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1 - Y5 Psych > Misc Psych (capsule, passmed, firms lectures etc) > Flashcards

Misc Psych (capsule, passmed, firms lectures etc) Flashcards

1
Q

What are the EPSEs of antipsychotics?

A
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2
Q

Which types of patients are more susceptible to EPSEs

A

more common in elderly and patients with pre-existing neuro damage

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3
Q

a) Which drug class is most likely to cause EPSEs?
b) of this class, which drug is most likely to cause EPSEs?

A

a) atypical antipsychotics
b) risperidone

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4
Q

What are the main features of parkinsonism?

A

tremor

rigidity

bradykinesia

(also hypomimia, postural instability, shuffling gait)

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5
Q

Which drug can be given to patients presenting with Parkinsonism secondary to antipsychotic use?

What is the other management for this side effect?

A
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6
Q

What are the main types of dystonia seen secondary to antipsychotic use?

A

torticollis (distortion of the neck)

oculogyric crisis s

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7
Q

What is the management for acute dystonia secondary to antipscyhotic use?

A
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8
Q

Describe tardive dyskinsia

A

can be worsened by anti-cholinergics (e.g. procyclidine)

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9
Q

What is akithesia?

A

severe physical and mental restlessness

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10
Q

What is clozipine used to treat?

A

treatment-resistant schizophrenia

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11
Q

What is the maxiumum amount of time benzodiazipines should be prescribed for?

A

2-4 weeks (due to addictive potential)

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12
Q

What condition is sodium valproate used to treat?

A

bipolar disorder

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13
Q

Which drugs are commonly used for rapid tranquilisation?

A

lorezapam

Promethazine (sedating antihistamine)

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14
Q

What are Schnieder’s first rank symptoms of schizophrenia?

A
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15
Q

What is the difference between 2nd person and 3rd person auditory hallucinations?

A
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16
Q

What is the most common type of hallucination?

A

auditory (rarely somatic, olfactory, etc)

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17
Q

What are the ICD-10 classifcations of schizophrenia?

A
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18
Q

What are the main features of schizophrenia?

A
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19
Q

What are the negative symptoms of schizophrenia?

A
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20
Q

Summarise the epidemiology of szhizophrenia

A
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21
Q

Summarise the prognosis of schizophrenia

A
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22
Q

What are some differentials for schizophrenia?

A
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23
Q

Name some physical health differntials of schizophrenia

A
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24
Q

what are some investigations for suspected schizophrenia?

A
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25
Q

Name some typical antipsychotics

A
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26
Q

Name some atypical antispscyhotics

A
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27
Q

What is the pharmocology of antipsychotics (how do they work?)

A

Dopamine receptor antagonist - except aripriprozole (partial agonist)

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28
Q

What are the main side effects of typical antipsychotics?

A
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29
Q

What are the main side effects of atypical antipsychotics?

A
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30
Q

What is the most effective antipsychotic (in research)?

A

clozipine (usually reserved for treatment-resistant schizophrenia)

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31
Q

Define Tx-resistant schizophrenia

A
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32
Q

What are the risks associated with clozapine?

A

agranulocytosis (rare and potentially fatal idiosyncratic reaction)

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33
Q

Which bloods must be conducted for patients on clozapine regularly?

A

FBC

regularity decreases over time

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34
Q

What are some other side effects of clozapine

A

excessive sedation

hypersalivation

postural hypotension

weight gain & metabolic syndrome

anticholinergic effects - particularly constipation

cardiomyopathy, fatal myocardititis

reduced seizure threshold

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35
Q

What other drug should be started concurrently when starting clozapine?

A

laxative

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36
Q

What is role of the mesolimbic pathway in schizophrenia?

A
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37
Q

What is role of the mesocortical pathway in schizophrenia?

A
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38
Q

Which pathway in the brain is responsible for the EPSEs of antipsychotics?

A

Nigrostriatal pathway

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39
Q

Which brain pathway is reponsible for hyperprolactinaemia in antipsychotics?

A

tuberoinfundibular pathway

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40
Q

What is the normal QTc interval?

A

<440ms in men

<470ms for women

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41
Q

Which antipsychotics have increased risk of QTc interval prolongation?

