Passmed Psych Flashcards
1
Q
What is the first line medication used in for ADHD in adults?
A
Methylphenidate or lisdexamfetamine
2
Q
At what age is a child legally able to consent to sex?
A
13
3
Q
What is the first line medication used to treat generalised anxiety disorder?
A
Sertraline (SSRI)
4
Q
Give examples of an SNRI?
A
duloxetine and venlafaxine
5
Q
What do antipsychotics increase the risk of?
A
Ischaemic stroke, venous thromboembolism
6
Q
What are some typical side effects of antipsychotics?
A
parkinsonism, acute dystonia, restlessness, dry mouth, blurred vision, sedation, raised prolactin, impaired glucose tolerance, neuroleptic malignant syndrome, reduced seizure threshold (atypicals), urinary retention
7
Q
What side effects are associated with tricyclic antidepressants?
A
blurred vision, drowsiness, dry mouth, constipation, urinary retention, postural hypotension, Long QT
8
Q
What are the side effects of lithium?
A
Nausea/vomiting, fine tremor, nephrotoxicity, thyroid enlargement, T-wave flattening, IIH, leucocytosis, hyperparathyroidism
9
Q
What medications can be used to manage bipolar disorder?
A
Lithium, anticonvulsants and antipsychotics
10
Q
What do you need to monitor in patients on clozapine?
A
FBC - clozapine can cause agranulosis or neutropenia
11
Q
Which anti-psychotic reduces seizure threshold?
A
Clozapine
12
Q
Which side effect is more common in atypical than conventional antipyschotics?
A
weight gain
13
Q
What are the main side effects of clozapine?
A
neutropaenia, agranulocytosis, constipation, myocarditis, hypersalivation
14
Q
How does smoking cessation affect clozapine levels?
A
It can increase them
15
Q
Which antipsychotics cause hyperprolactinaemia?
A
Most typical and atypical antipsychotics (aripiprazole has less of these side effects)
16
Q
What is conversion disorder?
A
A neurological symptom presenting after a period of stress - usually loss of motor or sensory function
17
Q
What is a somatisation disorder?
A
multiple physical symptoms present for at least 2 years
18
Q
What is illness anxiety disorder (hypochondriasis)?
A
persistent belief in the presence of an underlying serious disease
19
Q
What is factitious disorder?
A
munchausen’s syndrome. intentional production of physical or psychological symptoms (e.g. purposely taking too much insulin)
20
Q
What is malingering?
A
fraudulent simulation or exaggeration of symptoms with the intention of financial or other gain
21
Q
What is hoover’s sign?
A
compensatory movement of the oppositive limb due to synergistic contraction - when the unaffected leg is flexed against resistance, the affected leg involuntarily extends. can differentiate between organic and non-organic paralysis
22
Q
What are the typical antipsychotics?
A
haloperidol, chlorpromazine, loxapine,
23
Q
What are the atypical antipsychotics?
A
clozapine, risperidone, olanzapine, aripiprazole, quetiapine
24
Q
What is delusional parasitosis?
A
Patients with a fixed false belief that they are infested by bugs
25
What is capgras syndrome?
delusional misidenification syndrome where the patient believes that someone significant in their life has been replaced by an identical imposter
26
What is delirium tremens?
A condition caused by alcohol withdrawal, presents with visual/tactile hallucinations, tremor, sweating and disorientation
27
What is fregoli syndrome?
a delusional misidentification syndrome where the patient believes that multiple people are one person who is constantly changing their appearance
28
What is the definition of chronic insomnia?
Present for at least 3 months
3/7 nights of the week
29
Which hypnotics are used to treat short-term insomnia?
benzodiazepines or zopiclone/zolpidem/zaleplon
30
What is cotard's delusion?
a fixed false belief that a person believes that part of their body is dead or dying
31
What is formication?
a type of paraesthesia that feels like insects crawling on the skin
32
What are the features of serotonin syndrome?
agitation, restlessness, confusion, muscle rigidity, hyperreflexia, dilated pupils and flushed skin
33
What is the first line SSRI for depression in children and adolescents?
fluoxetine
34
Which SSRI should be used in patients who have had an MI?
Sertraline
35
What is the most common side effect of SSRIs?
GI symptoms - increased risk of GI bleeds
36
What side effect is associated with citalopram?
QT prolongation
37
What medication should you not take with SSRIs?
