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Passmed psych Flashcards

1
Q

Side effects of TCAs?

A

Dry mouth (anticholinergic) and weight gain (antihistaminic)
Urinary retention

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2
Q

Why should SSRIs and MAOIs never be mixed?

A

Risk of serotonin syndrome

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3
Q

Difference between depression and dementia presentation?

A

Depression - global memory loss rather than short-term (pseudodementia)

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4
Q

What is word salad and what is it associated with?

A

Disorganised speech - mania and psychosis

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5
Q

Acute stress disorder vs PTSD?

A

Acute stress <4w but PTSD >4w

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6
Q

What common symptom can TCAs cause?

A

Urinary retention

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7
Q

Management of PTSD?

A

CBT, EMDR
Drugs - SSRI or venlaxafine

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8
Q

Are men or women more likely to be successful in a suicide attempt?

A

Men

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9
Q

What suggests depression over dementia?

A

Sleep disturbance, stress triggers and normal MMSE with global memory

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10
Q

What is the 666 rule for SSRIs?

A

Wait 6 weeks to take effect
Continue for 6 months to stabilise and avoid relapse
Takes at least 6 weeks for the washout period in order to avoid adverse effects

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11
Q

What is somatisation disorder?

A

Multiple physical symptoms that can’t be explained by any medical condition

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12
Q

What is the life threatening side effect of clozapine and how is it monitored?

A

Agranulocytosis/neutropenia - FBC

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13
Q

What is the cutoff for severe depression in the PHQ-9?

A

16

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14
Q

Which SSRI is the most likely to prolong QT and cause torsades de pointes?

A

Citalopram

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15
Q

What is borderline personality disorder associated with?

A

History of recurrent self-harm and intense interpersonal relationships that alternate between idealisation and devaluation

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16
Q

1st line drug for GAD?

A

Sertraline

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17
Q

How does Wernicke’s encephalopathy present?

A

Gait ataxia, ophthalmoplegia and nystagmus

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18
Q

How does Korsakoff’s syndrome present?

A

Retrograde/anterograde amnesia and confabulation

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19
Q

What is De Clerambault’s syndrome?

A

Ertomania -form of paranoid delusion with an amarous quality. The patient is oftena single woman who believes that a famous person is in love with her

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20
Q

What is delusional parasitosis?

A

Fixed, false belief (delusion) that they’re infested by bugs

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21
Q

What is Hoover’s sign used for? What is the test?

A

Differentiating organic from non-organic leg paresis.

-Non-organic: pressure is felt under paretic leg when lifting non-paretic leg against pressure due to involuntary contralateral hip extension

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22
Q

How is hypomania characterised?

A

Elevated mood, pressured speech and flight of ideas without psychotic symptoms

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23
Q

What is the risk of schizophrenia for an affected monozygotic twin?

A

50% - suggests genetics play a vital role in schizophrenia development

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24
Q

Most common SE of atypical antipsychotics?

A

Weight gain

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25
Q

What is akathisia?

A

Sense of inner restlessness and inability to keep still

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26
Q

Management for more severe depression?

A

Individual CBT and antidepressant

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27
Q

What symptoms are seen in SSRI discontinuation syndrome?

A

GI - diarrhoea

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28
Q

What are the risks of antipsychotics in the elderly?

A

Increased risk of stroke and VTE

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29
Q

Common side effect of electroconvulsive therapy?

A

Memory impairment - retrograde amnesia

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30
Q

What is the difference between retrograde and anterograde amnesia?

A

Retrograde - can’t recall memories from past

Anterograde - can’t form new memories but can still remember things from before amnesia development

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31
Q

What is the risk of zopiclone in the elderly?

A

Falls

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32
Q

In GAD, what do you use if sertraline is ineffective/not tolerated?

A

Try another SSRI or SNRI

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33
Q

What is cotard syndrome?

A

Characterised by a person believing they’re dead or non-existent

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34
Q

Short-term SE of ECT?

A

Arrhythmia, headache, nausea, memory loss/impairment

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35
Q

How does tardive kinesis present?

