MRCP Psych Flashcards
Schizophrenia
though disorder
hallucination
delusions
Side effect of risperidone
hyperprolactinaemia
Typical antipsychotic
haloperidol
chlorpromazine
Atypical antipsychotic
clozapine
risperidone
olnazapine
quetiapine
aripriprazole
Atypical antipsychotic side effects
extrapyramidal (less)
hyperprolactinaemia
metabolic
Typical antipsychotic side effect
extrapyramidal (more)
hyperprolactinaemia
Side effects of haloperidol
prolonged QT
Alcohol abstinence
naltrexone- reduce cravings
disulfuram- nausea with alcohol
acamprosate- reduce cravings
Depression scoring
PHQ<16 mild
PHQ>16 moderate to severe
teenager depression management
CBT
note: medical therapy increases risk of suicide
Conversion disorder
neurological functional loss from stress
aka: stress converts into loss of motor sx
Somatisation
multiple SYMPTOMS >2 yrs
Hypochondriacal
belief of underlying serious DISEASE (cancer)
Reference delusion is associated with…
paranoid schizophrenia
refer to belief that normal everyday occurance (news) is directed towards the patient
Grandiose delusion
unique powers
special mission
Bizarre delusion
fixed belief that cannot be true
Opioid dependence
Methadone
Maintenance therapy for antidepressant
continue at effective dose for 6 months
then gradual weaning to stop
OCD vs OCPD
OCD- repetitive (compulsion)
Mx: SSRI
Schizoid personality disorder
voluntary social withdrawal
Management for alzheimers
ACEinhinbitor
Benzo withdrawal
anxiety
psychosis
seizures
tremor
Heroin withdrawal
D+V
abdo cramps
Agoraphobia
Irrational fear of open space/crowd/unfamiliar setting
Dissociative disorder
feel detached from body/reality
defence mechanism in psycho stress
Extrapyramidal side effects more common in…
typical antipsychotics
EPS (extra pyramidal side effect)
- akathisia- restless
- parkinsonism
- dystonia= involuntary muscle spasm (oculogyric crisis, painful)
- tardive dyskinesia- face and trunk involuntary movement (lip smacking, jaw movement)
zinc deficiency
hair loss
glossitis
wound healing
Drug misuse
alcohol
legal- benzo, caffeine, nicotine
opioid- heroin, morphine, methadone
stimulant- cocaine, ecstasy/MDMA, amphetamine
hallucinogens- LSD, solvents
Anorexia good prognostic factor
normal milestone for social adjustment in childhood
Persecutory delusion
unfounded belief that someone is trying to cause you harm
Cluster A odd eccentric
Paranoid
Schizoid
Schizotypal
Cluster B dramatic emotional
Antisocial
Borderline (Emotionally Unstable)
Histrionic
Narcissistic
Cluster C anxious fearful
Obsessive-Compulsive
Avoidant
Dependent
Grief lasts…
12 months
prolonged if >12 months
4 phases of grief
- numbness - shock
- pining- preoccupation with deceased (does not want to feel distant)
- disorganisation despair - accept loss and aimless
- reorganisation repair - final stage, engage in acitivites towards future
Pseudo dementia due to depression
poor effort during cognitive testing
Sundowning
wandering and confusion worse at bedtime in alzheimers
Acute dystonia is due to…. managed with…
antipsychotics (older typicals)
anticholinergics - procyclidine
SSRI and warfarin
increase risk of bleed
Mirtazapine
sleep and appetite
TCA side effect
Prolonged QTc
SNRI- venlafaxine contraindicated in…
heart disease
uncontrolled hypertension
Mania vs hypomania
mania- irritable, euphoria, psychomotor activity, no sleep, graniosity.
hypomania- symptoms not severe enough to cause impairement in social/occupational function
Antisocial PD
impulsive
irritable
aggressive
Defence mechanisms
Rationalisation- distortion of reality so that actual act/event seems to be desirable
Sublimation- channelling negative life events into art
Intellectualisation- avoid uncomfortable feelings by focusing on facts and logic
Displacement- action is shifted to substitue target when actual cause is not avaiable.