NSAIDS - (can give with PPI), warfarin/heparin, aspirin, triptans and MAOIs (increased risk of serotonin syndrome)
38
What symptoms are associated with discontinuation of SSRIs?
increased mood change, restlessness, difficulty sleeping, unsteadiness, sweating, GI symptoms, paraesthesia
39
Can you take SSRIs in pregnancy?
yes, but there are some disadvantages. increased risk of congenital heart defects in 1st trimester, pulmonary hypertension of the newborn if used in 3rd trimester
40
When checking lithium levels at what time should the sample be taken?
12 hours post-dose
41
How often should lithium levels be checked?
Weekly and after every dose change until stable - then every 3 months. renal and thyroid function checked every 6 months
42
What are the side effects of lithium?
- vomiting, diarrhoea, fine tremor, nephrotoxicity, hypothyroid, T wave inversion, weight gain, IIH, hyperparathyroidism
43
What is Russel's sign?
Calluses on the knuckles or back of hand due to self-induced vomiting
44
What is the difference between binge-eating and bulimia?
Bulimia = purging behaviours
Binge eating - no purging
45
What is Pica?
ingestion of non-food like substances - for example soil
46
What is the criteria for a bulimia nervosa diagnosis?
- recurrent episodes of binge eating
- lack of control during the episode
- purging
- binging and purging behaviours occur once a week
- body dysmorphia
47
Which antipsychotic drug is best for dealing with the negative symptoms of schizophrenia?
Clozapine
48
Tricyclic antidepressants can cause what type of incontinence?
Overflow - anticholinergic effects
49
Name some tricyclic antidepressants
- amitriptyline
- imipramine (less sedative)
50
What are the side effects of tricyclic antidepressants?
- anti-histamine - drowsiness
- anti-muscarinic - dry mouth, blurred vision, constipation, urinary retention
- anti-adrenergic - postural hypotension
- long QT
51
How long should antidepressants be taken for?
For at least 6 months after remission of symptoms to reduce the risk of relapse
52
What are the peak times of alcohol withdrawal symptoms?
symptoms - 6-12 hours
seizures - 36 hours
delirium tremens - 72 hours
53
What is the first-line medication given for alcohol withdrawal?
Long acting benzodiazepines - diazepam/chlordiazepoxide
54
What physiological abnormalities are seen in patients with anorexia nervosa?
hypokalaemia, low FSH, LH, oestrogen, testosterone, high GH and cortisol, impaired glucose tolerance, hypercholesterolaemia, low T3.
hypotension, bradycardia, enlarged salivary glands
55
What are the characteristic features of PTSD?
Nightmares, avoidance, hyperarousal. sleep problems, emotional numbing
56
What medications can be used in PTSD?
Venlafaxine (SNRI), SSRIs
57
What are the indications for using ECT?
Treatment resistant depression, manic episodes, moderate depression in someone who has responded to ECT in the past, catatonia
58
What is an absolute contraindication to ECT?
Raised intracranial pressure
59
What side effects are associated with ECT?
headache, nausea, short and long term memory impairment, cardiac arrhythmia, loss of memory of events leading up to ECT
60
What is the definition of chronic insomnia?
Difficulty falling of staying asleep at least 3 nights a week for 3 months or longer
61
What is the first line management of OCD?
CBT and exposure and response prevention
62
What drugs are used in the management of OCD?
SSRI or Clomipramine. Increase the dose of the SSRI before switching to clomipramine - should be trialled for 12 weeks
63
What is the strongest risk factor for psychotic disorders?
Family history of psychotic disorders
64
What is 'Knight's move'?
When the patient is speaking in different sentences that are entirely unrelated to one another
65
What is circumstantiality?
The inability to answer a question without giving excessive detail
66
What is clang associations?
Where the patient says words that are related to each other by the fact that they rhyme or sound similar
67
What is flight of ideas?
When the patient moves from one thought to another but there are clear links between the ideas
68
What is tangentiality?
Wandering from a topic without returning to it
69
What are the features of paranoid personality disorder?
Hypersensitivity when insulted, questions the loyalty of friends, reluctant to confide in others, preoccupation with conspirational beliefs
70
What are the features of schizoid personality disorder?
Indifference to praise and criticism, preference for solitary activities, lack of interest in sexual interactions and companionship, emotional coldness, few interests
71
What are the features of schizotypal personality disorder?
Odd beliefs and magical thinking, unusual perceptions, paranoid ideation, eccentric behaviour, inappropriate affect, odd speech, lack of close friends
72
What are the cluster A personality disorders?
Odd or eccentric - paranoid, schizoid, schizotypal
73
What are the features of antisocial personality disorder?
Failure to conform to social norms, deception, impulsiveness, aggressiveness, reckless disregard for own safety and the safety of others, irresponsibility
74
What are the features of EuPD?
avoids real or imagined abandonment, unstable interpersonal relationships, unstable self-image, impulsivity in self-damaging areas, suicidal behaviour, affective instability, emptiness, difficulty controlling temper
75
What are the features of histrionic personality disorder?
