart)
  2. Waist circumference
  3. Pulse + BP
  4. Bloods (fasting blood glucose, HbA1C, lipid profile, + prolactin levels)
  5. Assessment of any movement disorders
  6. Assessment of nutritional status, diet, physical activity
  7. ECG (if necessary)
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37
Q

What treatment is recommended for a first presentation of psychosis?

A

An oral antipsychotic with CBT

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38
Q

What are the 5 main groups of side effects of antipsychotic drugs?

A
  1. Metabolic (weight gain, diabetes, metabolic syndrome, hyperlipidemia)
  2. Sedation
  3. Extrapyramidal (movement disorders - akathisia, dyskinesia, dystonia)
  4. Cardiovascular (prolonged QT interval)
  5. Hormonal (increased plasma prolactin)
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39
Q

Name 3 commonly used antipsychotics

A
  1. Olanzapine
  2. Clozapine
  3. Haloperidol
  4. Amisulpride
  5. Aripiprazole
  6. Quetiapine
  7. Risperidone
  8. Zuclopenthixol
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40
Q

What is the dopamine hypothesis of psychosis?

A

Positive symptoms of psychosis (delusions, hallucinations) are caused by increase of dopamine in the mesolimbic pathway. Typical antipsychotics treat these symptoms.

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41
Q

What are typical antipsychotics? Give 2 examples and understand where they act.

A

D2 dopamine receptor antagonists. Bind to D2 receptors with high affinity. Thus, have a higher risk of extrapyramidal side effects (i.e. dyskinesia)

  1. Haloperidol (high potency)
  2. Chlorpromazine (low potency)
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42
Q

List a limbic selective antipsychotic

A

Amisulpride

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43
Q

What are the atypical antipsychotics? Give 2 examples and understand where they act.

A

Serotonin-dopamine 2 antagonists (SDAs)

Considered atypical in the way that they affect dopamine and serotonin neurotransmission in the 4 key dopamine pathways in the brain.

  1. Risperidone -> SE: hyperprolactinemia!
  2. Olanzapine -> SE: significant weight gain!
  3. Quetiapine -> SE: orthostatic hypotension, prolong QTc!
  4. Aripriprazole -> SE: akithesia (use with benzodiazepine if pt is agitated)
  5. Clozapine -> SE: agranulocytosis; lower seizure threshold (only used for treatment resistant psychosis!)
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44
Q

When is clozapine used in psychotic disorders? What are its 7 side effects?

A

Reserved for treatment resistance due to its significant side effect of AGRANULOCYTOSIS!

Other side effects include:

  1. Agranulocytosis
  2. Lowered seizure threshold
  3. Weight gain
  4. Sedation
  5. Deranged LFTs
  6. Hypercholesteremia
  7. Hyperglycemia
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45
Q

What are the 9 symptoms of neuroleptic malignant syndrome?

A
  1. Autonomic dysfunction (hyperthermia, hypertension, hyporeflexia)
  2. Severe muscle rigidity
  3. High fever
  4. Confusion
  5. High WBC + LFTs + CK
  6. Rhabdomyolysis
  7. Hyperkalemia
  8. Kidney failure
  9. Seizures
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46
Q

What is the treatment for neuroleptic malignant syndrome?

A
  1. Discontinue medication
  2. ICU (may require circulatory/ventilator support)
  3. Active cooling for hyperthermia
  4. Dantrolene/Amantadine/Bromocriptine (“DAB”) for muscle rigidity
  5. Benzodiazepines for agitation
  6. IV hydration with diuresis
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47
Q

What are the 4 dopamine pathways in the brain and what antipsychotic drug side effects are associated with each pathway?

A
  1. Mesolimic pathway = positive symptoms
  2. Mesocortical pathway = negative symptoms
  3. Nigrostriatal pathway = extrapyramidal symptoms + tardive dyskinesia
  4. Tuberoinfundibular pathway = hyperprolactinemia
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48
Q

What are 3 risk factors for schizophrenia?

A
  1. Birth complications
  2. Smoking cannabis
  3. Family history of schizophrenia
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49
Q

When should section 2 of the mental health act be used?

A

To detain patients when diagnosis is unclear

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50
Q

What are the 6 stages of change (the transtheoretical model)?

A
  1. Pre-contemplation
  2. Contemplation
  3. Preparation
  4. Action
  5. Maintenance
  6. Relapse/lapse
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51
Q

What are 6 alcohol withdrawal symptoms?

