Pastest - PSYCHIATRY Flashcards
What are the objective signs of opioid withdrawal?
dilated pupils, yawning, rhinorrhoea (nose running), eiphoria (eyes watering)
Which med is used to treat hypersalivation in clozapine-treated patients?
hyoscine
A 60-year-old male is admitted to the in-patient psychiatric unit last night. On reviewing him this morning, he is a poor historian, answering most questions minimally and stating he does not need to be here as he is deceased, and hospitals should be for living patients.
What is the name of this delusional disorder and which condition is it most commonly associated with?
Cotard syndrome and major depressive disorder
You have been asked to review a patient with chest pain awaiting assessment by the psychiatry team.
Examination and investigations are normal, however, you note that he is acting strangely. He is reluctant to answer questions and does not maintain eye contact. After developing trust with him, he discloses he has never been in a relationship and that he prefers to be on his own as he won’t embarrass himself. He has no friends and doesn’t speak to his family because they criticise everything he does.
Which form of personality disorder is he likely suffering from?
Avoidant
A 29-year-old man is on the psychiatric ward under section 2 of the mental health act for suspected schizophrenia. He has a 3-month history of increasing suspicion of his family and had recently begun to collect weapons to defend himself. He started olanzapine 2 weeks ago. He has no other medical conditions and takes no other medications.
Today staff on the ward raised concerns due to his abnormal behaviour. He was found in his room sat on the floor with his back arched and legs hunched upwards. It is reported that he has been like this for the last 2 hours. His observations are normal. He has not spoken or made any movements during this time.
Which of the following best describes his current presentation?
Catatonia = stopping of voluntary movement or staying still in an unusual position
A 64-year-old male who has been on long term chlorpromazine presents with repetitive eye blinking. He reports he is unable to control this and is worried about what might be causing it. He is otherwise well in himself and has no visual disturbance. He has a normal facial and ocular examination with the exception of excessive rapid blinking.
What is the most likely cause of his symptoms?
tardive dyskinesia: can present as chewing, jaw pouting or excessive blinking due to late onset abnormal involuntary choreoathetoid movements in patients on conventional antipsychotics
A 23-year-old man presents to the emergency department following a recent diagnosis of migraine by his GP. He describes the headaches as right-sided, lasting around 6 hours, and brought on by work stress. He often feels nauseated with the headaches which resolve when he lies in a quiet room. He has a past history of depression and takes sertraline. He has no allergies. Neurological examination is unremarkable. The doctor reviewing him is concerned about a medication he has started for his symptoms.
What is the medication that the doctor is most likely to be concerned about in this patient?
Options:
1. ibuprofen and omeprazole
2. metoclopramide
3. paracetamol
4. prochlorperazine
5. sumatriptan
sumatriptan - triptans should be avoided in patients taking a SSRI
when does delirium tremens tend to occur?
48-72 hours after acute alcohol withdrawal
what is the most appropriate next step in management of more severe OCD which is unresponsive to CBT/exposure and response prevention?
Add an SSRI eg sertraline or fluoxetine
What is dialectical behaviour therapy (DBT) and when is it indicated?
focuses primarily on emotional regulation and is predominantly used in patients with emotionally unstable personality disorder (EUPD)
What is EMDR and when is it indicated?
eye movement desensitisation and reprocessing
predominantly used in PTSD
What type of urinary incontinence is the most associated with amitriptyline?
overflow incontinence - associated with tricyclic antidepressants
What are confabulations?
fabrications of imaginary experiences due to loss of memory - common phenomenon in patients with significant cognitive impairment eg dementia
A patient presents with complaints of involuntary muscle movements of her tongue, fingers and trunk for the past 2 months. She was diagnosed with schizophrenia 5 years ago and has been on flupenthixol and the haloperidol with good compliance. There is pronounced choreoathetoid movement. What is the next line of management of this patient?
stop the haloperidol and start olanzapine
which axis is involved in the pathophysiology of anxiety disorders, panic disorder and PTSD…?
hypothalamic pituitary adrenal axis (HPA)
Which Questionnaire is used to monitor response to treatment in patients with depression?
patient health questionnaire (PHQ-9)
What is schizoid personality disorder?>
disorder where patient has a long history of loneliness, odd behaviours and flat affects
they do not have any weird/magical thinking (schizotypal) or psychotic symptoms (schizophrenia, schizoaffective disorder)
which blood investigations can be used for assessing alcohol intake?
