MLA Psychiatry Flashcards
What’s an acute stress reaction?
A reaction to a life-threatening/stressful event. Shows in a few days of event
Symptoms: Anxiety, increased arousal, confusion, sadness, anger, despair, overactivity, inactivity, social withdrawal, or stupor
What is the structure of a psychiatric history?
- HPC exploring delusion, self-harm, substance misuse, depression, psychosis, mania
- ICE
- Past psychiatric history. Contact with services, current treatment
- Forensic history
- Past medical history
- Drug history
- Family history
- Personal history, going from childhood till now
- Social history
- Insight
What is the management for bipolar disorder?
- Prescribe an antipsychotic like haloperidol, olanzapine, quetiapine, or risperidone
- Add lithium or valproate is reaction inadequate
- Benzodiazepines are helpful PRN
- Carbamazepine can be used long-term is patient is unresponsive to lithium or valproate
What are the different types of dementia?
- Alzheimer’s (most common)
- Vascular. Affects planning, concentration, and thinking speed
- Lewy-body. Causes movement issues and delusions
- Frontotemporal (AKA Pick’s disease). Affects personality and behaviour
- Creutzfeldt-Jabok disease
- Primary progressive aphasia
- Mixed dementia
- Young onset dementia
- Alcohol-related
What are the different types of delirium?
Hyperactive: restless, agitated, hallucinations, mood swings
Hypoactive: inactive, sleepy, depressed, reduced concentration
What are the different types of eating disorder?
- Anorexia nervosa: limited food and fluid intake
- Avoidant restrictive food intake disorder (ARFID): person avoids eating certain foods
- Binge eating disorder (BED): loss of control over quantity of food eaten
- Bulimia nervosa: cycle of eating lots and then vomiting, fasting, or using laxatives to compensate
- Orthorexia: Unhealthy obsession with eating ‘pure’ food
- Other specified feeding or eating disorder (OSFED): symptoms don’t fit elsewhere
- PICA: eating non-food substances
- Rumination disorder: brining up party digested food
What are the different types of personality disorder?
- Paranoid
- Schizoid: prefers to be alone and not interested in having relationships
- Schizotypal: unusual thoughts and behaviours, uncomfortable forming relationships
- Antisocial: manipulates and exploits
- EUPD
- Histrionic: dramatic strong emotions
- Narcissistic: lacks empathy
- Avoidant
- Dependent
- Obsessive-compulsive: perfectionist
What is the definition of schizophrenia?
Disruption of thought processes, perceptions, emotional responsiveness, and social interaction
Symptoms: Hallucinations, delusions, disorganised thinking, reduced emotional expression, motor and cognitive impairment
What’s the different between psychosis and schizophrenia?
Psychosis: patient is disconnected from reality. Affects the mind
Psychosis may be a symptoms of schizophrenia
What is somatisation?
Experiencing psychological distress and physical symptoms
Eg. pain, dizziness, dyspnoea, nausea
What is Wernicke’s encephalopathy?
Thiamine (B1) deficiency
A neurological emergency
How do different drug overdoses present?
- Opioid: pinpoint pupils
- SSRI: drowsiness, tremor, tachycardia
- Paracetamol: N+V, abdo pain
What’s included in a mental state examination?
- Appearance and behaviour: hygiene, clothing, eye contact, body language, abnormal movements
- Speech: rate, quantity, tone, volume, fluency
- Mood and affect
- Thoughts: form, content, possession, coherence, speed,
- Perception: hallucinations, derealisation, depersonalisation
- Cognition: orientation in time and place
- Insight
- Risk to self/others
What is a matched care model?
Matching the treatment to the diagnosis
- Depends on acuteness
What are the different sections of detaining someone under the MHA?
2: 28 days for assessment
3: 6 months for treatment
5(4): 6 hours by nurse
5(2): 72 hours by doctor
136: arrested for 24 hours and put into place of safety
How long do antidepressants take to work?
Will notice difference by day 10, especially in terms of mood
Full effects by 6 weeks
What is the SUSS score?
Sit up, squat, stand test
0: unable
1: uses hands to help
2: noticeable difficulty
3: no difficulty
Give examples of SNRI’s
Duloxetine
Venlafaxine
At what dose can Mirtazapine be prescribed to help sleep?
30mg antidepressant effects
15mg sedating effects
Why is Paroxetine avoided in young groups?
Ineffective
Increases risk of self-harm/suicide
Give examples of tricyclic antidepressants
Amitriptyline
Nortriptyline
Not prescribed for depression anymore
Name some MAOI’s
Dicarboxamide
Phenelzine
Selegiline
Not used anymore
What are the symptoms of antidepressant discontinuation syndrome?
flue-like symptoms
Sensory issues
Nausea
Insomnia
Mood changes, anxiety
Drugs with long half lives have less effect. Worse with Venlafaxine, less with fluoxetine
Name some mood stabilisers
Valproate
Lithium
Antipsychotic:
Olanzapine
Quetiapine
Carbamazepine
Lamotrigine
What is the monitoring required for lithium?
- Check lithium levels often, has narrow therapeutic levels
- Becomes toxic with dehydration caused by D+V illness so advise to take lower dose when ill
- Renal and thyroid function
What are some signs of lithium toxicity?
- Coarse tremor
- Confusion
- Seizures
What are the teratogenic effects of sodium valproate?
Spina bifida
Cleft lip and palate
Atrial septal defect
Hypospadias
Polydactyly
Craniosynostosis
What are the side effects of sodium valproate?
Nausea
Diarrhoea
Tremor
Tiredness
Weight gain
Hair thinning
What are ‘Z’ drugs?
Zopiclone
Zolpidem
Non-benzodiazepine medications used for insomnia
Who is most likely to developed anorexia nervosa?
