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MLA Psychiatry Flashcards

1
Q

What’s an acute stress reaction?

A

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

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2
Q

What is the structure of a psychiatric history?

A
  • 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
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3
Q

What is the management for bipolar disorder?

A
  • 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
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4
Q

What are the different types of dementia?

A
  • 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
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5
Q

What are the different types of delirium?

A

Hyperactive: restless, agitated, hallucinations, mood swings

Hypoactive: inactive, sleepy, depressed, reduced concentration

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6
Q

What are the different types of eating disorder?

A
  • 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
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7
Q

What are the different types of personality disorder?

A
  • 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
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8
Q

What is the definition of schizophrenia?

A

Disruption of thought processes, perceptions, emotional responsiveness, and social interaction

Symptoms: Hallucinations, delusions, disorganised thinking, reduced emotional expression, motor and cognitive impairment

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9
Q

What’s the different between psychosis and schizophrenia?

A

Psychosis: patient is disconnected from reality. Affects the mind

Psychosis may be a symptoms of schizophrenia

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10
Q

What is somatisation?

A

Experiencing psychological distress and physical symptoms

Eg. pain, dizziness, dyspnoea, nausea

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11
Q

What is Wernicke’s encephalopathy?

A

Thiamine (B1) deficiency

A neurological emergency

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12
Q

How do different drug overdoses present?

A
  • Opioid: pinpoint pupils
  • SSRI: drowsiness, tremor, tachycardia
  • Paracetamol: N+V, abdo pain
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13
Q

What’s included in a mental state examination?

A
  • 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
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14
Q

What is a matched care model?

A

Matching the treatment to the diagnosis
- Depends on acuteness

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15
Q

What are the different sections of detaining someone under the MHA?

A

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

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16
Q

How long do antidepressants take to work?

A

Will notice difference by day 10, especially in terms of mood
Full effects by 6 weeks

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17
Q

What is the SUSS score?

A

Sit up, squat, stand test

0: unable
1: uses hands to help
2: noticeable difficulty
3: no difficulty

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18
Q

Give examples of SNRI’s

A

Duloxetine
Venlafaxine

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19
Q

At what dose can Mirtazapine be prescribed to help sleep?

A

30mg antidepressant effects
15mg sedating effects

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20
Q

Why is Paroxetine avoided in young groups?

A

Ineffective
Increases risk of self-harm/suicide

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21
Q

Give examples of tricyclic antidepressants

A

Amitriptyline
Nortriptyline

Not prescribed for depression anymore

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22
Q

Name some MAOI’s

A

Dicarboxamide
Phenelzine
Selegiline

Not used anymore

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23
Q

What are the symptoms of antidepressant discontinuation syndrome?

A

flue-like symptoms
Sensory issues
Nausea
Insomnia
Mood changes, anxiety

Drugs with long half lives have less effect. Worse with Venlafaxine, less with fluoxetine

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24
Q

Name some mood stabilisers

A

Valproate
Lithium

Antipsychotic:
Olanzapine
Quetiapine
Carbamazepine
Lamotrigine

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25
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
26
What are some signs of lithium toxicity?
- Coarse tremor - Confusion - Seizures
27
What are the teratogenic effects of sodium valproate?
Spina bifida Cleft lip and palate Atrial septal defect Hypospadias Polydactyly Craniosynostosis
28
What are the side effects of sodium valproate?
Nausea Diarrhoea Tremor Tiredness Weight gain Hair thinning
29
What are 'Z' drugs?
Zopiclone Zolpidem Non-benzodiazepine medications used for insomnia
30
Who is most likely to developed anorexia nervosa?
Female aged 14-18 Common co-morbidities: anxiety, depression, autism, OCD
31
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
32
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)
33
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
34
What are some complications of eating disorders?
Refeeding syndrome Sudden cardiac death Electrolyte imbalance Circulatory collapse Premature osteoporosis Infection VTE Suicide
35
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
36
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)
37
What are some positive symptoms of psychosis?
Added functions Eg. delusions, hallucinations, disorganised soeech, thought, or behaviour
38
What are some negative symptoms of psychosis?
Decreased functions Eg. Reduced emotional and speech ability, lack of concentration, depression
39
What's the difference in management of negative vs positive symptoms?
Positive: treated with antipsychotics Negative: life-style interventions, antipsychotics
40
What is the ICD-10 criteria for diagnosing schizophrenia?
Symptoms for at least 1 month most of the time
41
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
42
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
43
Which antipsychotics have which common side effects?
Clozapine and olanzapine: anticholinergic, glycaemic control, sedation, weight gain Quetiapine: sedation Risperidone: increased prolactin
44
Give examples of common depot antipsychotics
Flupentixol Haloperidol Aripiprazole
45
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
46
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
47
What are the key side effects of Clozapine?
- Constipation - Agranulocytosis - Weight gain - Hypersalivation (treated with hyoscine hydrobromide) - Cardiomyopathy
48
What is the presentation of neuroleptic malignant syndrome?
- Autonomic dysfunction Eg. fever, variable BP, sweating, tremor - Rigidity - Confusion
49
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
50
Which questionnaires can be offered to assess severity of depression?
PHQ-9 (Patient Health Questionnaire)
51
Which questionnaire can be offered to assess severity of anxiety?
GAD-7 (Generalized Anxiety Disorder Questionnaire)
52
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
53
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
54
How can alcohol misuse be screened?
CAGE acronym - Cut down - Annoyed when people ask - Guilt - Eye opening (waking up in the morning and drinking)
55
Which tool can be used to identify alcohol misuse?
AUDIT (alcohol use disorders identification test) A 20 question quiz to identify issues
56
How long does it take for alcohol withdrawal symptoms to appear?
24-48 hours
57
What are the common symptoms of alcohol withdrawal?
Anxiety Depression Irritability Fatigue Sweating Loss of appetite Nausea and vomiting
58
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
59
How is delirium tremens treated?
Benzodiazepines and Pabrinex Symptomatic control
60
What is the triad for Wernicke's syndrome?
Confusion, ataxia, and ophthalmoplegia (weakness/paralysis of eye muscles)
61
What is opthalmoplegia?
Paralysis or weakness in the muscles that move the eye

Year 5 (23 decks)

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