passmed/pastest Flashcards
a prodromal phase of schizophrenia is associated with a poor/good prognosis
poor prognosis
factors associated with a poor prognosis in schizophrenia
strong family history gradual onset low IQ premorbid history of social withdrawal lack of obvious precipitant
where in the body does lithium get concentrated?
bone and thyroid
what is the most commonly used prophylactic mood stabiliser used in bipolar disorder
lithium
adverse effects of lithium
nausea/vomiting, diarrhoea fine tremor nephrotoxicity nephrogenic DI T wave flattening/inversion weight gain idiopathic intracranial hypertension
how often should lithium levels be tested when started
weekly, and after each dose change until concentrations are stable
once lithium concentrations are stable, how often should lithium levels be checked
every 3 months
when should lithium levels be checked
12 hours post dose
how often should thyroid and renal function be checked in patients on lithium
every 6 months
which serious side effect is relatively common with clozapine?
agranulocytosis
what is passivity
the belief that your movements or sensations are controlled by an external force
what is avolition
a decrease in motivation to perform directed, purposeful activities
what is catatonia
a state of unresponsiveness that may include repetitive movements or abnormal postures
what is neologism
creation of new words
what type of hallucinations are most common in schizophrenia
3rd person auditory hallucinations discussing the patient or a running commentary on the patient’s behaviour
which antipsychotic most commonly causes galactorrhea
risperidone
also may occur with olanzapine or quetiapine
what are signs of somatisation disorder
multiple physical symptoms present for at least 2 years
patient refuses to accept reassurance or negative test results
what are signs of hypochondriacal disorder
persistent belief in the presence of an underlying serious disease, eg cancer
patient refuses to accept reassurance or negative test results
what are signs of conversion disorder
typically involves loss of motor or sensory function
the patient doesn’t consciously feign the symptoms (factitious disorder) or seek lateral gain (malingering)
patients may be indifferent to their apparent disorder
what is dissociative disorder
dissociation is a process of ‘separating off’ certain memories from normal consciousness
in contrast to conversion disorder it involves psychiatric symptoms, eg amnesia, fugue, stupor
dissociative identity disorder is the new term for multiple personality disorder as is the most severe form of dissociative disorder
what are signs of munchausen’s syndrome
also known as factitious disorder
the intentional production of physical or psychological symptoms
what are sings of malingering
fraudulent simulation or exaggeration of symptoms with the intention of financial or other gain
what are risk factors for suicide completion
sex (male) age (young adult or elderly) depression previous attempt (highest risk factor) alcohol or drug use no spouse or other social support stated future intent
what does a sore throat in a patient taking clozapine suggest and what should the investigation be
agranulocytosis
FBC
what is the underlying mechanism of tar dive dyskinesia
long term dopamine receptor blockade causing hypersensitive of dopamine receptors in the nigrostriatal pathway
what is a potential serious side effect of BDZs
respiratory depression
especially when prescribed with other respiratory depressant drugs eg opioids
symptoms of BDZ withdrawal syndrome
tremor
anxiety
perspiration
seizures
which ions flow through GABA receptor-gated channels
chloride
how does GABA cause inhibitory effects
binds to GABA receptors, causing an influx of chloride ions and hyper polarisation, reducing the membrane potential
what is an obsession
an intrusive, unpleasant and unwanted thought
what is a compulsion
a senseless action taken to reduce the anxiety caused by an obsession
when is Eye Movement Desensitisation and Reprocessing (EMDR) therapy used
PTSD
what is Dialectical Behaviour Therapy (DBT) used for
borderline personality disorder
what is exposure-response prevention (ERP) therapy used for
OCD
protective factors of suicide completion
family support
having children at home
religious belief
mechanism of amitriptyline
inhibits monoamine reuptake on the presynaptic membrane
symptoms of SSRI discontinuation syndrome
increased mood change restlessness difficulty sleeping unsteadiness sweating GI symptoms (pain, cramping, diarrhoea, vomiting) paraesthesia
mechanism of action of haloperidol
block dopamine receptors
what is Korsakoff’s syndrome
marked memory disorder often seen in alcoholics
thiamine deficiency causes damage and haemorrhage to the mammillary bodies of the hypothalamus and the medial thalamus
often follows on from untreated Wernicke’s encephalopathy
features of Korsakoff’s syndrome
anterograde amnesia (inability to acquire new memories)
retrograde amnesia
confabulation
features of wernicke’s encephalopathy
nystagmus
ophthalmoplegia
ataxia