A

all of them

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42
Q

What complications can arise from prolonged QTc interval?

A

torsades de points

VT

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43
Q

Which antipsychotics are linked to metabolic syndrome?

A

atypical antipsychotics (worst is olanzapine)

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44
Q

What monitoring does NICE recommend for patients on any antipsychotic?

A
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45
Q

Which antipsychotic can be started prophylactically (on top of another antispsychotic) in order to control the metabolic syndrome risk?

A

aripipozale

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46
Q

What is neuroleptic malignant syndrome?

A
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47
Q

Which drugs cause neuroleptic malignant syndrome?

A

any antipsychotic

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48
Q

What is the aetiology of neuroleptic malignant sydnrome?

A

reduced dopamine in hypothalamus –> reduced temp.

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49
Q

What are the risk factors for neuroleptic malignant syndrome?

A
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50
Q

What are the investigations for suspected neuroleptic malignant syndrome?

A
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51
Q

What is the management of neuroleptic malignant syndrome?

A
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52
Q

What are the main difference

A

different causes: lack of dopamine (NMS) vs excess serotonin (serotonin syndrome)

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53
Q

What is the treatment for mild depression?

A
  • prescribe nothing & follow up in 2 weeks
  • refer for psychological Tx
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54
Q

How long does it take to see a response to an antidepressant?

A

2-4 weeks

At least 4 weeks at an effective dose is needed before deciding that the patient has failed to respond.

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55
Q

What are some symptoms of discontinuation syndrome?

A
  • flu like symptoms
  • insomnia
  • vivid dreams
  • dizziness
  • irritability
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56
Q

Which drugs have been linked to depression?

A
  • corticosteroids
  • oral contraceptives
  • statins
  • ranitidine
  • antihypertensives
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57
Q

For a 1st episode depression, how long should drug Tx be continued after symotoms subside?

A

For a first episode of depression, treatment should be continued for 6 months after remission

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58
Q

For a 2nd episode depression, how long should drug Tx be continued after symotoms subside?

A

2 yearss

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59
Q

Describe serotonin syndrome

A
  • cognitive symptoms (eg confusion, headache)
  • autonomic symptoms (eg sweating, hyperthermia, tachycardia)
  • neurological symptoms (eg myoclonus, hyper-reflexia)

this is something to be aware of when:

  • prescribing high dose SSRI’s
  • antidepressants are used in combinations.
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60
Q

which class of drug is venlafaxine?

A

SNRI

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61
Q

which class of drug is duloxetine?

A

SNRI

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62
Q

which class of drug is mirtazapine?

A

noradrenline reuptake inhibitor (NARI)

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63
Q

which class of drug is escitalopram?

A

SSRI

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64
Q

which class of drug is reboxetine?

A

noradrenline reuptake inhibitor (NARI)

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65
Q

Name some Tx options for Tx-resistant depression

A
  • lithium augmentation
  • antidepressant combinations
  • ECT
  • liothyronine (T3) augmentation
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66
Q

Describe amitriptyline

A
  • Amitriptyline is a tricyclic antidepressant.
  • The indications for its use include neuropathic pain and migraine prophylaxis.
  • It is no longer recommended as a first-line treatment for major depression due to its side-effects and cardio-toxicity risks in overdose; it is sometimes used for treatment-resistant depression.
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67
Q

Name some side effects of amitriptyline

A

Common side effects include:

  • Dry mouth
  • Sedation
  • Blurred vision
  • Constipation
  • Postural hypotension

Rare side effects include:

  • Urinary retention
  • Convulsions
  • Cardiac dysrhythmias
  • Weight gain
  • Precipitation of glaucoma
  • Hyponatremia
  • Hepatic impairment
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68
Q

What are some contraindications to amitriptyline?

A
  • known allergy
  • immediately post myocardial infarction
  • cardiac arrhythmias.
  • complete heart block.
  • amitrypyline is metabolised in the liver and can precipitate an acute crisis in those with Acute Porphyria.
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69
Q

Amitriptyline increase the risk of ____ when combined with a beta blocker

A

ventricular arrhythmias

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70
Q

How can amitriptyline and concerrant warfarin can affect the INR?

A

unpredictable effect

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71
Q

What does amitriptyline and concurrant MAOI Tx increase the risk of?

