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Phase 3a > Module 3 Psychiatry notes > Flashcards

Module 3 Psychiatry notes Flashcards

1
Q

First rank symptoms of Schizophrenia

A

3rd person auditory hallucinations Thought withdrawal, insertion and broadcast Delusional perceptions Delusions of control Somatic passivity

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2
Q

Schizophrenia positive symptoms

A

An excess or distortion of normal functioning Delusions, hallucinations and thought disorders Caused by overactivity of receptors in the mesolimbic pathway

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3
Q

Schizophrenia negative symptoms

A

Decrease or loss of functioning Blunting of affect, poverty of speech Caused by underactivity of receptors in the mesocortical pathway

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4
Q

Types of schizophrenia

A

Paranoid Catatonic Hebephrenic Residual Simple

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5
Q

Paranoid schizophrenia features

A

paranoid delusions, auditory hallucinations and perceptual disturbances

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6
Q

Catatonic schizophrenia features

A

hyperkinesis or negativism

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7
Q

Hebephrenic schizophrenia features

A

fluctuating affect

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8
Q

Residual schizophrenia features

A

long term negative symptoms

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9
Q

Simple schizophrenia features

A

negative symptoms without psychotic symptoms

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10
Q

First generation antipsychotics include/mechanism

A

Chlorpromazine, haloperidol, promazine, flupentixol and zuclopenthixol D2 antagonists, more potent than SGA due to increased occupancy of D2 receptors. Can worsen negative symptoms. Also block D2 receptors in nigrostriatal pathway causing extrapyramidal symptoms and in tuberoinfundibular pathway causing increased prolactin.

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11
Q

Second generation antipsychotics include/mechanism

A

ROCQAA- risperidone, olanzapine, clozapine, quetiapine, aripiprazole, amisulpride 5HT2A and D2 antagonists (dopamine, serotonin antagonists). High affinity for 5HT2A receptors than D2 receptors. Less extrapyramidal SE but more metabolic SE.

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12
Q

Third generation antipsychotics include/mechanism

A

Only licensed TGA is aripiprazole Dopamine partial agonists. Less SE but less efficacious.

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13
Q

Clozapine mechanism

A

SGA used in treatment resistant schizophrenia. Blocks D1 and D4 receptors, lower affinity for D2 receptors, also block 5HT2A receptors. Risk of agranulocytosis.

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14
Q

Significant Antipsychotic SEs

A

Pseudoparkinsonism Acute distonia Akathisia Tardive dyskinesia

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15
Q

Less significant antipsychotics SEs

A

Metabolic- weight gain, diabetes Anticholinergic- dry mouth, blurred vision, difficulty passing urine, urinary retention, constipation Anti-adrenergic- postural hypotension, tachycardia, sexual dysfunction Anti-histaminergic- sedation Cardiovascular (including prolonging the QT interval) Hormonal (including increasing plasma prolactin)

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16
Q

Acute dystonic reaction

A

Happens within a week or starting/increasing dose of antipsychotic Presentation: Mainly affects muscles of head and neck Torticollis, trismus, forceful protrusion of tongue, grimacing, oculogyric spasm, opisthotonos, blepharospasm Less commonly affects laryngeal/pharyngeal muscles- dyspshagia Management: Discontinue causative agent IM anticholinergic e.g. procyclidine

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17
Q

Neuroleptic Malignant Syndrome

A

Life threatening complication of antipsychotic medications. Presentation: hyperthermia (above 38°c), muscle rigidity, altered mental status, autonomic dysfunction (e.g. hypotension, incontinence) Elevated CK Management: ABCDE Stop causative agent IV benzos for agitation Cooling devices/antipyretics Treat rhabdomyolysis Sometimes bromocriptine and amantadine are used as muscle relaxants

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18
Q

ICD 10 classification of BPD

A

Two or more episodes in which the patient’s mood and activity levels are significantly disturbed At least one= hypomania (<4 days)/ mania (>7days)