Female aged 14-18
Common co-morbidities: anxiety, depression, autism, OCD
What are some physical symptoms of anorexia nervosa?
- Hair loss, dry skin, lanugo hair
- Bradycardia
- Hypothermia
- Muscle wasting/weakness
- Dizziness, seizures
- Chronic tiredness
- Amenorrhoea
- Erectile dysfunction
- Reduced bone density/ fractures
- Brittle nails
What is Russel’s sign?
Calluses, abrasions, or scars on the knuckles or back of their hands
- Injuries caused by self-induced vomiting (Bulimia eating disorder)
What is lanugo hair?
Fine, soft hair that covers the body naturally in newborns
Occurs in eating disorder to help them regulate their body temperature
What are some complications of eating disorders?
Refeeding syndrome
Sudden cardiac death
Electrolyte imbalance
Circulatory collapse
Premature osteoporosis
Infection
VTE
Suicide
What is the pathophysiology of refeeding syndrome?
A shift in the bodies chemistry 1-5 days after the patient begins eating again
- Insulin is released after food causing absorption of Mg, K, Phosphate, causing deficiency
- Demand for thiamine suddenly increases
- Glycogenolysis
- Decreased basal metabolic rate
How is re-feeding syndrome managed?
- Monitor electrolytes
- IV Pabrinex (thiamine)
- Replace electrolytes
- Refer to HDU/ITU
- Start on low-calorie diet and gradually increase (10-20kcal/kg/day)
What are some positive symptoms of psychosis?
Added functions
Eg. delusions, hallucinations, disorganised soeech, thought, or behaviour
What are some negative symptoms of psychosis?
Decreased functions
Eg. Reduced emotional and speech ability, lack of concentration, depression
What’s the difference in management of negative vs positive symptoms?
Positive: treated with antipsychotics
Negative: life-style interventions, antipsychotics
What is the ICD-10 criteria for diagnosing schizophrenia?
Symptoms for at least 1 month most of the time
What is the difference between typical and atypical antipsychotics?
Typical (1st generation)
- Block dopamine receptors so cause extrapyramidal as side effects
Eg. Haloperidol
Atypical (2nd generation)
- Less selective so have less movement side effects. Cause weight gain, high cholesterol, diabetes
Eg. Olanzapine
What are the 4 types of extrapyramidal side effects of antipsychotics?
- Akathisia: Motor restlessness or anxiety. Common with aripiprazole
- Parkinsonian symptoms: Mask-like face, tremors, shuffling gait, hypersalivation
- Dystonias: Spasms and rigid muscles. Treated with procyclidine
- Tardive dyskinesia: Facial movements the patient isn’t aware of Eg. tongue protrusion, puffing of cheeks, chewing/puckering of mouth. Treated with switching to clozapine
Which antipsychotics have which common side effects?
Clozapine and olanzapine: anticholinergic, glycaemic control, sedation, weight gain
Quetiapine: sedation
Risperidone: increased prolactin
Give examples of common depot antipsychotics
Flupentixol
Haloperidol
Aripiprazole
When is psychosis concidered treatment resistent?
When at least 2 different antipsychotics have been tried at maximal tolerable dose, both typical and atypical drugs were unsuccessful
What is agranulocytosis?
Low granulocytes (Eg. neutrophils, eosinophils, basophils)
Requires weekly monitoring for 18 weeks and then fortnightly and then monthly because it’s so dangerous but rare
Risk highest at beginning but remains
What are the key side effects of Clozapine?
- Constipation
- Agranulocytosis
- Weight gain
- Hypersalivation (treated with hyoscine hydrobromide)
- Cardiomyopathy
What is the presentation of neuroleptic malignant syndrome?
- Autonomic dysfunction Eg. fever, variable BP, sweating, tremor
- Rigidity
- Confusion
What is neuroleptic malignant syndrome?
A life-threatening reaction to antipsychotics
Diagnosis: Creatinine kinase showing muscle rigidity
Treatment: stop antipsychotic and treat the symptoms. Protect the kidneys
Which questionnaires can be offered to assess severity of depression?
PHQ-9
(Patient Health Questionnaire)
Which questionnaire can be offered to assess severity of anxiety?
GAD-7
(Generalized Anxiety Disorder Questionnaire)
How is capacity assessed?
- Understand the information relevant to the decision, including the consequences
- Retain the information long enough to make the decision
- Use or weigh the information to make the decision
- Communicate the decision in any recognizable way
How can substance dependence be investigated?
COW T1C
- Cravings
- Over doing the substance
- Withdrawal
- Tolerance
- 1 (is it the most important)
- Carry on despite consequences
Or use CAGE or AUDIT screening
How can alcohol misuse be screened?
CAGE acronym
- Cut down
- Annoyed when people ask
- Guilt
- Eye opening (waking up in the morning and drinking)
Which tool can be used to identify alcohol misuse?
AUDIT (alcohol use disorders identification test)
A 20 question quiz to identify issues
How long does it take for alcohol withdrawal symptoms to appear?
24-48 hours
What are the common symptoms of alcohol withdrawal?
Anxiety
Depression
Irritability
Fatigue
Sweating
Loss of appetite
Nausea and vomiting
What are the symptoms of delirium tremens?
Onset 2 days after stopping alcohol, lasts 3-4 days
Symptoms:
- Confusion (delirium)
- Hallucination
- Affective change (fear)
- Gross tremor
-Autonomic disturbance (sweating, tachycardia, hypertension/hypotension)
- Delusion
How is delirium tremens treated?
Benzodiazepines and Pabrinex
Symptomatic control
What is the triad for Wernicke’s syndrome?
Confusion, ataxia, and ophthalmoplegia (weakness/paralysis of eye muscles)
What is opthalmoplegia?
Paralysis or weakness in the muscles that move the eye
