Misc Flashcards
1
Q
What is recommend for treatment of premenstrual syndrome?
A
SSRIs
2
Q
What are the pharmacological options for restless leg syndrome?
A
- iron replacement if needed
- dopamine agents i.e. ropinorole and levadopa
- anticonvulsants
- opioids
- clonazepam
- gabapentin
3
Q
Which factors are most significant predisposing factors for post-concussion symptoms amongst soldiers?
A
Depression and post traumatic stress
4
Q
What is the prevalence of somatoform pain disorder?
A
8%
5
Q
The connectivity between amygdala and which structure is thought to be crucial for fear processing?
A
orbitofrontal cortex
6
Q
The most common cause of a fugue is?
A
Epilepsy
7
Q
NREM Sleep disorders include
A
Sleep walking, sleep terrors and confusion arousals.
8
Q
REM sleep parasomnias include
A
REM behavioural disorder, Night mares and Sleep paralysis
9
Q
What’s the most common concurrent psychiatric disorders in patients with hypochondriasis?
A
Generalised anxiety disorder (71%)
10
Q
Hyperorality, hypersexuality, and abnormal eating behaviour characterized by carbohydrate craving after herpes encephalitis is suggestive of?
A
Kluver-Bucy syndrome resulting from medial temporal lobe damage.
11
Q
Features of REM sleep
A
- decreased parasympathetic activity
- increased cerebral blood flow
- increased tendon reflexes
- increased resp rate
12
Q
Mean age of onset of chronic fatigue syndrome
A
29-35 years
13
Q
Features of REM sleep disorders
A
- complex behaviours
- limited awareness of surrounding
- episodes arise during middle to latter third of the night
- may occurs idiopathically
14
Q
Features of Gerstmann syndrome?
A
DOMINANT (LEFT) PAREITAL LOBE DYSFUNCTION
- left-right disorientation
- finger agnosia
- agraphia
- acalcul
15
Q
Features of non dominant (right) pareital lobe dysfunction
A
- anosognosia
- constructional apraxia
- contralateral neglect
16
Q
Features of bilateral pareital lobe dysfunction (Balint syndrome)
A
- optic ataxia
- ocular apraxia
- simultanagnosia
17
Q
Which signs are seen in Delusional infestation?
A
- Pin bottle sign
- Matchbox sign
18
Q
Post concussion symptom that happens in first 7-10 days
A
Hypersensitivity to noise
19
Q
What is the genetic/biological basis of narcolepsy
A
- Can be sporadic but often associated with HLA DQB1*0602 or HLA-DR2 markers
- Low concentrations of hypocretin in CSF observed
20
Q
Features of chronic fatigue syndrome
A
Low cortisol Motivational disturbances in f-MRI scan Physical emphasis with regard to symptom origin Deficient natural killer cell function Altered physiological response to stress
21
Q
At any given time, the proportion of general population (in percentage) who report sleep disturbances is
A
30%
22
Q
The rate of spontaneous congenital malformations associated with pregnancy is
A
2-3%
23
Q
What predicts poor treatment response in chronic fatigue syndrome when treated with CBT/graded exercise?
A
- claiming a disability related benefit
- low sense of control
- strong focus on physical symptoms
- being passive with reduced activity
- membership of self help group
24
Q
Inability to recognise objects, persons, sounds, shapes or smell is indicative of
A
Agnosia
25
By what percentage should the seven day Crisis Response Service as part of priority actions for the NHS reduce suicide?
10%
26
is able to read occasional words, but is not able to grasp the meaning of the whole sentence.
Anterior alexia
27
people from which ethnic background showed the longest delay in help seeking for mental illness
Asian
28
What is Dhat?
Culture bound syndrome seen in India
vague somatic symptoms of fatigue, weakness, anxiety, loss of appetite and guilt attributed to semen loss through nocturnal emissions, urine and masturbation though there is no evidence of loss of semen.
29
Utilisation behaviours are seen in?
Major depression, ADHD and frontotemporal dementia
30
Patient can copy or describe letters but can't read them?
Pure word blindness
| visual cortex and splenium of corpus callosum affected
31
Which antibiotic is most likely to contribute to raised QTc?
Erythromycin
32
What percentage of those non-compliant with medication are thought to be non-compliant due to forgetting their medication?
10%
33
The Suicide rate in patients with Epilepsy
10%
34
Economic cost of mental health illness to the UK per year
70 - 100 billion
35
What is piblokto?
culture-specific hysterical reaction in Inuit (arctic and subarctic eskimos) especially women, who may perform irrational or dangerous acts, followed by amnesia for the event.