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19
Q

DSM BPD types

A

Bipolar I- one or more manic episodes with or without a history of depressive episodes Bipolar II- one or more depressive episodes with at least one hypomanic episode

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20
Q

BPD mania symptoms

A

I DIG FAST Irritability/elevated mood Distractibility Inhibition loss Grandiosity Flight of ideas Activity increased Sleep not needed Talkative

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21
Q

Hypomania symptoms

A

Persistent mild elevation of mood Increased energy Marked feelings of well being Increased sociability Talkative Overfamiliar Increased sexual energy Hardly sleeping No impact on function

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22
Q

BPD treatments

A

Mood Stabilisers: Lithium Anticonvulsants: Valproate Lamotrigine +/- antipsychotics (haloperidol, olanzapine, quetiapine or risperidone) and antidepressants (fluoxetine) (Can try psychological treatment for depression)

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23
Q

Ebstein’s phenomenon

A

Ebstein’s anomaly is a congenital heart defect in which the septal and posterior leaflets of the tricuspid valve are displaced towards the apex of the right ventricle of the heart. In babies of mothers on lithium

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24
Q

Steven Johnson’s syndrome

A

Severe skin reaction to Lamotrigine

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25
Q

Valproate issue

A

Teratogenic

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26
Q

Lithium mechanism

A

Mechanism: inhibits cAMP production, cAMP inhibits monoamines so more monoamines available

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27
Q

Lithium safe level

A

Safe level: 0.6-1.0mmol/L

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28
Q

Lithium required monitoring

A

Li levels, U+E, TFTs, calcium

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29
Q

Lithium toxicity concentration

A

Toxicity: levels >1.5mmol/L

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30
Q

Lithium toxicity symptoms

A

Symptoms: tremor, anorexia, D+V, ataxia, dysarthria, delirium, fasciculations, hypotension, arrythmias, seizures, coma

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31
Q

Depression presentation

A

DEAD SWAMP Depressed mood Energy levels reduced Anhedonia Disturbed sleep Suicidal ideation Worthlessness Appetite reduced Mentation decreased (reduced concentration) Psychomotor retardation

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32
Q

Monoamine theory

A

Monoamine theory of depression where reduced monoamine function (5-HT, NA, DA) may cause depression. Precipitating factors: -Childhood trauma -Life events -Personality -Alcohol -Being female -Genetic -Illness

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33
Q

Depression severity categorisation

A

Mild Depression - 2 or 3 of the symptoms but can continue with day-to-day life Moderate Depression - 4+ of the symptoms and difficulty continuing with day-to-day life Severe Depression -Several symptoms are marked and distressing. Suicidal ideation common. Can be +/- psychosis

34
Q

Depression screening tools

A

Hamilton Depression Rating Scale -21 assessed items, 17 total score, 18-21 assesses severity Beck Depression Inventory -18 is mild, 19-29 moderate and >30 severe Patient Health Questionnaire -PHQ2 screens and PHQ9 for diagnosis and monitoring symptom severity Major Depression Inventory -10 items, diagnosed using score of 1 or 0, severity using 0-5. Major depression if score >26

35
Q

Depression management

A

Education Low intensity psychological interventions (sleep hygiene, computerised CBT self help, structured group physical activity programme), medication, referral or further assessment High intensity psychological interventions (CBT/IPT), medication, combined treatment, collaborative care, referral Inpatient care, input from MDT, ECT

36
Q

Dysthymia

A

Chronic depressive mood lasting at least several years

37
Q

Mental state symptoms of neuroses

A

depersonalisation/derealisation, fear of losing control, concentration difficulties

38
Q

Low mood/depression symptoms

A

Depressed Mood Anhedonia Fatigability/Loss of energy Disturbed sleep Lack of concentration/indecisiveness Low self confidence Increased/decreased appetite Suicidal thoughts or actions Slowing of movement or speech Feelings of guilt, worthlessness or self-reproach

