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Exam - M - Psychiatry (Meg) > Passmedicine > Flashcards

Passmedicine Flashcards

1
Q

What is the only contraindication to ECT

A

Raised ICP

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2
Q

What are the short term side effects of ECT

A

headache
nausea
short term memory impairment
memory loss of events prior to ECT
cardiac arrhythmia

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3
Q

What are the long term side effects of ECT

A

Memory problems
Apathy
Anhedonia
Difficulty concentrating
Loss of emotional responses
Difficulty learning new information

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4
Q

What scale is used for rating the severity of OCD

A

Y-BOCS scale

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5
Q

What is the treatment for OCD

A

Mild:
CBT or ERP +/- SSRI

Moderate:
SSRI and more intensive OCD
Any SSRI but fluoxetine for body dysmorphia
Alternative - clomipramine

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6
Q

What are the features of mania

A

Lasts for at least 7 days
causes severe functional impairment in social and work setting
May require hospitalisation
May present with psychotic symptoms

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7
Q

What are the features of hypomania

A

Lasts <7 days (usually 3-4)
Can be high functioning - doesn’t impair functional capacity in work or social setting
Unlikely to require hospitalisation
No psychotic symptoms

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8
Q

What is Munchausens syndrome

A

Purposefully causing symptoms

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9
Q

What is malingering

A

Faking symptoms for personal (usually financial) gain.

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10
Q

What are examples of typical antipsychotics

A

Haloperidol
Chlopromazine

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11
Q

What are examples of atypical antipsychotics

A

Clozapine
Risperidone
Olanzapine

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12
Q

What are the extrapyramidal side effects seen with typical antipsychotics

A

Parkinsonism
Acute dystonia
Akanthisia
Tardive dyskinesia

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13
Q

What are risks of antipsychotics in the elderly

A

Increased risk of stroke and VTE

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14
Q

What are other side effects of antipsychotics

A

Antimuscarinic - dry mouth, urinary retention, constipation
Sedation, weight gain
Raised prolactin (galactorrhoea)
Impaired glucose tolerance
Neuroleptic malignant syndrome
Reduced seizure threshold
Prolonged QT interval

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15
Q

what is used in the treatment of delirium tremens or alcohol withdrawal

A

Long acting benzodiazepines:
Chlordiazepoxide
Diazepam

Other:
Short acting benzodiazepine - Lorazepam

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16
Q

what are the features of alcohol withdrawal

A

6-12 hours: tremor, sweating, tachycardia, anxiety

36 hours: Peak incidence of seizures

48-72 hours: Delirium tremens (coarse tremor, confusion, delusions, auditory and visual hallucinations, fever, tachycardia)

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17
Q

What type of drug is mirtazipine

A

Noradrenergic and specific serotonergic antidepressants

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18
Q

What are side effects of tricyclic antidepressants

A

Drowsiness
Dry mouth
Blurred vision
Constipation
Urinary retention
Lengthening of the QT interval

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19
Q

what are poor prognostic factors of schizophrenia

A

Strong family history
Gradual onset
Lo IQ
Prodromal phase of social withdrawal
Lack of obvious precipitant

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20
Q

What are the side effects of clozapine

A

Agranulocytosis
Neutropenia
Reduced seizure threshold
Myocarditis
Constipation
Hypersalivation

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21
Q

What are examples of atypical antipsychotics

A

Clozapine
Olanzapine
Risperidone
Quetiapine
Amisulpride
Aripiprazole

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22
Q

What is erotmania

A

AKA De Clerambaults syndrome

A specific form of delusional disorder where a patient believes a famous actor is involve with them.

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23
Q

What are factors shown to increase the risk of suicide

A

Male
History of deliberate self harm
Alcohol or drug misuse
History of mental illness
History of chronic disease
Advancing age
Unemployment, social isolation, living alone
Being unmarried, divorced or widowed

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24
Q

what are the risks for completing suicide if a patient has already attempted it

A

Effort to avoid discovery
Planning
Leaving a written note
Final acts
Voilent method

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25
Q

What are the protective factors for reducing the risk of a patient committing suicide

A

Family support
Having children at home
religious beliefs

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26
Q

What is the step wise treatment for generalised anxiety disorder

A

Step 1:
Education about GAD and active monitoring

Step 2:
Low-intensity psychological interventions (non facilitated self-help)

Step 3:
High-intensity psychological interventions (CBT)
Drug treatment

Step 4:
Specialist input

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27
Q

What is the medical management for GAD

A

First line:
Sertraline

If ineffective:
Offer another SSRI or an SNRI (duloxetine or venlafaxine)

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28
Q

What is the management of bipolar disorder

A

Psychological intervention

Lithium is still the mood stabilizer of choice.