A

serotonin syndrome - never co-prescribe!

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72
Q

Which is the only SSRI recommended by NICE for use in Bipolar Affective Disorder?

A

Fluoxetine

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73
Q

Why should antidepressants be avoided in rapid cycling bipolar disorder or with a recent history of a manic episode?

A

risk of triggering a manic episode

hey should only be prescribed if the patient is also taking an antipsychotic or anti-manic agent

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74
Q

What is the normal therapeutic range for Lithium from bloods taken 12 hours post dose?

A

0.4 to 0.8mmol/L

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75
Q

Which lithium blood levels

a) present toxicity symptoms
b) are potentially fatal
c) require urgent Tx

A

a) Toxic symptoms can begin to appear when levels are >1.0mmol/L.
b) Levels >1.5mmol/L are potentially fatal
c) > 2.0mmol/L require urgent treatment.

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76
Q

What are the symptoms of lithium toxicity?

A
  • diarrhoea,
  • nausea,
  • anorexia,
  • myalgia,
  • ataxia,
  • blurred vision,
  • muscle twitches
  • coarse tremor.
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77
Q

What are the symptoms of sodium valproate toxicity?

A
  • hypotonia
  • hyporeflexia
  • CNS depression/coma
  • constriction of pupils
  • impaired respiratory function
  • metabolic acidosis
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78
Q

Which drugs can increase lithium toxicity?

A

NSAIDs

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79
Q

What are some side effects of long term lithium use?

A
  • (irreversible >15yrs) Nephrogenic Diabetes Insipidus
  • hypothyroidism
  • hyperparathyroidism
  • hyperglycaemia
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80
Q

Which blood tests are required for patients on lithium and how often?

A
  • TFTs and renal function at initiation and every 6 months
  • Lithium levels should be done at one week after initiation or dose change and once stable every 3 months
  • FBC if clinically indicated

an ECG at initiation if the patient has cardiac disease or risk factors for this, weight and height at the start of treatment and further weight measurements if the patient gains weight.

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81
Q

What is the Tx for acute mania?

A

antipyschotics: Olanzapine, Risperidone or Quetiapine

Consideration should be given to the side effect profile, the patient’s medical history and medical risk factors, such as weight/diabetes/cardiovascular disease etc, when making a choice

Lithium or Sodium Valproate can also be used, although antipsychotic are preferred for acute treatment. These mood stabilisers are more appropriate for prophylaxis of relapse than for acute treatment.

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82
Q

Why should sodium valproate not be used in pregnancy?

A

teratogenic

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83
Q

What are some side effects of sodium valproate?

A
  • nausea
  • weight gain
  • hair loss
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84
Q

What % of patients with mania will develop depression at some point?

A

90%

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85
Q

Can a Section 5(2) be used in A&E?

A

no, can only be used in those already admitted to hospital

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86
Q

What is activated charcoal used for?

A

in drug overdose (<1hr)

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87
Q

Peak plasma level of Paracetamol is reached ___ hours after ingestion

A

4 hours after ingestion

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88
Q

What is a mood stabiliser?

A
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89
Q

**What are the 3 types of mood stabiliser?

A
  1. lithium carbonate
  2. anti-epileptics
  3. anti-psychotics
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90
Q

What are the effects of lithium?

A
  • mood stabiliser
  • anti-suicide effects
91
Q

What is lithium used to treat?

92
Q

What is the therepeutic range of lithium?

93
Q

What are the complications of lithium use?

A
  • teratogenic
  • arrhythmias
94
Q

What are some common side effects of lithium?

95
Q

What are some persistent side effects of lithium?

96
Q

At what lithium blood level does lithium toxicity occur?

A

>1.5mmol/L

97
Q

What are some signs and symptoms of lithium toxicity?

98
Q

How do patients keep track of their lithium levels, etc?

A

lithium purple book

99
Q

Which bloods must be done before starting lithium?

A
  • FBC
  • U&E
  • Ca
  • TFTs

+ ECG (if cardiac risk factors)

100
Q

How often do lithium levels need to be monitored after initiation?

A

Weekly at the start

101
Q

Once lithium levels are stable, how often do bloods need to be done and which ones?