39
Q

EUPD

A

Often result of insecure attachment/ domestic violence/ childhood sexual abuse etc. Low self esteem and intense feel of rejection, abandonment, being unloved Develops very intense feelings for people very quickly, but also one bad move can totally destroy their image of somebody Find it hard to control emotions they feel very intensely, emotional rollercoaster Often self-harm, overdose, engage in dangerous risky behaviour (eg. sex with randoms to feel better, desired) Often associated with depression, alcohol abuse etc. Finds it difficult to cope with life stresses, esp. friendship/relationship conflict

40
Q

Delusion criteria

A

certainty (held with absolute conviction) incorrigibility (not changeable by compelling counterargument or proof to the contrary) impossibility or falsity of content (implausible, bizarre, or patently untrue)

41
Q

Schizophrenia 2nd rank symptoms

A

Other delusions/hallucinations Breaks in thought fluency: incoherence, irrelevant speech, neologisms Catatonic behaviour: excitement, stupor, mutism, posturing, waxy flexibility, negativism Negative symptoms: apathy, paucity of speech, blunted emotions, social withdrawal: not due to depression or neuroleptic medication

42
Q

Schizophrenia diagnosis

A

one 1st rank or two 2nd rank symptoms acutely for 1 month, with evidence of disturbance of functioning for 6 months.

43
Q

Aripiprazole side effects

A

akathsia, decreased prolactin

44
Q

Olanzipine SE

A

Anticholinergic symptons, diabetes, hyperlipidaemiam weight gain

45
Q

Paliperidone

A

Acute parkinsonism, elevated prolactin, weight gain

46
Q

Quetiapine

A

Diabetes, sedation, weight gain

47
Q

Risperidone

A

Acute parkinsonism, elevated prolactin, weight gain

48
Q

Ziprasidone

A

Prolonged QTc interval

49
Q

GAD disgnosis

A

The patient must have a 6-month Hx of tension, worry and anxiety about everyday issues. 4 of the following Sx must be present: Autonomic Sx: palpitations, sweating, trembling, dry mouth Chest/Abdomen Sx: breathing difficulty, choking sensation, chest pain/discomfort, nausea Brain/Mind Sx: dizzy, unsteady, derealisation, depersonalization, fear of losing control or passing out, fear of dying Tension Sx: muscle tension, aches, restlessness, globus hystericus General Sx: tingling/numbness, hot flushes C) The criteria for panic disorder, hypochondriasis and OCD are not fulfilled: D) No physical medical condition or medication could be responsible for these symptoms

50
Q

Compulsions

A

Senseless, repeated rituals

51
Q

Obsessions

A

stereotyped, purposeless words, ideas or phrases that come into the mind (perceived as non-sensical – not delusions!)

52
Q

GAD management

A

Step 1: Active monitoring Step 2: Individualised non-facilitated self help Step 3: CBT OR SSRI (sertraline is preferred, if not consider SNRI/pregabalin) Step 4: Psych referral for specialist care

53
Q

PTSD symptoms

A

Emotional numbing Avoidance Inability to recall Re-experiencing Hyperarousal

54
Q

How long should PTSD victims experience symptoms before diagnosis

A

1 month

55
Q

Depression diagnosis time

A

2 weeks

56
Q

Bulimia diagnosis time

A

3 months

57
Q

PTSD first line

A

TF-CBT or eye movement desensitisation and reprocessing (EMDR) therapy

58
Q

What 2 drugs may be used 2nd line in PTSD?

