MRCP Psych Flashcards
1
Q
Schizophrenia
A
though disorder
hallucination
delusions
2
Q
Side effect of risperidone
A
hyperprolactinaemia
3
Q
Typical antipsychotic
A
haloperidol
chlorpromazine
4
Q
Atypical antipsychotic
A
clozapine
risperidone
olnazapine
quetiapine
aripriprazole
5
Q
Atypical antipsychotic side effects
A
extrapyramidal (less)
hyperprolactinaemia
metabolic
6
Q
Typical antipsychotic side effect
A
extrapyramidal (more)
hyperprolactinaemia
7
Q
Side effects of haloperidol
A
prolonged QT
8
Q
Alcohol abstinence
A
naltrexone- reduce cravings
disulfuram- nausea with alcohol
acamprosate- reduce cravings
9
Q
Depression scoring
A
PHQ<16 mild
PHQ>16 moderate to severe
10
Q
teenager depression management
A
CBT
note: medical therapy increases risk of suicide
11
Q
Conversion disorder
A
neurological functional loss from stress
aka: stress converts into loss of motor sx
12
Q
Somatisation
A
multiple SYMPTOMS >2 yrs
13
Q
Hypochondriacal
A
belief of underlying serious DISEASE (cancer)
14
Q
Reference delusion is associated with…
A
paranoid schizophrenia
refer to belief that normal everyday occurance (news) is directed towards the patient
15
Q
Grandiose delusion
A
unique powers
special mission
16
Q
Bizarre delusion
A
fixed belief that cannot be true
17
Q
Opioid dependence
A
Methadone
18
Q
Maintenance therapy for antidepressant
A
continue at effective dose for 6 months
then gradual weaning to stop
19
Q
OCD vs OCPD
A
OCD- repetitive (compulsion)
Mx: SSRI
20
Q
Schizoid personality disorder
A
voluntary social withdrawal
21
Q
Management for alzheimers
A
ACEinhinbitor
22
Q
Benzo withdrawal
A
anxiety
psychosis
seizures
tremor
23
Q
Heroin withdrawal
A
D+V
abdo cramps
24
Q
Agoraphobia
A
Irrational fear of open space/crowd/unfamiliar setting
25
Dissociative disorder
feel detached from body/reality
defence mechanism in psycho stress
26
Extrapyramidal side effects more common in...
typical antipsychotics
27
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)
28
zinc deficiency
hair loss
glossitis
wound healing
29
Drug misuse
alcohol
legal- benzo, caffeine, nicotine
opioid- heroin, morphine, methadone
stimulant- cocaine, ecstasy/MDMA, amphetamine
hallucinogens- LSD, solvents
30
Anorexia good prognostic factor
normal milestone for social adjustment in childhood
31
Persecutory delusion
unfounded belief that someone is trying to cause you harm
32
Cluster A odd eccentric
Paranoid
Schizoid
Schizotypal
33
Cluster B dramatic emotional
Antisocial
Borderline (Emotionally Unstable)
Histrionic
Narcissistic
34
Cluster C anxious fearful
Obsessive-Compulsive
Avoidant
Dependent
35
Grief lasts...
12 months
prolonged if >12 months
36
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
37
Pseudo dementia due to depression
poor effort during cognitive testing
38
Sundowning
wandering and confusion worse at bedtime in alzheimers
39
Acute dystonia is due to.... managed with...
antipsychotics (older typicals)
anticholinergics - procyclidine
40
SSRI and warfarin
increase risk of bleed
41
Mirtazapine
sleep and appetite
42
TCA side effect
Prolonged QTc
43
SNRI- venlafaxine contraindicated in...
heart disease
uncontrolled hypertension
44
Mania vs hypomania
mania- irritable, euphoria, psychomotor activity, no sleep, graniosity.
hypomania- symptoms not severe enough to cause impairement in social/occupational function
45
Antisocial PD
impulsive
irritable
aggressive
46
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
47
Vascular dementia vs alzheimers
vascular
- can present with seizures
- stepwise manner with acute exacerbations with period of stability
48
Body dysmorphic disorder
excessive preoccupation with perceived defects/flaws of appearance
Mx: CBT +/- SSRI
49
Dyslexia
reading and writing difficulty
dysphraxia
50
Which diuretic increases risk of lithium toxicity
thiazide
51
Alcohol withdawal hallucinations
auditory or visual
52
Post partum mood
baby blue - first week
post natal depression- within 3 months (fluox/parox)
puerperal psychosis- first 2-3 weeks (MBU)
53
Poor prognosis of schizophrenia
FHx
insidious onset
low intelligence
premorbid personality (schizoid)
absence of precipitating stress
underlying organic disorder
prodromal phase of social withdrawal
54
SSRI and sodium
hyponatraemia
55
Down's syndrome is a a risk factor for early onset....dementia
alzheimers
56
ADHD
Problems with:
- attention
- completing task
- poor time management
Mx: methylphenidate
57
Sleep paralysis
dream like hallucination
feeling that someone else in room
unable to move just before onset of sleep
58
59
Erectile dysnfunction
>3 months of symptoms
- vascular
- neuro
- structural
- hormonal
- drug induced
- psychological- Mx: psychosexual counselling
60
Specific phobia in adults, patients know that belief of fear is...