A

Chewing, jaw-pouting, excessive blinking

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36
Q

Three common features of PTSD?

A

Re-experiencing, avoidance, hyperarousal

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37
Q

What is circumstantiality?

A

Long-winded answer but comes back around eventually whereas tangentiality is when the answer goes off in one direction forever

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38
Q

What is echolalia?

A

Repetition of someone else’s speech including the questions being asked (feature of schizophrenia - typically catatonic)

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39
Q

What is a neologism?

A

A made up word

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40
Q

What is palilalia?

A

Automatic repetition of one’s own words, phrases or sentences

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41
Q

What is echopraxia?

A

Meaningless repetition or imitation of the movements of others

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42
Q

What is copropraxia?

A

Involuntary performing of obscene or forbidden gestures or inappropriate touching

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43
Q

What is a characteristic physical finding of anorexia nervosa?

A

Lanugo hair

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44
Q

What should patients with OCD and severe functional impairment?

A

Referred to the secondary care mental health team - treatment can be started while waiting assessment

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45
Q

What is Münchausen’s syndrome?

A

Purposefully causing symptoms for personal gain

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46
Q

What is functional neurological disorder?

A

Conversion disorder - involves loss of motor or sensory function

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47
Q

What happens when there is poor oral compliance with antipsychotics?

A

Switch to IM antipsychotics (depot) - usually once monthly

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48
Q

What is Othello syndrome?

A

Delusional jealousy

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49
Q

What is the SSRI of choice for children and adolescents?

A

Fluoxetine

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50
Q

What is the first line treatment for young people with anorexia?

A

Anorexia focused family therapy

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51
Q

How is acute dystonia managed when secondary to antipsychotics?

A

Procyclidine

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52
Q

What are the symptoms of SSRI discontinuation syndrome?

A

Dizziness, electronic shock sensations, anxiety

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53
Q

What is the acute management of mania/hypomania in patients taking antidepressants?

A

Consider stopping antidepressant and starting antipsychotics

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54
Q

When starting ECT treatment on antidepressants, what should be done?

A

Antidepressants reduced not stopped

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55
Q

Which drug can you give to reverse benzodiazepines?

A

Flumenazil

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56
Q

When taking SSRI and NSAID what else should be prescribed and why?

A

A PPI

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57
Q

What’s a good type of therapy for patients with OCD and why?

A

Exposure and response prevention - exposing them to an anxiety-provoking situation

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58
Q

What are the useful side effects on mirtazapine?

A

SNRI - sedation and increased appetite (better eating and sleeping)

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59
Q

What are the metabolic side effects of antipsychotics?

A

Dysglycaemia, dyslipidaemia and diabetes mellitus

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60
Q

What are the first rank symptoms of schizophrenia?

A

Thought broadcasting, thought withdrawal, delusional perceptions and auditory hallucinations

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61
Q

What is the strongest risk factor for psychotic disorders?

A

Family history

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62
Q

Before diagnosing GAD, what is important to rule out?

A

Hyperthyroidism

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63
Q

What is a GI side effect of clozapine?

A

Constipation, intestinal obstruction

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64
Q

Which type of antidepressants give the most antimuscarinic SEs?

A

TCAs - dry mouth and blurred vision

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65
Q

Are pseudohallucinations common after grief?

A

Yes - doesn’t imply psychosis

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66
Q

What is an important investigation in elderly patients with sudden-onset psychosis?

A

CT head - rule out organic cause

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67
Q

What is the difference between Knight’s move thinking and flight of ideas?

A

Knight’s move - illogical leaps from one idea to another
Flight of ideas - links from one idea to another

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68
Q

What is the link between clozapine and seizures?

A

Clozapine reduces the seizure threshold making seizures more likely

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69
Q

What is illness anxiety disorder?

A

Persistent belief in the presence of an underlying disease

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70
Q

What is Charles-Bonnet syndrome associated with?

A

Age related macular degeneration

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71
Q

What is Charles-Bonnet syndrome?

A

Persistent or recurrent complex hallucinations (visual or auditory) occurring in clear consciousness. Generally against a background of visual impairment. Insight usually preserved. Occurs in absence of other psychiatric disorders

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72
Q

Circadian rhythm in schizophrenia?