36
What is zar?
culture bound syndrome - experience of spritual possession, which may inlcude dissociative episodes that include laughing, hitting, singing or weeping. Apathy and withdrawal may also be seen
Seen in North Africa and the Middle East
37
What is Trichotillomania and which disorders is it related to?
recurrent, irresistible urges to pull hair from the scalp, eyebrows, eyelids, and other areas of the body, despite repeated attempts to stop or decrease hair pulling
```
Seen in:
OCD
Alopecia Areata
Stereotypic movement disorder
Facticious disorder
```
38
Approximately what percentage of patients who attend hospital with self-harm receive a psychosocial assessment from a mental health practitioner?
50%
39
Risk factors for completed suicide
Psychiatric history
Male
Older age
Previous attempts
Unemployment
Poor physical health
Living alone
Medical severity of the act - especially near-fatal self-harm
Hopelessness
Continuing high suicidal intent
40
Risk factors for non-fatal repetition of self-harm
A history of self-harm prior to the current episode
Psychiatric history, especially as an inpatient
Current unemployment
Lower social class
Alcohol or drug-related problems
Criminal record
Antisocial personality
Uncooperativeness with general hospital treatment
Hopelessness
High suicidal intent
41
What is the risk of a spontaneous major malformation in a confirmed pregnancy?
2-4%
42
Which medication would increase the risk of liver damage in a patient who has taken an overdose of paracetamol?
Phenytoin
43
According to NICE guidelines, women who need inpatient care for a mental disorder should be admitted to a specialist mother and baby unit if they become unwell within which time period following delivery?
0 - 12 months
44
SSRIs taken after 20 weeks gestation may be associated with an increased risk of what in the neonate?
Persistent pulmonary hypertension
45
A 24 year old man is admitted to hospital following an episode of deliberate self-harm. What would you estimate to be his risk for suicide over the next 12 months?
0.5%
46
What's rhythmic movement disorder?
A group of stereotyped, repetitive movements involving large muscles, usually of the head and neck. The movements typically occur immediately prior to sleep onset and are sustained into light sleep.
47
Who is rhythmic movement disorder common in?
In infants and toddlers and usually resolves in the second or third year of life
Persistence beyond four years of age is unusual.
48
What are the subclasses of Dyssomnias (primary sleep disorders)?
Intrinsic sleep disorder
Extrinsic sleep disorders
Circadian rhythm disorders
49
Examples of Intrinsic sleep disorders?
Narcolepsy, psychopsychologic insomnia, idiopathic hypersomnia, restless leg syndrome, periodic limb movement disorder, obstructive sleep apnea
50
Examples of Extrinsic sleep disorders?
Inadequate sleep hygiene, alcohol dependent sleep disorder
51
Examples of Circadian rhythm disorders?
Jet lag syndrome, shift work sleep disorder, irregular sleep wake pattern, delayed sleep phase syndrome, advanced sleep phase disorder
52
What are the subclasses of parasomnias (affect sleep process)?
Arousal disorders
Sleep wake transition disorders
Parasomnias associated with REM sleep
Other parasomnias
53
Examples of Arousal disorders?
Sleep walking, sleep terrors
54
Examples of Sleep wake transition disorders?
Rhythmic movement disorder, sleep talking, nocturnal leg cramps
55
Examples of Parasomnias associated with REM sleep?
Nightmares, sleep paralysis
56
Examples of Other parasomnias?
Sleep bruxism
57
Risk factors for restless leg syndrome
```
Iron deficiency and anaemia = MOST COMMON secondary cause
Older age
Female sex (2:1)
Pregnancy
Renal failure
Hypothyroidism
Diabetes
B12 and Magnesium deficiency
Medications i.e. antihistamines, antipsychotics, caffeine, antidepressants
```
58
Which SSRI is associated with significant neonatal withdrawal symptoms?
Paroxetine
59
The spontaneous abortion rate in confirmed pregnancies is
10-20%
60
The risk of spontaneous major malformation in confirmed pregnancies is
2-3% (1 in 40)
61
AEDs assoiciated with risk of neural tube defects
Valproate - 1-2%
| Carbamazepine - 0.5-1%
62
Risk of Ebstein's abnormality if Lithium is used in pregnancy?
1: 1 000
63
Relative risk of Ebstein's abnormality if Lithium is used in pregnancy?