Inappropriate sexual seductiveness, need to be the centre of attention, rapidly shifting emotions, suggestibility, self-dramatization, relationships considered to be more intimate than they are
76
What are the features of narcissistic personality disorder?
Self-importance, sense of entitlement, taking advantage of others to meet needs, lack of empathy, chronic envy, arrogant
77
What are the cluster B personality disorders?
Dramatic, emotional, erratic - antisocial, borderline, histrionic
78
What are the cluster C personality disorders?
Anxious and fearful - obsessive compulsive, avoidant, dependant
79
What are the features of obsessive compulsive personality disorder?
Occupied with derails, lists, rules, demonstrates perfectionism that hampers with completing tasks, dedicated to work, unwilling to pass on tasks, stingy spending style
80
What are the features of avoidant personality disorder?
Avoidance of occupational activities with others due to fear of criticism or rejection, unwilling to be involved unless certain of being liked, restraint in intimate relationships, views self as inept or inferior to others, craves social contact with social isolation
81
What are the features of dependent personality disorder?
Difficulty making everyday decisions without excessive reassurance from others, difficulty in expressing disagreement with others due to fear of losing support, urgent search for another relationship when a close one ends
82
What psychotherapy technique is used in personality disorders?
Dialectical behavioural therapy
83
What scoring system do you use for alcohol withdrawal?
Clinical institute withdrawal assessment for alcohol (CIWA)
84
What is the first line for acute stress disorders?
CBT - trauma focused
85
When do you use EMDR in acute stress disorders/PTSD?
After 4 weeks
86
What is the difference between mania and hypomania?
Mania - lasts for at least 7 days, severe impairments, may require hospitalisation, presents with psychotic symptoms (delusions of grandeur, auditory hallucination)
Hypomania - A lesser version of mania, lasts for 3-4 days, unlikely to require hospitalisation, does not exhibit any psychotic symptoms
87
What are features of atypical grief?
Grief that occurs more than two weeks after event, grief lasting more than 12 months
88
What are the core symptoms of depression?
anhedonia, anergia, low mood
89
What are the atypical symptoms of depression?
increased appetite, hypersomnia
90
What are the somatic symptoms of depression?
loss of emotional reactivity, diurnal mood variation, anhedonia, early morning waking, psychomotor agitation or retardation, loss of appetite or weight, loss of libido
91
How long does depression have to last before it becomes a depressive episode?
2 weeks
92
Can you use anti-psychotics in dementia patients?
Yes, but only when necessary. They increase risk of mortality
93
What are the metabolic side effects of antipyschotics?
dysglycaemia, dyslipidaemia, diabetes mellitus
94
What is the acute management of a manic episode?
stop antidepressant, commence antipsychotic olanzapine/haloperidol
95
What are two examples of SNRIs?
Duloxetine, venlafaxine
96
What drugs can be used in PTSD?
venlafaxine or SSRI
97
What is the first line treatment for anorexia nervosa?
family therapy
98
What medication is used to treat alcohol withdrawal seizures?
chordiazepoxide
99
Which psychiatric medication is used to help stimulate appetite?
Mirtazapine
100
What is the treatment for severe OCD?
SSRI + CBT with exposure and response prevention
101
What is catatonia?
stopping of voluntary movement or staying still in an unusual position
102
What is the difference between acute stress disorder and PTSD?
Acute stress < 4 weeks after traumatic event
PTSD - diagnosed after 4 weeks
103
Over how long should you taper a dose of an SSRI?
4 weeks
104
What should be monitored in patients on SNRIs?
Blood pressure
105
What biochemical features are seen in neuroleptic malignant syndrome?
raised creatinine kinase and raised white cell count
106
What is the management of acute dystonia?
Procyclidine
107
What is a common discontinuation symptom of SSRIs?
Diarrhoea
108
What is the first line ADHD med in kids?
Methyphenidate
109
When should follow up occur for people started on SSRIs?
<25 = 1 week
>25 = 2 weeks
110
If clozapine doses are stopped for more than 48 hours what do you do?
Retitrate the clozapine doses slowly
111
Which medication makes alcohol make you sick?
Disulfiram
112
Which medication reduces alcohol cravings?
Acamprosate
113
What medication can be used in PTSD?
Venlafaxine or SSRI
114
What are Schneider's first rank symptoms of schizophrenia?
Auditory hallucinations, thought disorders, passivity phenomenon and delusional perceptions
115