Antidepressants are not recommended but if needed - fluoxetine is the antidepressant of choice.

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29
Q

Which medications can interact with SSRIs

A

NSAIDs (if co-prescribed - also give a PPI)
Warfarin/Heparin
Aspirin
Triptans (Increased risk of serotonin syndrome)
MAOI

30
Q

What are the features of discontinuation symptoms of SSRIs

A

Should be reduced over 4 weeks (not necessary for fluoxetine)

Increased mood changes
Restlessness
Difficulty sleeping
Unsteadiness
Sweating
GI symptoms
Parasthesia
Electric shock sensations
Dizziness
Anxiety

31
Q

What are the core symptoms of depression

A

Low mood
Fatigue
Anhedonia

32
Q

What is the criteria for bulimia nervosa

A
  • Recurrent episodes of binge eating
  • Sense of lack of control over eating during these episodes
  • Recurrent compensatory behaviour (vomiting, laxatives, diuretics, excessive exercise)
  • Recurrent vomiting (erosion of teeth, Russells sign)

The binge eating and compensatory behaviours both occur at least once a week for 3 months

33
Q

What is Disulfiram

A

AKA Antabuse

Causes a build up of acetaldehyde within 20-30 minutes of alcohol consumption.

Causes facial flushing, nausea and vomiting.

Taken once daily and its effect lasts for 7 days.

34
Q

What is acamprostate

A

Taken 3 times a day and is used as an anti craving medication. It is safe in combination of alcohol.

It is used to prevent relapse.

35
Q

What is buprenorphine

A

Mixed opioid agonist/antagonist.

Given as a sublingual tablet and is an alternative opioid replacement to methadone.

36
Q

What are examples of MAOI

A

Tranylcypromine
Phenelzine

37
Q

What must be avoided when taking MAOI

A

Tyramine containing foods: Cheese, pickled herring, bovril, oxo, marmite, broad beans

Can cause hypertensive reactions

38
Q

What are the symptoms of depression

A

3 Core symptoms:
Depressed mood
Loss of interest (anhedonia)
Reduced energy levels(anergia)

Other common symptoms:
Decreased self-esteem and confidence
Guilt and worthlessness
Bleak and pessimistic views of the future
Ideas or acts of self harm or suicide
Disturbed sleep
Diminished appetite and weight loss
Psychomotor agitation or retardation
Loss of libido

39
Q

What is the criteria for a mild depressive episode

A

At least 2 out of 3 of the core symptoms of depression

2 other symptoms

Minimum duration of 2 weeks

Individuals may be distressed but should be able to function

40
Q

what is the criteria for a moderate depressive episode

A

At least 2 out of 3 core symptoms

At least 3 or 4 other symptoms

Minimum duration of 2 weeks

Individuals will have difficulty continuing with normal work and social functioning

41
Q

What is the criteria for a severe depressive episode

A

All 3 of the core symptoms

At least 4 of the other symptoms

Minimum of 2 weeks duration (if symptoms are severe, may be appropriate to make an early diagnosis)

Also might be psychotic symptoms

Individuals show severe distress and or agitation

42
Q

what are the two screening equations for depression

A

‘During the last month, have you often been bothered by feeling down, depressed or hopeless?’

‘During the last month, have you often been bothered by having little interest or pleasure in doing things?’

43
Q

What are the risks of SSRI use in pregnancy

A

first trimester - increased risk of congenital heart defects

Third trimester - Persistne pulmonary hypertension of the new born

Paroxetine - increased risk of congenital malformations

44
Q

which is the preferred antidepressant following an MI

A

sertraline

45
Q

what is a side effect of citalopram

A

Dose dependent QT interval prolongation

46
Q

What are schneiders first rank symptoms (4)

A
  1. Auditory Hallucinations:
    - Thought echo
    - Voices commenting on patients behaviour
    - Two or more voices discussing the patient in third person
  2. Thought disorder:
    - Thought insertion
    - Thought withdrawal
    - Thought broadcasting
  3. Passivity phenomena
    - Bodily sensations being controlled by an external influence
    - Actions/impulses/feelings - experiences which are imposed on the individual or influenced by others
  4. Delusional perceptions:
    - A normal object is perceived then theres a delusional insight into the objects meaning
47
Q

what are other features of schizophrenia

A

impaired insight

negative symptoms:
- incongruity or blunting of affect
- anhedonia
- alogia
- avolition