10-20 times
64
Which abnormalities in the newborn is use of benzos in pregnancy associated with?
oral clefts in newborns
urinary tract malformationn
floppy baby syndrome (if used late in pregnancy)
65
Which SSRI is associated with with an increased risk of congenital malformations (particulaly heart defects ASD and VSD)?
Paroxetine
66
Which antidepressants are suggested in pregnancy?
```
Fluoxetine
Sertraline
Amitriptyline
Imipramine
Nortriptyline
```
67
Which antidepressants should be avoided in pregnancy?
Paroxetine
| Clomipramine and all MAOIs
68
Which antipsychotics are suggested in pregnancy?
```
Olanzapine
Quetiapine
Haloperidol
Clozapine
Chlorpromazine
```
69
Which mood stabilisers are recommended during pregnancy?
None - use antipsychotics instead
* however if patients are controlled on mood stabiliser do not discontinue unless absolutely necessary
* if valproate/carbamemezapine used then px 5mg folate and prophylactic vit K to mum and baby
70
Which sedatives are recommended in pregancy?
Promethazine (widely used but little data)
| Benzodiazepines (probably not teratogenic but avoid in late pregnancy due to floppy baby syndrome)
71
Which antidepressants are suggested in breastfeeding?
Setraline or Paroxetine
72
Which antipsychotics are suggested in breastfeeding?
Olanzapine or Sulpiride
73
Which mood stabilisers are suggested in breastfeeding?
None - use antipsychotics instead
| Valproate if a must
74
Which sedatives are suggested in breastfeeding?
For anxiety - Lorazepam
| For insomnia - Zolpidem
75
What are infants of mothers who take first gen antipsychotics during pregnancy most susceptible to?
Premature delivery
76
Which drug can lead to fingernail hypoplasia when used during pregnancy?
Carbamemezapine
77
Benzodiazepines should be avoided in pregnancy except in which of the following situations?
Extreme anxiety and agitattion
78
What was the first fully structured instrument developed to be used by lay interviewers?
Diagnostic Interview Schedule (DIS)
79
The usage of SSRIs for the treatment of depressive disorders in pregnancy could lead to which abnornalities?
- pulmonary hypertension
- reduction in gestational age
- reduction in birth weight
- spontaneous abortion
80
The usage of paroxetine and venlafaxine in pregnancy for the treatment of depressive disorder has been linked to the development of which abnormalities?
agitation and irritatability
81
Lamotrigine is a medication that requires further evaluation as it is not routinely used in pregnancy. It might result in the development of which abnormalities?
Cleft palate
| Stevens-johnson syndrome
82
Which of antipsychotic should be avoided in breastfeeding?
Clozapine
83
What percentage of women experience transient episodes of emotional lability following childbirth?
50%
84
After a personal and family history of psychiatric illness, what appears to be the most important risk factor for puerperal psychosis?
parity
85
What is the prevalence of narcolepsy?
0.025%
86
What are the features of narcolepsy?
- sudden sleep attacks (REM sleep - refreshing)
- excessive daytime sleepiness
- sleep paralysis (30% of patients)
- cataplexy (75%)
- Hypnagogic hallucinations
Only 10% experience all of these
87
How is narcolepsy treated?
Stimulants i.e. methylphenidate, modafanil
| Imipramine for cataplexy
88
In what stage of sleep does sleepwalking occur?
Stage 3
89
What is REM B Sleep Disorder?
- No loss of muscle tone and dreams are acted out as complex behaviours with limited awareness of surroundings
- Occurs in middle/latter third of night during REM sleep
- Can be idiopathic or associated with/prodromal of Parkinson's, LBD, multiple system atrophy and Guillain Barre
- Treated with clonazepam
90
What is the difference between Restless Legs Syndrome and PLMD (Periodic Limb Movement Disorder)?
Patient is asleep with PLMD which must be diagnosed using EMG
91
What is bruxism?
- Persistent grinding of the teeth (usually during sleep) - associated with stress and anxiety
- Basal ganglia dysfunction is a potential cause
92
What is the prevalence of Chronic Fatigue Syndrome?
0.5% (M:F = 1:3)
93
What is the mean illness duration for CFS?
3-9 years
94
What are the features of Chronic Fatigue Syndrome?
Persistent/chronic fatigue not due to exertion or organic disease and not alleviated by rest for at least 6 months
4 of the following for at least 6 months:
- Impaired memory/concentration
- Sore throat
- Tender axillary or cervical lymph nodes
- Muscle pain
- Joint pain (several joints)
- New headaches
- Unrefreshing sleep
- Malaise after exertion
Psychiatric disorders must be excluded
95
What is the cause of Chronic Fatigue Syndrome?