102
Q

What must not be prescribed when prescribing lithium?

A

NSAIDs or ACEi

103
Q

Which is the only antipsychotic licenced for BPAD?

A

olanzapine

104
Q

What are some common anticonvulsant drug given for BPAD?

A
  • sodium valproate
  • carbamapazepine
  • Lamotrigine
105
Q

Can sodium valproate be used in women of childbearing age?

106
Q

What are the side effects of sodium valproate?

107
Q

What is particularly important complication of lamotrigine?

108
Q

How do you treat acute mania in a new patient?

109
Q

How do you treat acute mania in a known patient? (relapse)

110
Q

What is malingering?

A

deliberately feigning symptoms for external gain e.g. money through insurance after car crash (not an illness)

111
Q

What is facticious disorder?

A

AKA Munchausen’s syndrome

Deliberately feigning symptoms for receiving medical care

112
Q

What is the defintion of a personality disorder?

113
Q

What is general personality disorder?

114
Q

What are the 3 clusters of personality disorders as defined by DSM-5?

115
Q

Name some personality disorders within each of the personality disorder clusters in DSM-5

116
Q

Describe paranoid personality disorder

117
Q

Describe schizoid personality disorder

118
Q

Describe schizotypal personality disorder

119
Q

Can one have psychotic symptoms in schizotypical personality disorder?

120
Q

Describe dissocial/antisocial personality disorder

121
Q

Describe emotionally unstable personality disorder/BPD

122
Q

What is the difference between BPD and BAD?

A

emotional lability is faster than in BPD than in BAD (even rapid cycling)

123
Q

Describe histrionic personality disorder

A
  • over-dramatic
  • theatrical
  • lack of consideration for others
124
Q

Describe narcissistic personality disorder

125
Q

Describe anxious/avoidant personality disorder

126
Q

Describe dependent personality disorder

127
Q

Describe anankastic/obsessive compulsive personality disorder

128
Q

What is the difference between OCD and obsessive compulsive personality disorder?

A
  • OCPD can have thoughts that are distressing, but they do not automatically require a soothing behaviour in form of the compulsion
  • nature of obsessive thoughts are not as severe as an obsession in OCD
129
Q

What are the main Txs for personality disorders?

A
  • psychological therapy
  • sometimes psychotropic medication
130
Q

What are the main types of psychological therapies for Cluster B personality disorders?

131
Q

What is dialetic BT mainly used to treat?

A
  • self-harm elements of emotionally-unstable PD
132
Q

Which psychotropic drugs are licenced for personality disorders?

A

none have been licenced

133
Q

Which psychotropic drugs are used to Tx personality disorders?

A

top 2 more commonly used

134
Q

What is the major difference between a feature of a personality disorder and a normal trait that may be maladaptive?

A
  • PD features really affect functioning vs normal personality traits
135
Q

What is the most common eating disorder?

A

Binge eating disorder

136
Q

What is the least commonly diagnosed eating disorder?

A

Binge eating disorder

137
Q

What is an eating disorder?

138
Q

Give some behavious intended to control weight

139
Q

How do eating disorders impair physical health?

140
Q

How do eating disorders impair psychosocial functioning?

141
Q

Name some eating disorders in the DSM-5 classification

A

pica - eating non-nutritional substances

rumination disorder - chewing, spitting out and eating food

142
Q

What is anorexia nevosa (DSM-5)?

143
Q

What is purging disorder?

144
Q

What is avoidant restrictive food intake disorder?

145
Q

What is binge eating disorder?

146
Q

What are the 3 main subtypes of avoidant restrictive food intake disorder?

A
  • 2nd is most common in boys
  • 3rd e.g. someone who has choked on food
147
Q

Can a person with avoidant restrictive food intake disorder have a fear of eating?

A

no, once there are fears of eating involved, it becomes anorexia nervosa

148
Q

Describe the epidemiology of eating disorders

A
  • ED total incidence = 0.16% in 15-19yrs
  • much higher incidence in girls than boys
  • AN = atypical anorexia nervosa
149
Q

What are some psychological markers of an eating disorder (in a consultation)?

150
Q

What are some indications that a person with ?eating disorder requires hospitalisation?