A

Disturbed

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73
Q

Which antidepressant increases the risk of suicide the most at the start of treatment?

A

Venlaxafine (but all of them do)

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74
Q

Feature of avoidant personality disorder?

A

Fearful of criticism, being unliked, rejected and ridiculed

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75
Q

Features of anorexia?

A

Most things are low except G’s and C’s:

-Growth hormone, glucose, glands (salivary)
-Cortisol, cholesterol, carotinaemia

76
Q

What is the typical patient at high risk of suicide?

A

Male with history of drug and alcohol abuse with deliberate self-harm

77
Q

Key feature of bulimia?

A

Erosion of teeth

78
Q

What happens if a patient misses their clozapine dose for 48h?

A

Has to be restarted again slowly

79
Q

Which atypical antipsychotic has the best side effect profile?

A

Aripiprazole (particularly for prolactin elevation)

80
Q

SSRI use in pregnancy?

A

Weight up benefits and risk:
1st trimester use - small congenital heart defect risk
3rd trimester use - can result in persistent pulmonary hypertension of newborn

81
Q

Paroxetine use in pregnancy?

A

Increased risk of congenital malformations, particularly in first trimester
(serotonin is required for establishing left-right asymmetry of heart in embryogenesis)

82
Q

What is cotard syndrome associated with?

A

Severe depression

83
Q

What is an obsession?

A

Intrusive, unpleasant and unwanted thought

84
Q

What is a compulsion?

A

Senseless action taken to reduce the anxiety caused by obsession

85
Q

Does smoking affect clozapine levels?

A

Smoking cessation can cause a rise in clozapine blood levels

86
Q

What is the prognosis of a prodromal phase of social withdrawal in schizophrenia?

A

Poor prognosis

87
Q

What is the effect of long-term antipsychotic use?

A

Development of glucose dysregulation and diabetes

88
Q

Features of schizotypal personality disorder?

A

Lack close friends other than family and have odd/eccentric behaviour, speech and beliefs

89
Q

Prognosis of low IQ in schizophrenia?

A

Poor prognosis

90
Q

What is tangentiality?

A

Wandering from a topic without returning to it

91
Q

Does brief psychotic disorder result in long-term consequences?

A

No - return to baseline functioning

92
Q

Which electrolyte abnormality are SSRIs associated with?

A

Hyponatraemia

93
Q

Which sex is affected more by antisocial personality disorder?

94
Q

Symptoms of alcohol withdrawal?

A

6-12h: tremor, sweating, headache, anxiety
36h: seizures
72h: delirium tremens

95
Q

What is a clang association?

A

Ideas related only by rhyme or being similar sounding

96
Q

What can lithium precipitate on bloods?

A

Benign leukocytosis

97
Q

What is the difference between type 1 and 2 bipolar disorder?

A

I - Associated with mania
II - Associated with hypomania

98
Q

How does mirtazapine work?

A

Noradrenergic and specific seritonergic antidepressant - increases release of neurotransmitters by blocking a2 adrenoreceptors

99
Q

What is malingering?

A

Lying or exaggerating for financial gain

100
Q

What is used to treat moderate/severe tardive dyskinesia?

A

Tetrabenazine

101
Q

1st line treatment for acute stress disorders?

A

Trauma-focused CBT

102
Q

Five negative symptoms of schizophrenia?

A

Incongruity/bluntness of affect
Anhedonia
Alogia (poverty of speech)
Avolition (poor motivation)
Social withdrawal

103
Q

What is clozapine reserved for?

A

Cases of treatment resistant schizophrenia
Cases where patients experience negative symptoms

104
Q

What are the negative symptoms of schizophrenia?

A

Incongruity/blunting of affect
Anhedonia
Alogia
Avolition
Social withdrawal

105
Q

What is seasonal affective disorder?

A

Recurrent episodes of depression that occur during the same season each year, often in winter

106
Q

What is used to treat moderate/severe tardive dyskinesia?

A

Tetrabenazine

107
Q

Which antipsychotic makes seizures more likely?