Likely multifactorial, factors include
- Predisposing: neuroticism, childhood inactivity or illness
- Precipitating: Glandular fever, Q fever, Lyme disease, any serious life event
- Perpetuating: strong belief in physical cause, activity avoidance, poor self control, primary/secondary gains
*HPA axis and serotonin pathway abnormalities described - 1/3 have low cortisol
96
What is the treatment of Chronic Fatigue Syndrome?
1st line = CBT, Graded exercise therapy
2nd line = Pacing
*Do NOT routinely use antidepressants
97
What is the rate of depression among patients with CFS?
23% - current
| 50-75% - history of
98
What conditions are associated with CFS?
Fibromyalgia (significant overlap)
IBS
TMJ dysfunction
Multiple chemical sensitivity
99
What percentage of depressed adults report pain?
43%
100
The DAI and the MARS are useful scales for assessing
compliance with medication
101
Which medication level is done via a peak (not a trough) sample?
Lithium
102
What % of major congenital malformations do drugs account for?
5 in 100 (5%)
103
What is the risk of pueperal psychosis?
0.1-0..25% in the general population
50% in BPAD
50-90% if personal hx of pueperal psychosis
104
Incidence of pueperal psychosis
1 in 1000
105
Risks of untreated perinatal mental illness
To mother: suicide, substance misuse, poor compliance with appointments, impulsivity, unhealthy lifestyle
To baby: low birth weight, small head circumference, preterm birth, FAS if alcohol dependence, neglect, infanticide
106
What happens to blood volume in 3rd trimester and how should this affect prescribing?
Increases by 30% so increased doses may be required
107
Which antidepressant has the least placental exposure?
Sertraline
108
Risk of any malformation if Lithium is used in pregnancy?
1 in 100
109
Risks of using carbamezapine in pregnancy
```
Spina bifida and neural tube defects
fingernail hypoplasia
poor growth and reduced head circumference
craniofacial defects
developmental delay
```
110
Risks of using valproate in pregnancy
```
foetal distress
poor growth
hepatotoxicity
congenital malformations: spina bifida and neural tube defects, digit and limb defects, urogenital defects
low IQ
```
7.2% risk of birth defects
111
In a catatonic patient with no psych hx that worsens with benzos what are the differentials?
Organic causes - tumours, encephalitis
112
Prevalence of suicide in the UK
8 - 11 per 100 000
113
Most common method of suicide in men (and therefore overall)?
Hanging (40%)
Overdose (20%)
Car exhaust fumes (10%)
114
Most common method of suicide in women?
Overdose (46%)
| Hanging (27%)
115
Whch occupations are high risk for suicide?
Doctors - especially female: anesthetists, GPs, psychiatrists
Farmers
116
Risk of suicide in mood disorder?
6-10%
117
Risk of suicide in alcohol dependence?
7%
118
Risk of suicide in schizophrenia?
6% (10x higher than general population)
119
Relative risk of sucide in anorexia nervosa?
20x higher than gen population
120
Global annual rate of suicide
1 in 6 000 per year
121
M:F suicide
2.4:1
122
Most common psychiatric diagnoses in suicide
```
Depression (30-31%)
Alcohol dependence (17-24%)
```
123
% suicides that have at lease one DSH attmept
40-60%
124
% that repeat DSH within a year
30%
125
% in suicides that had contact with psychiatric services within one year of death
25%
| 25% on outpatient registers
126
% suicides attempted under the influence of alcohol
25%
| 50% of these had alcohol within 6 hours of attempt
127
% suicides seen by psychiatrist in previous week
12.5%
128
% suicides seen by health worker in prev 3 weeks
33%
129
% suicides seen by GP in last four weeks
66%
130
% suicides seen by GP in last week
40%
131
% inpatient suicide in first week of admission
25%
132
% inpatient suicide when under routine obs
80%
133
% suicides not compliant with medication
20%
134
% suicides within 3 months of discharge
25%
135
Strongest risk factor for suicide
Previous attempt/DSH
136
% suicide of Care Plan approach cases
50%
137
% older patients who visited GP on same day as suicide
20%
138
% older patients who visited GP within a week of suicide
40%
139
% older patients who visited GP within a month of suicide
70%
140
% inpatient suicides descrried as preventable by mental health teams in England and Wales
22%
141
rate of DSH in the UK
3 per 1000
142
% DSH that eventually complete suicide
10%
143
Management of catatonia
Benzos
| Consider dantrolene or bromocriptine if concerned about NMS
144
Managmet of agitation in delirious patients
Haloperidol
145
What is catastrophic reaction?