A
  1. Headaches
  2. Nausea
  3. Breathing difficulties
  4. Anxiety
  5. Depression
  6. Delirium tremens (hallucinations, cardiovascular problems, psychosis)
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52
Q

What are the 7 symptoms of mania?

A

DIG FAST

D-distractibility
I-irresponsibility
G-grandiosity

F-flight of ideas
A-activity increase
S-sleep deficit
T-talkativeness

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53
Q

How do you differentiate between an episode of hypomania and mania?

A

According to the DSM IV, a hypomanic period should last for at least 4 days whereas manic episodes last for the minimum of a week. This state has to be “clearly different from the usual non-depressed mood”. The major difference between a hypomanic and a manic episode however is that the hypomanic episode is associated with an “unequivocal change in functioning that is uncharacteristic of the person when not symptomatic” and “the episode is not severe enough to cause marked impairment in social or occupational functioning, or to necessitate hospitalisation, and there are no psychotic features”.

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54
Q

What are the 10 symptoms of delirium tremens?

A
  1. Delirium
  2. Autonomic hyperactivity
  3. Tachycardia
  4. Fever
  5. Insomnia
  6. Anxiety
  7. Hypertension
  8. Perceptual distortions
  9. Visual/tactile hallucinations (formication- insects crawling on skin)
  10. Fluctuating motor activity (from hyperexcitability to lethargy)
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55
Q

How is delirium tremens treated? (3)

A
  1. Benzodiazepine (lorazepam/diazepam/chlordiazepoxide/oxazepam)
  2. IV fluids
  3. Pabrinex (vitamin B complex to reduce risk of Wernicke’s encephalopathy)
56
Q

What are the 3 characteristics of Wernicke’s encephalopathy?

A
  1. Ophthalmoparesis with nystagmus
  2. Ataxia
  3. Confusion
57
Q

What is the cause of Wernicke’s encephalopathy?

A

Thiamine deficiency (B1)

58
Q

What is the difference between Wernicke’s encephalopathy (5) and Korsakoff’s syndrome (8)?

A

Wernicke’s:

  • Acute neurological condition
  • Reversible
  • Caused by thiamine deficiency
  • Triad of characteristics (nystagmus, ataxia, confusion)
  • Confabulations are often spontaneous

Korsakoff’s:

  • Neuropsychiatric disorder
  • Irreversible
  • Caused by thiamine deficiency
  • Caused from at least 1 episode of Wernicke’s encephalopathy
  • Associated with memory disturbances (antegrade + retrograde memory problems)
  • Immediate memory retained but short term memory diminished
  • Associated with patients fabricating stories in the setting of clear consciousness
  • Confabulations are often provoked
59
Q

What are the 5 regions of the brain that are involved in the reward model?

A
  1. Ventral tegmental area
  2. Nucleus accubens
  3. Orbital frontal cortex
  4. Prefrontal cortex
  5. Amygdala/hippocampus
60
Q

What is Bipolar 1?

A

≥2 weeks of depression + ≥1 week of mania

61
Q

What is Bipolar 2?

A

≥2 weeks of depression + ≥4 days of hypomania

62
Q

What is cyclothymia?

A

Milder depression and hypomania that cycle back and forth for at least 2 years

63
Q

What drug is used for the acute treatment of mania?

A

Olazapine

64
Q

What are the 6 criteria for dependence syndrome?

A

3 of the following symptoms, present together at some time during the previous year or constantly for 1 month:

  1. Strong desire to take the substance
  2. Difficulties in controlling substance-taking behaviour
  3. Evidence of tolerance
  4. Physiological withdrawal state when substance use has ceased/reduced
  5. Progressive neglect of alternative pleasures/interest interests because of substance use
  6. Persisting with substance use despite clear evidence of overtly harmful consequences
65
Q

What is Disulfiram?

A

Drug used to support the treatment of chronic alcoholism by producing an acute sensitivity to ethanol.

Works by inhibiting the enzyme acetaldehyde dehydrogenase, causing many of the effects of a hangover to be felt immediately following alcohol consumption

66
Q

How many hours after acute cessation of alcohol intake can delirium tremens occur?

A

72h

67
Q

What drug is used for mood stabilization in bipolar disorder, and to reduce risk of relapse?

A

Lithium

68
Q

What medication is contraindicated when taking lithium?

A

NSAIDs

- Lithium is renally excreted and NSAIDs can reduce renal function

69
Q

What drug can be used in addition to lithium and/or an atypical antipsychotic for bipolar disorder?

A

Benzodiazepine (clonazepam)

70
Q

What are the 2 classes of dementia medications, and name 1 drug in each class?