A
  • CBS compromise
151
Q

Name some factors involved in the aetiology of eating disorders

A
  • psychosocial factors
  • genetic factors
    • both psychiatric (e.g. neuroticism) and metabolic factors (e.g.BMI, insulin resistance)
152
Q

Name some other psychosocial risk factors for eating disorderse

153
Q

Which steps are invovled in de-escalation?

154
Q

Give some examples of rapid tranqilisation prescriptions

155
Q

What is a risk associated with haloperidol (antipsychotic), that less likely with benzodiazepines?

A

arrhythmias

156
Q

Which must be monitored after rapid tranquilisation?

A
  • BP
  • HR
  • GCS
  • temp (looking for Neuroleptic Malignant Syndrome)

no ECG, full neuro obs or blood glucose required

157
Q

What are some important considerations before prescribing rapid tranquilisation?

158
Q

What is a sedative?

A

drug with hypnotic or anxiolytic effects (enhancing GABA –> reducing neuronal excitability)

159
Q

Which considerations are important when prescribing benzodiazipines/sedatives?

A

tolerance

dependence

withdrawal

160
Q

What are some indications for benzodiazapines?

161
Q

Name some common benzodiazapines and their uses

162
Q

Which pre-existing conditions and other risks of benzodiazapines must be considered before prescribing?

163
Q

Which are the only benzodiazapines that can be used in liver impairment?

164
Q

What must be given for a benzodiazapine (and what dose?)?

165
Q

What are the side effects of benzodiazapines?

A

+ overdose risk

166
Q

Name some hypnotics

A
  • promethazine
    • sedating antihistamine
    • non-addictive
    • anticholinergic side effects
  • pregablin
    • anticonvulsant licenced for GAD
    • similar structure to GABA
    • big potential for abuse
167
Q

What is the method of action of diazepam?

A

GABA allosteric modulator

168
Q

Summarise the aetiology of personality disorders

169
Q

What is the neuropsychiatry of developmental trauma

170
Q

What is the Weichsler Adult Intelligence Scale?

A

Used to measure IQ to diagnose intellectual disability

171
Q

How is the WAIS scored?

172
Q

What are some psychiatric conditions associated with learning disabilities?

173
Q

What is a typical speech impairment seen in autism?

174
Q

What are the clinical features of dementia?

A
  • mood changes
  • abnormal behaviour e.g. disinhibition, agitiation, aggression
  • hallucinations + delusions

= Behavioural and psychological symptoms of dementia

175
Q

What is the epidemiology of dementia?

176
Q

What are some cognitive tests used in memory clinics (for dementia)?

A
  • Abbreviated Mental Test Score (AMTS)
177
Q

Recall the qs asked in the AMTS

178
Q

Define delirium

179
Q

What are some screening questionnaires for alcohol dependence?

A
  • CAGE
  • AUDIT
  • MAST
180
Q

What are the investigations for ?depression?

181
Q

What is the ICD-10 criteria for depression?

182
Q

How is the severity of depression calculated?

183
Q

What is the Tx for moderate-to-severe depression?

184
Q

Describe atypical depression

185
Q

Describe dysthymia

186
Q

What is the ICD-10 criteria for diagnosis of bipolar affective disorder?

187
Q

What is the epidemiology of bipolar affective disorder?

188
Q

Which signs are required for an episode to be classified as manic?

189
Q

Describe the psychotic features of mania that may be seen in bipolar affective disorder

190
Q

Name some antidepressant medications, their classes and their side effects

191
Q

Name some TCAs and their common side effects

192
Q

Name some less commonly used antidepressants and their side effects

193
Q

What are the Tx options for refractory depression?

194
Q

Describe the features/signs and management of serotonin syndrome

195
Q

Name some anxiety disorders and their typical age of onset

196
Q

What is the aetiology of depression?

197
Q

Describe the common eating disorders by their features/signs

198
Q

Describe the epidemiology of eating disorders

199
Q

What are some psychological or behavioural markers/signs of eating disorders?

200
Q

recall the signs O/E, history and management of someone presenting with an eating disorder at A&E

201
Q

What are the indications for immediate hospitalisation in someone presenting with an eating disorder

202
Q

What are some psychological treatments for eating disorders?

203
Q

What are some common psychiatric problems that people with learning disorders have?