A

Clozapine - reduces seizure threshold

108
Q

Which medication precipitates a benign leukocytosis?

109
Q

Dangerous short-term side effect of ECT?

A

Cardiac arrhythmia

110
Q

How does tardive kinesia present?

A

Chewing, jaw pouting or excessive blinking due to late onset abnormal involuntary choreoathetoid movements (conventional antipsychotics - usually long-term)

111
Q

Schizoid vs schizotypal PD?

A

Both cold and not interested in forming close relationships but schizotypal has odd/eccentric behaviour, speech and beliefs

112
Q

Which type of incontinence do TCAs cause?

A

Overflow incontinence

113
Q

Malingering vs Munchausen?

A

Malingering - faking symptoms
Munchausen - self-inflicted symptoms

114
Q

Features of avoidant PD?

A

Fearful of criticism, being unliked. rejection and ridicule

115
Q

What is acute dystonia?

A

Sustained muscle contraction such as torticollis or oculoghric crisis

116
Q

Which SSRI has the highest incidence of SSRI discontinuation syndrome?

A

Paroxetine

117
Q

Treatment of personality disorders?

A

Dialectical behavioural therapy (DCT)

118
Q

How is acute dystonia secondary to antipsychotics managed?

A

Procycldine

119
Q

What is Othello syndrome?

A

Delusional jealousy - usually believing partner is unfaithful

120
Q

Symptoms of SSRIs discontinuation syndrome?

A

Dizziness, electric shock sensations, anxiety and diarrhoea

121
Q

What is akathisia?

A

Severe restlessness

122
Q

Symptoms of mania/hypomania in primary care?

A

Mania - Urgent referral to CMHT
Hypomania - Routine referral to CMHT

123
Q

Most common endocrine disorder developed as a result of chronic lithium toxicity?

A

Hypothyroidism

124
Q

Most common side effect of clozapine?

A

Constipation

125
Q

Which electrolyte abnormality occurs to due SSRIs?

A

Hyponatraemia

126
Q

Pseudohallucinations in grieving?

127
Q

Factors associated with poor prognosis of schizophrenia?

A

Family history
Gradual onset
Low IQ
Prodromal phase of social withdrawal
Lack of obvious precipitant

128
Q

What is cotard syndrome?

A

When patients with severe depression believe they or part of them is dead

129
Q

What is the difference between knight’s move thinking and flight of ideas?

A

Knight’s move - illogical leaps from one idea to another
Flight of ideas - discernible links between ideas

130
Q

Patients with obsessive-compulsive PD?

A

Rigid with respect to morals, ethics and values. Often reluctant to surrender to work

131
Q

Antipsychotic use in the elderly?

A

Risk of VTE/stroke

132
Q

How to acutely manage mania/hypomania in those taking antipsychotics?

A

Stop antidepressant and start antipsychotic

133
Q

Main indication for ECT?

A

Treatment resistant depression and catatonia

134
Q

What is word salad and what is is associated with?

A

Disorganised speech - associated with mania and psychosis

135
Q

Metabolic side effects of antipsychotics?

A

Dysglycaemia, dyslipidaemia and diabetes mellitus

136
Q

What is hypomania?

A

Elevated mood, pressured speech and flight of ideas without psychotic symptoms

137
Q

When checking lithium levels, when are the bloods taken?

A

12h post dose

138
Q

Difference between type I and type II bipolar?

A

Type I - mania
Type II - hypomania

139
Q

Before diagnosing GAD, what has to be ruled out?

A

Thyroid disease

140
Q

What are the symptoms of delirium tremens?

A

Hallucinations, confusion and delusions

141
Q

What is tangentiality?

A

Wandering from a topic without returning to it

142
Q

Bloods for bulimia?

A

Hypochloraemic hypokalaemia metabolic alkalosis due to excessive vomiting

143
Q

Most serious side effect of clozapine and how to monitor?

A

Agranulocytosis/neutropenia - FBC

144
Q

PTSD management?

A

Trauma focussed CBT or EMDR
Venlaxafine

145
Q

First-line treatment for children and young-people with anorexia?