A
  1. Acetylcholinesterase inhibitors (mild-moderate Alzheimers)
    - Donepezil
    - Galantamine
    - Rivastigmine (also used in LB dementia)
  2. Glutamate/NMDA receptor antagonist (moderate-severe Alzheimers; mixed dementia)
    - Memantine
71
Q

How are donepezil and galantamine metabolized?

A

In the liver

72
Q

How is memantine metabolized?

A

In the kidney

- Do not use in those with renal impairment!

73
Q

Which dementia drug is safest to use in patients with polypharmacy and heart disease?

A

Rivastigmine

74
Q

If suspecting dementia in a patient, what 3 investigations would you do to confirm the diagnosis?

A
  1. Urinalysis (check for UTI -> confusion)
  2. Bloods (check for inflammatory markers -> delirium)
  3. CT/MRI brain
75
Q

What is the best cognitive function test to perform for dementia?

A

ACE III (as this takes a while to do, MOCA can also be used)

  • Score < 82 on the ACE III is highly suggestive of dementia
76
Q

What are 9 non-cognitive symptoms of dementia?

A
  1. Hallucinations
  2. Delusions
  3. Anxiety
  4. Marked agitation/aggressive behaviour
  5. Wandering
  6. Hoarding
  7. Sexual disinhibition
  8. Apathy
  9. Disruptive vocal activity (shouting)
77
Q

What 2 investigations must be done before starting a patient on a dementia medication?

A
  1. ECG (can prolong QTc interval)

2. U&E (memantine can cause acute renal function)

78
Q

What are 5 contraindications for acetylcholinesterase inhibitors for treating dementia?

A
  1. Prolonged QTc interval
  2. LBBB
  3. Bradykinesia
  4. Seizures (can use with caution)
  5. Gastric ulcer hx (can use with caution)
79
Q

What are 6 side effects of acetylcholinesterase inhibitors that are used for dementia?

A
  1. Diarrhea
  2. Dizziness
  3. N+V
  4. Anorexia
  5. Weightlessness
  6. Insomnia
80
Q

What are 6 psychological treatment options for dementia?

A
  1. Cognitive stimulation therapy
  2. CBT
  3. Reminiscence therapy
  4. Aromatherapy
  5. Sensory stimulation
  6. Music therapy
81
Q

What is the pathophysiology of Alzheimer’s disease? (2)

A
  1. Extracellular amyloid plaque accumulation

2. Intracellular neurofibrillary tangles (tau)

82
Q

What is a Deprivation of Liberty Safeguards?

A

The person is under continuous supervision and control and is not free to leave, and the person lacks capacity to consent to these arrangements.
- Can be implemented for a max of 12mo

83
Q

What are the 2 mandatory parts of standard dementia screening?

A
  1. History taking

2. Cognitive testing (ACE III ideally)

84
Q

What are the 4 core clinical features of LB dementia?

A
  1. Fluctuating cognition with pronounced variations in attention + alertness
  2. Recurrent visual hallucinations (often animals/people)
  3. REM sleep behaviour disorder, which may precede cognitive decline
  4. Spontaneous cardinal features of PD: bradykinesia, rest tremor, or rigidity
85
Q

What is the most common abnormality on CT seen in Alzheimer’s Disease?

A

Hippocampal atrophy/loss of media temporal lobe structures

86
Q

What are 5 characteristics of Alzheimer’s Disease that distinguish it from LB Dementia?

A
  1. More common in women (vs men)
  2. Hallucinations may occur at LATE stages (vs early)
  3. Decrease in facial expression late in disease (vs early)
  4. Gradual decline in cognition (vs fluctuating)
  5. Physical deterioration at late stage
87
Q

What are the 3 indicative biomarkers of LB dementia?

A
  1. Reduced dopamine uptake in basal ganglia by SPECT/PET scan
  2. Low uptake of 123iodine-MIGB on myocardial scintigraphy
  3. Polysomnographic confirmation of REM sleep without atonia
88
Q

What is the diagnostic criteria for “probable” LB dementia? (2)

A
  1. 2+ core clinical features with no indicative biomarker evidence
  2. 1 core clinical feature with 1+ indicative biomarker
89
Q

How are PD dementia and LB dementia differentiated?

A

There is at least 1 year between the onset of dementia and parkinsonism in LB dementia

90
Q

What are 4 supportive features of LB dementia?

A
  1. Falls
  2. Autonomic dysfunction
  3. Delusions
  4. Depression
91
Q

What is the pathophysiology of LB dementia?