Porojection- projecting unwanted emotions to another
Vascular dementia vs alzheimers
vascular
- can present with seizures
- stepwise manner with acute exacerbations with period of stability
Body dysmorphic disorder
excessive preoccupation with perceived defects/flaws of appearance
Mx: CBT +/- SSRI
Dyslexia
reading and writing difficulty
dysphraxia
Which diuretic increases risk of lithium toxicity
thiazide
Alcohol withdawal hallucinations
auditory or visual
Post partum mood
baby blue - first week
post natal depression- within 3 months (fluox/parox)
puerperal psychosis- first 2-3 weeks (MBU)
Poor prognosis of schizophrenia
FHx
insidious onset
low intelligence
premorbid personality (schizoid)
absence of precipitating stress
underlying organic disorder
prodromal phase of social withdrawal
SSRI and sodium
hyponatraemia
Down’s syndrome is a a risk factor for early onset….dementia
alzheimers
ADHD
Problems with:
- attention
- completing task
- poor time management
Mx: methylphenidate
Sleep paralysis
dream like hallucination
feeling that someone else in room
unable to move just before onset of sleep
Erectile dysnfunction
> 3 months of symptoms
- vascular
- neuro
- structural
- hormonal
- drug induced
- psychological- Mx: psychosexual counselling
Specific phobia in adults, patients know that belief of fear is…
irrational
Psychotherapy
- countertransferance- therapist feeling towards patient
- transferance- unconcious process where patient transfers to the therapist
- resistance- wordand actions of patient that stops them from accessing unconscious (refusing topic)
- acting out- expressing unconscious emotional confluc into actions without knowing
What suggests post partum depression
- irritable and unable to sleep
- worthlessness
- not enjoying baby
- suicidal ideation
- presence of guilt
Management fo schizophrenia
early use of antipsychotics -> better outcome
Firstline management: risperidone and olanzapine
GAD and panic disorder management
SSRIs are first-line.
If contraindicated or no response after 12 weeks then imipramine or clomipramine should be offered
Buspirone action
partial 5HT14 agonist
for anxiety
Suicide risk factors
male sex
history of deliberate self-harm
alcohol or drug misuse
history of mental illness
depression
schizophrenia: NICE estimates that 10% of people with schizophrenia will complete suicide
history of chronic disease
advancing age
unemployment or social isolation/living alone
being unmarried, divorced or widowed
future suicide risk
efforts to avoid discovery
planning
leaving a written note
final acts such as sorting out finances
violent method
Tuberous sclerosis
LD
multisystemic benign tumours
Serotonin syndrome
anxiety
agitation
autonomic dysfunction
tremor
increased tone
hyperreflexia
PCM overdose
NAC within 8 hrs
Methadone overdose
drowsy
long QT
pinpoint pupil
low RR
Opioid incl methadone reversal
naloxone infusion
Speech disorder
flight of idea
- flit rapid between subjects
Clang association
- similar sounding words grouped
Pressured speech
- rapid speech
Fragile X sydnrome
large forehead
long face long nose
prominent jaws
large bat ears
pale iris
Commonest genetic cause of mental disability
fragile X
Obsession and compulsion
obsession- repetitive senseless thoughts preoccupying mind
compulsion- repetitive behaviours to neutralise above thought
Diagnosis of schizophrenia
symptoms for >1 month
Opiate withdrawal diarrhoea managmenet
Loperamide
Methadone dosing
tolerance to large dose subside within 3 days
if missed >3 days of doses, restart at lower dose
high dose can cause respiratory depression
Buspirone side effects
nasal congestion
First line therapy for depression
SSRI
note increase bleeding risk in eldery and on NSAID/steroid
Lithium level should be checked…
5-7 days after commencing, 12 hrs after dose.
target level 0.8-1
once stable monitor 1-2 month interval for first 6 months then 3-6 month intervals
Lithium side effects
LITHIUM
L - lethargy
I - diabetes insipidus
T - tremor
H - hyper/hypothyroid
I - insides (GI upset)
U - increased urine (due to DI)
M - metallic taste
Anorexia nervosa
weight loss >15% + BMI <17.5
lack of intake and XS exercise
Body dysmorphic disorder vs anorexia
weight loss and XS exercise not seen in BDD
however BDD can be seen in AN
Bulimia nervosa
eating disorder
preoccupied with eating
irresitable craving
result in episode of binging
purging self induced
period of starving and diuretic use
Emotional reactions
- repression- conscious effort to forget unpleasant event
- catharsis- release strong or repressed emotion–> relief
- retrogression- returns to state of childhood
- depression- low mood, loss of interest, loss of pleasure
- ## amnesia- loss of memory
Huntington trinucleotide repeat
> 37 of CAG
OCD management
CBT and ERP (exposure respinse prevention)
Somatisation management
CBT
Resistent schizophrenia defined by….and managed with…. which has side effects of….
failure of 2 antipsychotics
clozapine
neutropenia
Phobia management
graded exposure
Schizoaffective disorder
auditory hallucination
Lewy body dementia cardinal presentation
fluctuating cognitive function
varying levels of alertness
daytime somnolence
Korsakoff
alcoholism
confabulation
Depression length of antidepressant
6 months after recovery
if high risk then 2 years
IQ scale for learning disability
average 100
mild LD: 50-69
moderate: 20-34
severe <20
Schizotypa PD
socially withdraw
eccentric behaviour or beliefs
paranoid ideas
delusions of reference
Factitious
severe: munchausen
- intentional production or feigning of physical or psychological symptoms
Ganser syndrome
stress induced
aka nonsense syndrome
- pseudohallucination
- somatic conversion
- amnesia
Benzo withdrawal
heightened sensitity
restless
anxiety
sweating
insomnia
Familial alzheimer gene
PS1
Familial variant frontotemproal gene and motor neuron disease
C9orf72 gene
Illusion
false perception of real external stimulus
Second line therapy for bipolar
sodium valproate
Drug induced manic episode due to…
Cocaine
PTSD
psychotherapy +/- meds
Which bacterial infection is associated with development of OCD?
