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Year 5 > MLA Psychiatry > Flashcards

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
Q

What is the monitoring required for lithium?

A
  • 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
Q

What are some signs of lithium toxicity?

A
  • Coarse tremor
  • Confusion
  • Seizures
27
Q

What are the teratogenic effects of sodium valproate?

A

Spina bifida
Cleft lip and palate
Atrial septal defect
Hypospadias
Polydactyly
Craniosynostosis

28
Q

What are the side effects of sodium valproate?

A

Nausea
Diarrhoea
Tremor
Tiredness
Weight gain
Hair thinning

29
Q

What are ‘Z’ drugs?

A

Zopiclone
Zolpidem

Non-benzodiazepine medications used for insomnia

30
Q

Who is most likely to developed anorexia nervosa?

A

Female aged 14-18

Common co-morbidities: anxiety, depression, autism, OCD

31
Q

What are some physical symptoms of anorexia nervosa?

A
  • 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
Q

What is Russel’s sign?

A

Calluses, abrasions, or scars on the knuckles or back of their hands
- Injuries caused by self-induced vomiting (Bulimia eating disorder)

33
Q

What is lanugo hair?

A

Fine, soft hair that covers the body naturally in newborns

Occurs in eating disorder to help them regulate their body temperature

34
Q

What are some complications of eating disorders?

A

Refeeding syndrome
Sudden cardiac death
Electrolyte imbalance
Circulatory collapse
Premature osteoporosis
Infection
VTE
Suicide

35
Q

What is the pathophysiology of refeeding syndrome?

A

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
Q

How is re-feeding syndrome managed?

A
  • Monitor electrolytes
  • IV Pabrinex (thiamine)
  • Replace electrolytes
  • Refer to HDU/ITU
  • Start on low-calorie diet and gradually increase (10-20kcal/kg/day)
37
Q

What are some positive symptoms of psychosis?

A

Added functions

Eg. delusions, hallucinations, disorganised soeech, thought, or behaviour

38
Q

What are some negative symptoms of psychosis?

A

Decreased functions

Eg. Reduced emotional and speech ability, lack of concentration, depression

39
Q

What’s the difference in management of negative vs positive symptoms?

A

Positive: treated with antipsychotics

Negative: life-style interventions, antipsychotics

40
Q

What is the ICD-10 criteria for diagnosing schizophrenia?

A

Symptoms for at least 1 month most of the time

41
Q

What is the difference between typical and atypical antipsychotics?

A

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
Q

What are the 4 types of extrapyramidal side effects of antipsychotics?

A
  • 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
Q

Which antipsychotics have which common side effects?

A

Clozapine and olanzapine: anticholinergic, glycaemic control, sedation, weight gain

Quetiapine: sedation

Risperidone: increased prolactin

44
Q

Give examples of common depot antipsychotics

A

Flupentixol
Haloperidol
Aripiprazole

45
Q

When is psychosis concidered treatment resistent?

A

When at least 2 different antipsychotics have been tried at maximal tolerable dose, both typical and atypical drugs were unsuccessful

46
Q

What is agranulocytosis?

A

Low granulocytes (WBC)

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
Q

What are the key side effects of Clozapine?

A
  • Constipation
  • Agranulocytosis
  • Weight gain
  • Hypersalivation (treated with hyoscine hydrobromide)
  • Cardiomyopathy
48
Q

What is the presentation of neuroleptic malignant syndrome?

A
  • Autonomic dysfunction Eg. fever, variable BP, sweating, tremor
  • Rigidity
  • Confusion
49
Q

What is neuroleptic malignant syndrome?

A

A life-threatening reaction to antipsychotics

Diagnosis: Creatinine kinase showing muscle rigidity

Treatment: stop antipsychotic and treat the symptoms. Protect the kidneys

50
Q

Which questionnaires can be offered to assess severity of depression?

A

PHQ-9
(Patient Health Questionnaire)

51
Q

Which questionnaire can be offered to assess severity of anxiety?

A

GAD-7
(Generalized Anxiety Disorder Questionnaire)

52
Q

How is capacity assessed?

A
  • 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
Q

How can substance dependence be investigated?

A

COW T1C

  • Cravings
  • Over doing the substance
  • Withdrawal
  • Tolerance
  • 1 (is it the most important)
  • Carry on despite consequences
54
Q

How can alcohol misuse be screened?

A

CAGE acronym

  • Cut down
  • Annoyed when people ask
  • Guilt
  • Eye opening (waking up in the morning and drinking)
55
Q

Which tool can be used to identify alcohol misuse?

A

AUDIT (alcohol use disorders identification test)

A 20 question quiz to identify issues

56
Q

How long does it take for alcohol withdrawal symptoms to appear?

A

24-48

57
Q

What are the common symptoms of alcohol withdrawal?

A

Anxiety
Depression
Irritability
Fatigue
Sweating
Loss of appetite
Nausea and vomiting

58
Q

What are the symptoms of delirium tremens?

A

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
Q

How is delirium tremens treated?

A

Benzodiazepines and Pabrinex
Symptomatic control

60
Q

What is the triad for Wernicke’s syndrome?

A

Confusion, ataxia, and ophthalmoplegia

61
Q

What is opthalmoplegia?

A

Paralysis or weakness in the muscles that move the eye

Year 5 (22 decks)

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