A

Misfolding + aggregation of aSN forming lewy bodies in basal ganglia + cortex

92
Q

Name 3 conditions where there’s an aggregation of lewy bodies in neurons

A
  1. PD
  2. LB dementia
  3. Multi-system atrophy
93
Q

Name 2 drugs that are used to treat LB dementia

A
  1. Levodopa (for late motor parkinsonism symptoms)

2. Rivastigmine (for cognitive changes) - 4.6mg/24h starting dose

94
Q

What medication is effective in treating REM sleep behaviour disorder?

A

Clonazepam

95
Q

What antipsychotic medication is most commonly used in patients with PD or LB dementia?

A

Quetiapine (or clozapine although it requires more monitoring)

96
Q

What is autism?

A

A lifelong developmental disability that affects how a person communicates with and relates to other people, and how they experience the world around them

97
Q

What 3 areas are affected in autism (“triad of autism”)?

A
  1. Social communication (i.e. late to start talking)
  2. Social interaction (i.e. difficulty recognizing emotions)
  3. Social imagination (i.e. repetitive patterns of play, limited interests)
98
Q

Name 5 mental health conditions that are linked to autism

A
  1. Anxiety + poor stress management
  2. Low mood + depression
  3. OCD
  4. Sleep disturbance
  5. Gender dysphoria
99
Q

List 2 factors that increase risk of autism?

A
  1. Increasing parental age (father > 50, mother > 40)

2. Exposure to chemicals, medications, smoking, infections during pregnancy

100
Q

What are the 10 components of a physical examination in autism?

A
  1. General examination
  2. Height, weight, head circumference
  3. Gait + coordination
  4. Heel/toe
  5. Throwing/catching
  6. Fogs test
  7. Skin stigmata + neurocutaneous markers (neurofibromatosis/tuberous sclerosis)
  8. Injuries? (self harm/maltreatment)
  9. Congenital anomalies or dysmorphic features (consider genetic testing if indicated; macro/microcephaly)
  10. Mental state examination
101
Q

How is autism managed?

A

Create a needs-based management plan taking family + educational context into account

102
Q

What are the 3 core symptoms of ADHD?

A
  1. Inattention (i.e. unable to focus)
  2. Impulsivity (i.e. acts without thinking)
  3. Hyperactivity (i.e. fidgety)
103
Q

What are the 5 diagnostic criteria for ADHD?

A
  1. Symptoms evident in more than 1 environment (i.e. school, home, clinic)
  2. Onset before 6/7yrs old
  3. Persists for at least 6mo
  4. Have caused significant functional impairment
  5. Not better accounted for by other mental disorders
104
Q

What are the 3 management options for ADHD?

A
  1. Psychoeducation
  2. Behavioural management strategies
  3. Stimulant medications (i.e. methylphenidate)
105
Q

What medication can be used in ADHD? (1)

A

Methylphenidate

106
Q

What are 3 standardized tools you could use to help diagnose ASD?

A
  1. Autism Diagnostic Interview (ADI) -> interview with parents
  2. Autism Diagnostic Observation Schedule (ADOS-2) -> tasks that involve social interaction
  3. Diagnostic Interview for Social and Communication Disorders (DISCO) -> broad picture of patient’s behaviours/needs
107
Q

Name 4 genetic syndromes associated with autism

A
  1. Tuberous sclerosis
  2. Fragile X syndrome
  3. Congenital rubella
  4. Phenylketonuria
108
Q

What is the main structural difference visible on MRI scans in individuals with autism? (1)

A

Brain enlargement, especially of occipital, temporal and parietal lobes

109
Q

At what age does autism begin?

A

Before the age of 3

110
Q

What are 2 management options for autism?

A
  1. CBT (psychotherapy for both patient + parents)

2. SSRIs (as adjunct to psychotherapy)

111
Q

Name 1 questionnaire used to assess ADHD

A

Connor’s Questionnaire

112
Q

What is the Sally-Anne Test used to assess in autism?

A

Theory of mind (ability to empathize and understand what others may be thinking)

113
Q

What is the only medication licensed for use for aggressive behaviour in children?

A

Risperidone

114
Q

What is conduct disorder?

A

Repetitive and persistent pattern of dissocial, aggressive, or defiant conduct

115
Q

What are the 2 types of conduct disorder?

A
  1. Oppositional defiant disorder (younger children/milder)

2. Conduct disorder

116
Q

What are the 6 criteria of oppositional defiant disorder?