beta haemolytic streptococcus pharyngitis
Cheese reaction
hypertensive crisis
side effect of MAOinhibitors
due to tyramine from cheese,red wine,broad bean,yeast
cortical vs subcortical dementia
cortical
- grey matter
- memory and language and vision
- alzheimer
- frontotemporal
- CJD
subcortical
- white matter
- mental process, personality change
- vascular
- parkinsons
- multiple scerlosis
Dissociative amnesia
memory loss transient during period of crisis—> on and off on and off very suddently to cope
Schizophrenia symptoms
Auditory hallu - 2 or more people, echo, commenting
Broadcast, withdraw, insert
Control
Delusional perception
Echo
Alcohol dependence screening
CAGE questionnair
Tetrad of narcolepsy
daytime sleepiness
cataplexy
hallucinations
sleep paralysis
Cannabis use is associated with….
Schizophrenia
Haptic hallucination is…. associated with….
sensation of being touched/strangled/insect crawling
cannabis
Wernicke korsakoff syndrome…
neuronal loss in mammillary bodies
What is st johns wort for
mild depression
herbal medicine
GAD management
Firstline treatment: SSRI
Short term benzos
Narcolepsy diagnosis
immediate REM at sleep onset on two or more occasion
multiple sleep latency EEG
Buprpion action in smoking cessation
noradrenaline dopamine reuptake inhibitor
Cotard syndrome
nihilistic delusion
older depressed patients
all my insides have dies and disappearing
Delirium tranquilisation
first line: haloperidol
- if parkinson’s then give loraz
Schizophrenia diagnosis
2 of:
- delusion
- hallucination
- disorganised speech
- negative symptoms
Eating disorder questionnair
SCOFF
Switching antidepressants MAOi (seligiline) to SSRI (paroxetine) washout period
14 days
risk of Serotonin syndrome
High suicide risk patients refusing treatment
detain
What factor trumps all risk factors of suicide
delusional thoughts
i.e devere depression/mania/schizo
Panic attack managemnet
SSRI
Bipolar predominant disturbance
Affect or mood
psychosis may be present with congruent with mania or depression
Sleep cycle
REM- nightmares and dreams
Non REM
- 1: light sleep
- 2: brain waves slow down
- 3: delta waves appear
- 4: deep sleep
Splitting
psychological separation of all good qualitis into one individual and all bad qualities into another
Mefloquine induced psychosis
TCA imipramine side effects
Antimuscarinic
- dry mouth, constip, retention, blurred vision, acute glaucoma
Antiadrenergic
- postural hypotension, tachycardia
Antihistamine
- sedation, weight gain
ECG
- prolonged PT
Self injurious behaviours seen in…
Lesch nyhan syndrome
inborne metabolism
SSRI lisenced for OCD
paroxetine
only for severe funcitonal impairment
acute stress disorder onset
last 1 month shortly after life threatening event
adjustment disorder onset
within 3 months from significant life change/stressor
GAD onset
symptoms for at least 6 months
Absolute Contraindication to ECT
raised ICP
Oppositional defiant disorder
defying authority figures
conduct disorder
violation of age app social norm
fighting
runaway
theft
destruction of property
Disufiran mechanism of action
acetaldehyde dehyrdrogenase
NAUSEA
FLUSHING
HEADACHE
PALPITATION
First line treatment of depression in elderly is…
SSRI
Hypnagogic hallucination is…
transient as going to sleep
(visual/auditory/tactile)
Hypnopompic hallucination is….
experienced on waking
Management of neuroleptic malignant syndrome
dantrolene
Fragile X syndrome
trinucleotide CGC
FMR1 gene on X chromosome
Seasonal affective disorder managmenet
FIRST LINE: CBT
second: SSRI
SSRI withdrawal
psychomotor agitation
poor sleep
anxiety
vertigo
light headed
Regression
return to less mature levels of functioning
SSRI suicide risk
first 2 weeks of starting SSRI
- suicidal
EEG with photic stimulation
for photosensitive epilepsy
Risk factors for refeeding syndrome
low BMI <15
Spiralling visual field loss suggests
conversion disorder
Somatoform pain disorder
long term pain- no physical cause, no mental disorder
Lithium monitoring
hypothyroidism
Undoing
performance of acitivyt to reverse some previous behanour or thought
Malingering
intentional and fraudulent feinging or exaggeration of symptoms for external gain
Naltrexone uses
opioid dependence
alcohol
Delusion of reference
belief or perception that unrelated phenomena in the world is directly referred to them
Cyclothymia
mood swings cycling fro depression to hypomania (elevated mood without psychosis/impaired function)
Side effects of bisprolol
depression
erectile dysfunction
nightmares