204
Q

Name some causes of delirium

205
Q

Name and describe the different types of dementia

206
Q

How do benzodiazapines work?

207
Q

Name some drugs that are used to treat alcohol dependence and explain briefly how they work

208
Q

What are the ICD-10 criteria for dependence syndrome?

A

3 of the 6 required for diagnosis

209
Q

How might one intervene when a patient is at the pre-contemplation stage in their addiction to a substance?

210
Q

what are the complications of alcohol withdrawal?

A
  • seizures
  • delirium tremens
  • Wernicke’s / Korsakov’s psychosis
211
Q

What are the symptoms of alcohol withdrawal?

A

+ withdrawl seizures (20%) - generalised tonic-clonic seizures 1-2 days post last drink

212
Q

What is the management of alcohol withdrawal?

A

+ chlordiazepoxide

213
Q

What class of drugs does mirtazapine belong to?

A

Nassa (Noraadrenergic and specific serotonergic antidepressant) goes to mars (Mirtazapine)

214
Q

Name the groups of personality disorders

215
Q

A 27-year-old patient presents with new-onset paralysis 4 weeks after being in a road traffic accident. At the time, they were discharged from the hospital with no injuries.

They now cannot move their right leg and left arm. This paralysis came on when they woke up this morning, and they were fine the night before. This new paralysis is associated with significant distress, but no pain.

On examination, there is no visible injury, normal and equal tone, and intact sensation in all 4 limbs. All upper and lower limb reflexes are normal. Power in the right leg and left arm were MRC 0/5 but the contralateral limbs were MRC 5/5. Hoover’s sign is positive on the affected leg. A cranial nerve exam is unremarkable.

What is the likely diagnosis?

A

Conversion disorder is normally a neurological symptom presenting after a period of stress. This patient has presented after a stressful accident. There appears to be a level of functional paralysis, as she has no capability for voluntary movement, but involuntary movements are possible due to present reflexes and positive Hoover’s sign. Hoover’s sign is a compensatory movement of the other leg, due to synergistic contraction - when the unaffected leg is flexed against resistance, the affected leg involuntarily extends.

216
Q

A 40-year-old man is diagnosed with paranoid schizophrenia and has been prescribed clozapine. He has been taking the medication for three months. The patient has had monitoring blood tests carried out and is presenting for a review appointment with you.

Which of the following abnormalities is he most at risk from?

A

Agranulocytosis/neutropenia is a life-threatening side effect of clozapine - monitor FBC

217
Q

What are the metabolic side effects of antipsychotics?

A
  • weight gain,
  • increased glucose tolerance.
  • dysglycaemia,
  • dyslipidaemia,
  • diabetes mellitus
218
Q

What is Cotard’s delusion?

A
  • This is a fixed false belief that a person may hold where they believe that their body or body part is dead or dying.
  • This can occur with severe depression and psychosis.
219
Q

A 23-year-old male has been on antipsychotics for the past few months. He has been suffering from a side-effect of this drug, that you grade as severe, which causes repetitive involuntary movements including grimacing and sticking out the tongue. This side-effect is known to arise only in individuals who have been on antipsychotic for a while.

Which medication is therefore most suitable to treat this side-effect?

A

Tetrabenazine may be used to treat moderate/severe tardive dyskinesia

220
Q

What is the Tx for akathisia?

A

Propranolol

221
Q

What is the Tx for acute dystonia?

A

Procyclidine // benztropine

222
Q
A

Long-term lithium ~ → hyperparathyroidism + resultant hypercalcaemia

Long term use of lithium results in hyperplasia of the parathyroid gland leading to hyperparathyroidism, causing hypercalcaemia, which can lead to nephrolithiasis due to excessive concentration of calcium in the kidney. It can also lead to hypothyroidism, and so looking at TFTs may also be informative.

223
Q

What is the link between smoking and clozapine levels?

A

Smoking cessation ~ → rise in clozapine blood levels

Smoking uptake ~ → reduce clozapine blood levels

224
Q

Name the poor prognostic indicators for schizophrenia

A
  • strong family history
  • gradual onset
  • low IQ
  • prodromal phase of social withdrawal
  • lack of obvious precipitant

1 - Y5 Psych (23 decks)

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