Neoligisms
Catatonia

48
Q

what are some of the adverse effects of lithium

A

nausea/vomiting, diarrhoea
fine tremor
nephrotoxicity (polyuria - due to diabetes insipidus)
thyroid enlargement (hypothyroidism)
ECG - T wave flattening/inversion
Weight gain
Idiopathic intracranial hypertension
leucocytosis
hyperparathyroidism + Hypercalcaemia

49
Q

When should lithium levels be checked

A

12 hours post-dose

Performed weekly and after each dose change until concentrations are stable

Thyroid and renal function should be checked every 6 months

Once levels are stable - they are measured every 3 months.

50
Q

What is schizotypal personality disorder

A

Patients lack close friends other than family
Have odd or eccentric beliefs
Have a distorted view of reality, superstitions and unusual behaviours
Odd beliefs and magical thinking
Ideas of reference (some insight retained)

51
Q

What is the treatment for PTSD

A

Trauma focused CBT or eye movement desensitisation and reprocessing (EMDR)

Drug treatments:
Not routinely used - venlafaxine or a SSRI like sertraline can be used

Severe - Risperidone

52
Q

What is coward syndrome

A

when a person believes they are dead or non existent

53
Q

what is capgras syndrome

A

An irrational delusion of misidentification where the patient believes that a relative or friend has been replaced by an identical imposter

54
Q

What is de clerambault syndrome

A

AKA erotomania

A delusion disorder where patients believe another individual is infatuated with them.

55
Q

What is delusional parasitosis

A

AKA Ekbom syndrome

Patients have a fixed, false belief that they are infested by bugs

56
Q

What is the treatment for personality disorders

A

Psychological therapies - dialectical behavioural therapy

Treatment of any coexisting psychiatric conditions

57
Q

What is schizoid personality disorder

A

Characterised by a tendency towards solitariness
Lack of interest in social relationships
Emotional detachment
Lack of interest for sexual interactions
Few interests
Indifference to praise and criticism

58
Q

Which of the atypical antipsychotics has the best side effect profile

A

Aripiprazole

59
Q

When is clozapine likely to be trialled in schizophrenia

A

If it is not controlled despite the sequential use of two or more antipsychotic drugs (one should be a second generation).

Each must have been trialled for at least 6-8 weeks.

60
Q

What are the rules regarding clozapine monitoring

A

If doses are missed for more than 48 hours - you will need to restart it slowly.

Restarting clozapine must be done under a psychiatrist.

If its stopped for 72 hours - you may need frequent blood tests for a short period.

61
Q

What are the signs of serotonin syndrome

A

Hypertension
Muscle rigidity
Pupillary dilatation
Rapid heart rate
Confusion
Agitation
Loss of muscle coordination
Diarrhoea
Shivering
fever
Seizures

62
Q

What are the features of a brief psychotic episode

A

An episode of psychosis that lasts less than a month.

usually a return to baseline functioning

63
Q

What is the most common side effect of the atypical antipsychotics

A

Weight gain

Hyperprolactinaemia

64
Q

What is wernickes encephalopathy

A

a neurological condition due to longstanding thiamine (vitamin B1) deficiency.

Triad of:
confusion
Ataxia (broad based gait)
Occulomotor dysfunction (CN6 palsy and nystagmus)

65
Q

What is korsakoffs syndrome

A

Anterograde and retrograde amnesia
Confabulation

66
Q

What are examples of tricyclic antidepressants

A

Amitriptyline
Clomipramine
Dosulepin
Trazodone
Imipramine
Lofepramine
Nortriptyline

67
Q

What is antisocial personality disorder

A

Characterised by disregard for others, failure to conform to social norms.

Often results in criminal behaviour and lack of remorse.

68
Q

Which Scoring system is used to determine the severity of alcohol withdrawal

A

The revised clinical institute withdrawal assessment for alcohol (CIWA-Ar)

69
Q

What should be done when switching someone off of fluoxetine

A

A gap of 4-7 days should be left before starting an alternative SSRI

70
Q

What is the cardiac side effect associated with Citalopram

A

Prolonged QT leading to Tornadoes Des Pointes.

71
Q

When is a grief reaction classed as being abnormal

A

If present 6+ months following a bereavement.

72
Q

What are examples of SNRIs

A

Venlafaxine
Duloxetine

Exam - M - Psychiatry (Meg) (24 decks)

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