irrational
61
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
62
What suggests post partum depression
- irritable and unable to sleep
- worthlessness
- not enjoying baby
- suicidal ideation
- presence of guilt
63
Management fo schizophrenia
early use of antipsychotics -> better outcome
Firstline management: risperidone and olanzapine
64
GAD and panic disorder management
SSRIs are first-line.
If contraindicated or no response after 12 weeks then imipramine or clomipramine should be offered
65
Buspirone action
partial 5HT14 agonist
for anxiety
66
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
67
future suicide risk
efforts to avoid discovery
planning
leaving a written note
final acts such as sorting out finances
violent method
68
Tuberous sclerosis
LD
multisystemic benign tumours
69
Serotonin syndrome
anxiety
agitation
autonomic dysfunction
tremor
increased tone
hyperreflexia
70
PCM overdose
NAC within 8 hrs
71
Methadone overdose
drowsy
long QT
pinpoint pupil
low RR
72
Opioid incl methadone reversal
naloxone infusion
73
Speech disorder
flight of idea
- flit rapid between subjects
Clang association
- similar sounding words grouped
Pressured speech
- rapid speech
74
Fragile X sydnrome
large forehead
long face long nose
prominent jaws
large bat ears
pale iris
75
Commonest genetic cause of mental disability
fragile X
76
Obsession and compulsion
obsession- repetitive senseless thoughts preoccupying mind
compulsion- repetitive behaviours to neutralise above thought
77
Diagnosis of schizophrenia
symptoms for >1 month
78
Opiate withdrawal diarrhoea managmenet
Loperamide
79
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
80
Buspirone side effects
nasal congestion
81
First line therapy for depression
SSRI
note increase bleeding risk in eldery and on NSAID/steroid
82
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
83
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
84
Anorexia nervosa
weight loss >15% + BMI <17.5
lack of intake and XS exercise
85
Body dysmorphic disorder vs anorexia
weight loss and XS exercise not seen in BDD
however BDD can be seen in AN
86
Bulimia nervosa
eating disorder
preoccupied with eating
irresitable craving
result in episode of binging
purging self induced
period of starving and diuretic use
87
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
-
88
Huntington trinucleotide repeat
>37 of CAG
89
OCD management
CBT and ERP (exposure respinse prevention)
90
Somatisation management
CBT
91
Resistent schizophrenia defined by....and managed with.... which has side effects of....
failure of 2 antipsychotics
clozapine
neutropenia
92
Phobia management
graded exposure
93
Schizoaffective disorder
auditory hallucination
94
Lewy body dementia cardinal presentation
fluctuating cognitive function
varying levels of alertness
daytime somnolence
95
Korsakoff
alcoholism
confabulation
96
Depression length of antidepressant
6 months after recovery
if high risk then 2 years
97
IQ scale for learning disability
average 100
mild LD: 50-69
moderate: 20-34
severe <20
98
Schizotypa PD
socially withdraw
eccentric behaviour or beliefs
paranoid ideas
delusions of reference
99
Factitious
severe: munchausen
- intentional production or feigning of physical or psychological symptoms
100
Ganser syndrome
stress induced
aka nonsense syndrome
- pseudohallucination
- somatic conversion
- amnesia
101
Benzo withdrawal
heightened sensitity
restless
anxiety
sweating
insomnia
102
Familial alzheimer gene
PS1
103
Familial variant frontotemproal gene and motor neuron disease
C9orf72 gene
104
Illusion
false perception of real external stimulus
105
Second line therapy for bipolar
sodium valproate
106
Drug induced manic episode due to...
