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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
Valproate issue
Teratogenic
26
Lithium mechanism
Mechanism: inhibits cAMP production, cAMP inhibits monoamines so more monoamines available
27
Lithium safe level
Safe level: 0.6-1.0mmol/L
28
Lithium required monitoring
Li levels, U+E, TFTs, calcium
29
Lithium toxicity concentration
Toxicity: levels \>1.5mmol/L
30
Lithium toxicity symptoms
Symptoms: tremor, anorexia, D+V, ataxia, dysarthria, delirium, fasciculations, hypotension, arrythmias, seizures, coma
31
Depression presentation
DEAD SWAMP Depressed mood Energy levels reduced Anhedonia Disturbed sleep Suicidal ideation Worthlessness Appetite reduced Mentation decreased (reduced concentration) Psychomotor retardation
32
Monoamine theory
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
33
Depression severity categorisation
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
Depression screening tools
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
Depression management
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
Dysthymia
Chronic depressive mood lasting at least several years
37
Mental state symptoms of neuroses
depersonalisation/derealisation, fear of losing control, concentration difficulties
38
Low mood/depression symptoms
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
EUPD
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
Delusion criteria
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
Schizophrenia 2nd rank symptoms
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
Schizophrenia diagnosis
one 1st rank or two 2nd rank symptoms acutely for 1 month, with evidence of disturbance of functioning for 6 months.
43
Aripiprazole side effects
akathsia, decreased prolactin
44
Olanzipine SE
Anticholinergic symptons, diabetes, hyperlipidaemiam weight gain
45
Paliperidone
Acute parkinsonism, elevated prolactin, weight gain
46
Quetiapine
Diabetes, sedation, weight gain
47
Risperidone
Acute parkinsonism, elevated prolactin, weight gain
48
Ziprasidone
Prolonged QTc interval
49
GAD disgnosis
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
Compulsions
Senseless, repeated rituals
51
Obsessions
stereotyped, purposeless words, ideas or phrases that come into the mind (perceived as non-sensical – not delusions!)
52
GAD management
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
PTSD symptoms
Emotional numbing Avoidance Inability to recall Re-experiencing Hyperarousal
54
How long should PTSD victims experience symptoms before diagnosis
1 month
55
Depression diagnosis time
2 weeks
56
Bulimia diagnosis time
3 months
57
PTSD first line
TF-CBT or eye movement desensitisation and reprocessing (EMDR) therapy
58
What 2 drugs may be used 2nd line in PTSD?
Duloxetine or venlafaxine
59
Anorexia nervosa symptoms
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
Anorexia nervosa physical signs
Physical signs Dry skin Hypercarotenemia Lanugo body hair Acrocyanosis Breast atrophy Swelling of the parotid and submandibular glands Thinning hair
61
Anorexia emergency management name
MARSIPAN
62
Anorexia emergency signs
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
AN first line in adults
individual eating-disorder-focused cognitive behavioural therapy (CBT-ED) Maudsley Anorexia Nervosa Treatment for Adults (MANTRA) specialist supportive clinical management (SSCM).
64
AN management child
ANOREXIA BASED FAMILY THERAPY CBT = 2nd line
65
Bulimia nervosa features
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
OCD characteristics
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
OCD Treatment
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
Opiate overdose signs
Acute presentation = drowsiness Resp depression 🡪 resp acidosis (retaining CO2) Hypotension Tachycardia are possible. Pin point pupils Chronic = constipation
69
Opiate overdose management
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
Serotonin syndrome symptoms
Cognitive: headaches, agitation, hallucinations, coma Autonomic: sweating, shivering, tachycardia, hypertension, nausea, diarrhoea. Somatic: myoclonus, hyperreflexia (clonus), tremor.
71
SS treatment
Remove causative agent Support - cooling, fluids, benzodiazepine Serotonin antagonist - cyproheptadine, if persistent.
72
NMS - caused by
Antipsychotics Usually within 10 days of treatment
73
NMS features
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
NMS management
Stop drug Maintain fluid balance Diazepam for muscle rigidity Dantrolene for malignant hyperthermia Bromocriptine to get rid of dopamine blockade
75
MHA section 2
28 days, can't be renewed. 2 doctors
76
MHA section 3
6 months can be renewed. 2 docs, treatment and inv etc
77
MHA section 4
Emergency - 72 hr 1 doc, can change to a 2
78
MHA section 5
Detention within hospital, only stops leaving until reviewed under a 2 or 3
79
MHA section 135
Police can take you from a private place to a safe place
80
MHA section 136
like a 135 but from public place
81
Difference between pyramidal and extra-pyramidal

Phase 3a (13 decks)

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