A

Duloxetine or venlafaxine

59
Q

Anorexia nervosa symptoms

A

8 Ds Dieting Denial Dread of gaining weight Disturbed beliefs about weight Doesn’t want help Dual effect– dieting + over-exercise/diuretics, laxatives and self-induced vomiting Disinterested/socially withdrawn Decline in weight = rapid

60
Q

Anorexia nervosa physical signs

A

Physical signs Dry skin Hypercarotenemia Lanugo body hair Acrocyanosis Breast atrophy Swelling of the parotid and submandibular glands Thinning hair

61
Q

Anorexia emergency management name

A

MARSIPAN

62
Q

Anorexia emergency signs

A

BMI under 13/ rare of weight loss Pulse <40 SBP <90 DBP <70 Postural BP drop of 10< T <35C Bloods: Drop in Na, K, Mg, P. albumin and glucose. Rise in urea, Creatine, transaminases ECG: Prolonged QTc T-wave changes Bradycardia Squat test - cannot stand from sitting/lying with using arms for balance or leverage

63
Q

AN first line in adults

A

individual eating-disorder-focused cognitive behavioural therapy (CBT-ED) Maudsley Anorexia Nervosa Treatment for Adults (MANTRA) specialist supportive clinical management (SSCM).

64
Q

AN management child

A

ANOREXIA BASED FAMILY THERAPY CBT = 2nd line

65
Q

Bulimia nervosa features

A

Metabolic alkalosis on ECG Low chloride suggests cause is from loss of Cl- from stomach The ECG shows hypokalaemia recurrent binge eating lack of control during episode recurrent compensatory behaviour (vomiting, misuse of laxatives, diuretics, fasting, excessive exercise) once a week for 3 months self-evaluation is unduly influenced by body shape and weight

66
Q

OCD characteristics

A

present on most days at least 2 weeks acknowledge that they originate in the mind tries to resist them but is unsuccessful doing the act itself is not pleasurable interferes with functioning

67
Q

OCD Treatment

A

Based on function impact Mild: CBT and ERT or group CBT. SSRI if cannot engage Moderate: high intensity CBT and ERP - can chose SSRI instead Severe: High intensity CBT and ERP, SSRI in combination

68
Q

Opiate overdose signs

A

Acute presentation = drowsiness Resp depression 🡪 resp acidosis (retaining CO2) Hypotension Tachycardia are possible. Pin point pupils Chronic = constipation

69
Q

Opiate overdose management

A

ABCDE obviously Give naloxone intravenously (IV) if coma or respiratory depression is present (IM if crappy veins) Oral activated charcoal if have ingested a load

70
Q

Serotonin syndrome symptoms

A

Cognitive: headaches, agitation, hallucinations, coma Autonomic: sweating, shivering, tachycardia, hypertension, nausea, diarrhoea. Somatic: myoclonus, hyperreflexia (clonus), tremor.

71
Q

SS treatment

A

Remove causative agent Support - cooling, fluids, benzodiazepine Serotonin antagonist - cyproheptadine, if persistent.

72
Q

NMS - caused by

A

Antipsychotics Usually within 10 days of treatment

73
Q

NMS features

A

CNS- fluctuating consciousness, stupor Autonomic- hyperreflexia, unstable BP, bradycardia, excessive sweating, salivation, urinary incontinence Motor- muscular rigidity, dysphasia, dysponea Lab results- Raised WBC, raised CPK Complications- Pneumonia, cardiovascular collapse, thromboembolism, renal failure

74
Q

NMS management

A

Stop drug Maintain fluid balance Diazepam for muscle rigidity Dantrolene for malignant hyperthermia Bromocriptine to get rid of dopamine blockade

75
Q

MHA section 2

A

28 days, can’t be renewed. 2 doctors

76
Q

MHA section 3

A

6 months can be renewed. 2 docs, treatment and inv etc

77
Q

MHA section 4

A

Emergency - 72 hr 1 doc, can change to a 2

78
Q

MHA section 5

A

Detention within hospital, only stops leaving until reviewed under a 2 or 3

79
Q

MHA section 135

A

Police can take you from a private place to a safe place

80
Q

MHA section 136

A

like a 135 but from public place

81
Q

Difference between pyramidal and extra-pyramidal

A

Phase 3a (13 decks)

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