A

Family focused CBT

146
Q

First-line treatment for acute stress disorders?

A

Trauma-focused CBT

147
Q

Most commonly used drug in panic disorder?

A

SSRI - Sertraline

148
Q

What is echolalia?

A

Repetition of someone else’s speech including the questions being asked

149
Q

Which antipsychotic has the most tolerable side effect?

A

Aripiprazole

150
Q

How do benzodiazepines work?

A

GABA agonist

151
Q

Risk of SSRI and NSAIDs?

A

Bleeding risk - give PPI

152
Q

Common features of PTSD?

A

Re-experiencing
Avoidance
Hyperarousal

153
Q

What is somatisation disorder?

A

Multiple physical symptoms not explained by an organic cause

154
Q

Schizoid PD?

A

Prefer to be alone, don’t like relationships, low libido

155
Q

Treatment for OCD?

A

SSRI requiring a higher dose and a longer duration (12w)

156
Q

Most likely SSRI to cause Torsades to Pointes?

A

Citalopram - most likely to prolong QT interval

157
Q

How should an SSRI be stopped?

A

Remain on it for at least 6 months during remission then gradually reduce over 4 weeks

158
Q

Who are more likely to be successful in suicide?

159
Q

Post-MI, which SSRI is preferred?

A

Sertraline

160
Q

What is catatonia?

A

Stopping of voluntary movement or staying still in an unusual position

161
Q

What is the difference between an obsession and a compulsion?

A

Obsession - intrusive, unpleasant and unwanted thought

Compulsion - senseless action taken to reduced the anxiety caused by the obsession

162
Q

When does PHQ9 score indicate severe depression?

163
Q

Management of severe depression?

A

SSRI and CBT

164
Q

Management of severe OCD?

A

Add SSRI alongside CBT/ERP

165
Q

What is illness anxiety disorder?

A

Persistent belief in the presence of an underlying serious disease

166
Q

What is circumstantiality?

A

Inability to answer a questions without giving excessive, unnecessary detail

167
Q

Brief psychotic disorder?

A

Return to baseline functioning

168
Q

Mirtazapine mechanism of action?

A

Noradrenergic and serotongeric antidepressant increasing the release of neurotransmitters by blocking alpha2 adrenoreceptors

169
Q

Which drug may cause psychosis?

A

Corticosteroids

170
Q

Treatment of delirium tremens/alcohol withdrawal?

A

Chlordiazepoxide or other benzodiazepines

171
Q

Zopiclone use in the elderly?

A

Increases the risk of falls

172
Q

Useful side effects of mirtazapine?

A

Sedation and increased appetite

173
Q

Why are triptans avoided in patients taking SSRIs?

A

Increased risk of serotonin syndrome

174
Q

Anorexia features?

A

Most things low but G’s and C’s raised:
-GH, glucose, salivary glands
cortisol, cholesterol, carotinaemia

175
Q

What is clozapine reserved for?

A

Cases of treatment resistant schizophrenia
Cases where patients experience negative symptoms

176
Q

What is conversion disorder?

A

Functional neurological disorder - typically loss of motor or sensory function

177
Q

Protective factors against completed suicide?

A

Social support, religious belief, having children at home and regretting an attempt

178
Q

When can a PD be diagnosed?

A

After 18 years of age

179
Q

What is exposure and response prevention?

A

Used in OCD - exposing patient to an anxiety provoking situation

180
Q

What are clang associations?

A

Ideas related only by rhyme or being similar sounding

181
Q

Purging behaviours in bulimia?

A

Vomiting, laxatives, diuretics or exercising

182
Q

Choice of SSRI in children and young people?

A

Fluoxetine

183
Q

What is Russell’s sign?

A

Calluses on knuckles or back of hand due to repeated self-induced vomiting

184
Q

For moderate/severe OCD what may be used instead of SSRI?

A

Clomipramine (TCA)

185
Q

What is the strongest risk factor for psychotic disorders?

A

Family history

186
Q

What can long-term lithium use result in?

A

Hyperparathyroidism and hypercalcaemia

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