Response to cognitive challenge seen in patients with dementia
146
Which country has higher female than male rates of suicide?
China
147
Lifetime prevslence of DSH in possible psychotic disorder?
25%
148
Prevalence of suicidal ideation among school going adolescents in last year
15%
149
% suicide that have recognised Psychiatric disorder at time of death
90%
150
% elerly patients with cogntitve impairment who present with sexual disinhibition
10-19%
151
% patients who progress from having suicidal ideas to plans in 1 year is
60%
152
Persistent apnoea has been reported in babies with which drug started during breastfeeding?
Clonazepam
153
Surgery for male to female trans patients involves
Orchidectomy and Penectomy with Vaginoplasty using penile skin
154
Surgery for male to female trans patients does not involve
Phalloplasty
155
Surgery for FTM patients involves
bilateral mastectomy, hysterectomy, and bilateral salpingo-oopherectomy.
156
PTSD M:F
1:2
157
Alzheimer's M:F
1:2
158
BPD M:F
1:3
159
Alcohol dependence M:F
5:1
160
ASPD M:F
5:1
161
The percentage of patients who commit suicide seen by psychiatrist in the last one week
12.5%
162
Drug that is contraindicated in heart failure
Disulfram
163
Drug that is contraindicated post MI
Lofexidine
164
Drug that is contraindicated in sick sinus syndrome
Disulfram
165
Drug that is contraindicated in pulmonary insufficiency
Chlormethiazole, Diazepam
166
Important factors found in a parent that can predict the severity of suicidal behaviour in the children
History of early onset attempts
Cluster B personality traits
History of childhood sexual abuse
(independent of mood disorders)
167
Known risk factor for infanticide
- Mother who attempted suicide when pregnant
- domestic violence and a history of childhood maltreatment in the perpetrator
- concealed or denial of pregnancy
- unintended pregnancies in young women
168
Patient can speak normally but cant comprehend spoken speech
Pure word deafness
169
Which assessment of needs records both staff and patient views separately without giving primacy to either perspective?
Camberwell Assessment of Need
170
Tobacco smoking is unikely to affect the levels of which drug?
Lithium
171
Zopilclone is contraindicated in:
Unstable myesthenia gravis
Breastfeeding
Severe sleep apnoea
Respiratory failure
172
Features of frontal lobe damage
```
Contralateral hemiplegia
impaired problem solving
disinhibition
lack of initiative
Broca's aphasia and agraphia (dominant)
```
173
Features of temporal lobe damage
```
Wernicke's aphasia (dominant)
homonymous upper quadrantanopia
auditory agnosia (non-dominant)
```
174
Features of non-dominant parietal lobe damage
Anosognosia
dressing apraxia
spatial neglect
constructional apraxia
175
Features of dominant parietal lobe damage
```
Gerstmann's syndrome:
Finger agnosia
Right left disorientation
dyscalculia
dysgraphia
```
176
Features of occipital lobe damage
Visual agnosia
visual illusions
contralateral homonymous hemianopia
177
Risk of post partum depression
Without a history of depression, the risk of postpartum depression is 10%. This is increased to 25% if there is a history of depression, and to 50% if there is a history of postpartum depression.
178
Which of the following is the most accurate estimate of the proportion of those aged over 60 who commit suicide in the 12 months following an episode of self-harm?
1.5%
179
What percentage of people who attend an emergency department following self-harm will self-harm again in the following year?
15%
180
Chronic grief is present when symptoms of grief are still present how long after bereavement?
6 months
181
Which diagnosis is most commonly associated with dangerous driving?
Dementia
182
What is most likely to increase the risk of developing depression among people with epilepsy?
Complex partial seizures
183
Inpatient suicide rates in the UK have reduced significantly since 2000. What is thought to have contributing most to this decrease?
Removal of potential ligature points
184
What is the male: female ratio of reading difficulties?
2:1
185
Which of the following is the greatest risk factor for the development of an autism spectrum disorder?
low apgar score
186
Generalised, bilateral, synchronous, 3Hz (3 waves per second) spike and wave pattern
Petit Mal epilepsy
187
Hyperactive, fast trace on EEG
Delirium
188
Early on there is non specific slowing, later periodic biphasic and triphasic synchronous sharp wave complexes superimposed on a slow background rhythm on EEG
Sporadic CJD