Cocaine
107
PTSD
psychotherapy +/- meds
108
Which bacterial infection is associated with development of OCD?
beta haemolytic streptococcus pharyngitis
109
Cheese reaction
hypertensive crisis
side effect of MAOinhibitors
due to tyramine from cheese,red wine,broad bean,yeast
110
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
111
Dissociative amnesia
memory loss transient during period of crisis---> on and off on and off very suddently to cope
112
Schizophrenia symptoms
Auditory hallu - 2 or more people, echo, commenting
Broadcast, withdraw, insert
Control
Delusional perception
Echo
113
Alcohol dependence screening
CAGE questionnair
114
Tetrad of narcolepsy
daytime sleepiness
cataplexy
hallucinations
sleep paralysis
115
Cannabis use is associated with....
Schizophrenia
116
Haptic hallucination is.... associated with....
sensation of being touched/strangled/insect crawling
cannabis
117
Wernicke korsakoff syndrome...
neuronal loss in mammillary bodies
118
What is st johns wort for
mild depression
herbal medicine
119
GAD management
Firstline treatment: SSRI
Short term benzos
120
Narcolepsy diagnosis
immediate REM at sleep onset on two or more occasion
multiple sleep latency EEG
121
122
Buprpion action in smoking cessation
noradrenaline dopamine reuptake inhibitor
123
Cotard syndrome
nihilistic delusion
older depressed patients
all my insides have dies and disappearing
124
Delirium tranquilisation
first line: haloperidol
- if parkinson's then give loraz
125
Schizophrenia diagnosis
2 of:
- delusion
- hallucination
- disorganised speech
- negative symptoms
126
Eating disorder questionnair
SCOFF
127
Switching antidepressants MAOi (seligiline) to SSRI (paroxetine) washout period
14 days
risk of Serotonin syndrome
128
High suicide risk patients refusing treatment
detain
129
What factor trumps all risk factors of suicide
delusional thoughts
i.e devere depression/mania/schizo
130
Panic attack managemnet
SSRI
131
Bipolar predominant disturbance
Affect or mood
psychosis may be present with congruent with mania or depression
131
Sleep cycle
REM- nightmares and dreams
Non REM
- 1: light sleep
- 2: brain waves slow down
- 3: delta waves appear
- 4: deep sleep
132
Splitting
psychological separation of all good qualitis into one individual and all bad qualities into another
133
Mefloquine induced psychosis
134
TCA imipramine side effects
Antimuscarinic
- dry mouth, constip, retention, blurred vision, acute glaucoma
Antiadrenergic
- postural hypotension, tachycardia
Antihistamine
- sedation, weight gain
ECG
- prolonged PT
135
Self injurious behaviours seen in...
Lesch nyhan syndrome
inborne metabolism
136
SSRI lisenced for OCD
paroxetine
only for severe funcitonal impairment
137
acute stress disorder onset
last 1 month shortly after life threatening event
138
adjustment disorder onset
within 3 months from significant life change/stressor
139
GAD onset
symptoms for at least 6 months
140
Absolute Contraindication to ECT
raised ICP
141
Oppositional defiant disorder
defying authority figures
142
conduct disorder
violation of age app social norm
fighting
runaway
theft
destruction of property
143
Disufiran mechanism of action
acetaldehyde dehyrdrogenase
NAUSEA
FLUSHING
HEADACHE
PALPITATION
144
First line treatment of depression in elderly is...
SSRI
145
Hypnagogic hallucination is...
transient as going to sleep
(visual/auditory/tactile)
146
Hypnopompic hallucination is....
experienced on waking
147
Management of neuroleptic malignant syndrome
dantrolene
148
Fragile X syndrome
trinucleotide CGC
FMR1 gene on X chromosome
149
Seasonal affective disorder managmenet
FIRST LINE: CBT
second: SSRI
150
SSRI withdrawal
psychomotor agitation
poor sleep
anxiety
vertigo
light headed
151
Regression
return to less mature levels of functioning
152
SSRI suicide risk
first 2 weeks of starting SSRI
- suicidal
153
EEG with photic stimulation
for photosensitive epilepsy
154
Risk factors for refeeding syndrome
low BMI <15
155
Spiralling visual field loss suggests
conversion disorder
156
Somatoform pain disorder
long term pain- no physical cause, no mental disorder
157
Lithium monitoring
hypothyroidism
158
Undoing
performance of acitivyt to reverse some previous behanour or thought
159
Malingering
intentional and fraudulent feinging or exaggeration of symptoms for external gain
160
Naltrexone uses
opioid dependence
alcohol
161
Delusion of reference
belief or perception that unrelated phenomena in the world is directly referred to them
162
Cyclothymia
mood swings cycling fro depression to hypomania (elevated mood without psychosis/impaired function)
163
Side effects of bisprolol
depression
erectile dysfunction
nightmares