A

6mo history of 4+ of the following:

  1. Often losses temper
  2. Often argues with adults
  3. Often defies adult requests or rules
  4. Often deliberately annoys others
  5. Often shifts blame to others
  6. Often angry + resentful
117
Q

What initial investigations would you perform in an aggressive youth with history of CAMHS? (5)

A
  1. Full physical examination including all obs
  2. Bloods (FBC, U&E, LFT, TFT, Vit D)
  3. Urine drug screen
  4. Full psychiatric history
  5. Collateral social history
118
Q

What are 3 management strategies for someone with conduct disorder?

A
  1. Refer for multisystemic therapy (MST)
  2. Sessions with youth offenders team (YOT)
  3. Assessment on mental state (when concerned over development of co-morbid mental disorder)
119
Q

What are 4 common co-morbid mental disorders associated with conduct disorder?

A
  1. Depression
  2. Autism spectrum disorder
  3. ADHD
  4. Learning difficulties
120
Q

What is the first line treatment for conduct disorder? (1)

A

Multi-systemic therapy

121
Q

What are 6 risk factors for conduct disorder?

A
  1. Male
  2. ADHD
  3. Physical/sexual abuse
  4. Parental family history
  5. Substance misuse
  6. Low IQ
122
Q

What are the 2 types of emotionally unstable personality disorder?

A
  1. Impulsive type

2. Borderline type

123
Q

What are the 9 personality disorders?

A
  1. Paranoid personality disorder
  2. Schizoid personality disorder
  3. Dissocial personality disorder
  4. Emotionally unstable personality disorder
  5. Histrionic personality disorder
  6. Anankastic personality disorder
  7. Anxious/avoidant personality disorder
  8. Dependent personality disorder
  9. Mixed/other personality disorder
124
Q

How is personality disorder treated?

A

Bio/psycho/social model (dialectical behavioural therapy - DBT)

125
Q

What are the 3 categories that personality disorders can be grouped into, and list examples of each?

A

A = “odd/eccentric” -> paranoid, schizoid, schizotypal

B = “dramatic/emotional/erratic” -> antisocial, borderline, histrionic, narcissistic

C = “anxious/fearful” -> avoidant, dependent, obsessive compulsive personality disorder (different from OCD!)

126
Q

What are the 4 components of DBT?

A
  1. Structured individual therapy/family therapy
  2. Skills group (learning behavioural skills)
  3. Skills coaching
  4. Consultation team
  • Takes 3-4h/week
127
Q

What 5 conditions are proven to benefit from DBT?

A
  1. Borderline personality disorder
  2. Parasuicidal women
  3. Substance use disorders
  4. Binge-eating disorders
  5. Depression in elderly patients
128
Q

What are the 3 types of defence mechanisms, and give 1 example of each?

A
  1. Primitive (i.e. denial, regression, acting out, projection, splitting)
  2. Less primitive (i.e. intellectualization, rationalization, undoing)
  3. Mature (i.e. sublimation, compensation, assertiveness)
129
Q

What are 7 criteria for substance dependence syndrome?

A
  1. Craving the substance
  2. Increasing tolerance to substance
  3. Using the substance in preference of doing other things in life
  4. Narrowing repertoire of substances used
  5. Feeling that you have lost control of substance use
  6. Withdrawal symptoms
  7. Reinstatement after period of abstinence knowing it’s harmful
130
Q

What are the 3 main signs of borderline personality disorder?

A
  1. Instability of interpersonal relationships
  2. Instability of self-image and affect
  3. Marked impulsivity beginning by early adulthood
131
Q

What 4 investigations would you suggest for someone with personality disorder?

A
  1. Full physical examination
  2. Bloods (FBC, TFTs, LFTs, GGT for alcohol, U&E, paracetamol + salicylate levels)
  3. Urine (MSU for drug/infection screen)
  4. ECG (QTc interval)
132
Q

What 2 hormones have been associated with emotional dysregulation in emotionally unstable personality disorder?

A
  1. Serotonin

2. Dopamine

133
Q

What is the unique feature of Lofepramine compared to other tricyclic antidepressants?

A

Only example of this drug class that is not lethal in overdose

134
Q

What conditions are lithium used to to treat?

A
  1. Bipolar disorder
  2. Severe treatment resistant depression
  3. Severe high risk suicidality
135
Q

What is the main difference between Neuroleptic Malignant Syndrome and Serotonin Syndrome?

A

NMS = ‘lead-pipe’ rigidity

Serotonin Syndrome = hyperreflexia + clonus

Year 4 TCDs (16 decks)

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