mean corpuscular volume
LFTs
gamma glutamyl transferase
what is the level for lithium toxicity?
levels above 1.5 mmol/l
what is the mechanism of action of duloxetine?
serotonin and noradrenaline reuptake inhibitor
what is used to treat delirium tremens/alcohol withdrawal?
chlordiazepoxide or diazepam
what are the criteria in ICD-10 for mania?
elated mood/occasional irritability
increased energy
psychotic symptoms (?)
to diagnose need at least 3 of DIGFAST:
D – distractibility/inability to sustain attention
I – indiscretions/impulsivity/loss of social inhibitions/aggression (excessive pleasurable activities, risky sexual behaviour, drug taking, fast driving)
G – grandiosity (mood congruent – as elated)/extravagance
F – flight of ideas– difficult to interpret
A – activity increase/excessive optimism
S – sleep deficits/decreased need for sleep
T – talkativeness/pressure of speech
what is hypomania according to ICD-10?
lesser degree of mania but too persistent and marked to be cyclothymia
features:
elated mood, increased energy and activity
Feeling of mental and physical wellbeing and efficiency
Increased sociability, overfamiliarity, sexual drive
Decreased need for sleep
Irritability
NO PSYCHOTIC SYMPTOMS, OR DISRUPT TO WORK/SOCIAL ACTIVITIES
What is the difference between hypomania and mania?
hypomania has no psychotic symptoms and it does not disrupt work/social activities
What medication is good to use for children or adults with learning difficulties who have irregular natural sleep-wake cycles?
melatonin
What are some of the sudden discontinuation symptoms from abruptly stopping SSRIs?
rebound anxiety or depressive symptoms, flu-like symptoms, dizziness, nausea or sleep disturbances
When is EMDR (eye movement desensitisation and reprocessing) not used in PTSD? What would be used instead?
EMDR is recommended treatment of PTSD, except in the case of combat-related trauma - instead trauma-focused CBT would be used
A 19 year old woman presents to her GP with a 3 year history of restricting food intake and self-induced vomiting. She attends her GP for the first time with her sibling reporting a recent worsening of her symptoms. The GP suspects anorexia nervosa. What is the most appropriate investigation to determine whether the patient requires urgent hospital admission?
ECG
for any cardiovascular instability, including assessment of HR, along with assessment of the QT interval
What is factitious disorder?
refers to a patient with no physical or organic disease but who finds satisfaction in taking on the ‘sick role’ and wants to be taken care of
What is factitious or induced illness?
similar to factitious disorder but involves a patient seeking the ‘sick role’ vicariously through a second patient
*think about the film ‘the act’ where the mother suffering from factitious disorder will abuse her child so that she can bring the child to the doctor for treatment
What is conversion disorder?
refers to manifestation of psychological illness or neurologic pathology. These patients suffer from weakness, numbness, blindness or paralysis as symptoms of an underlying psychiatric illness
What is zopiclone used for?
used as a hypnotic to help people sleep.
An 18 year old male student spontaneously disrobed while watching a film. He saw wavy lines on the screen and then reported a brief episode of mental blankness, followed soon after by a headache and extreme fatigue. What is the most likely diagnosis?
Partial complex seizure or Focal Impaired Awareness epilepsy
What needs to be monitored when giving a patient Clozapine?
there is up to 2% risk of developing agranulocytosis (lowered WBC) therefore WBC should be monitored
clozapine can cause bone marrow suppression leading to lowered WBC count and increasing the risk of infection in these patients
A 50 year old woman is brought in by her son because she is acting ‘wild’ again. She drinks moderately about once a week. She is not sleeping much, talks incessantly about plans to read the great books and has made many impulsive and irrational purchases. She reports hearing voices but refuses to discuss this issue when questioned by the admitting psychiatrist. She begins a task but does not complete it, all the while making lists of things to be done. She has been starting tasks and not finishing them. She had a similar episode 4 years ago. She also has depressive episodes several times over the last few years and recovered in between them. What is the most likely underlying diagnosis?
bipolar, manic, with mood-congruent psychotic features
What is schizophreniform disorder?
symptoms of schizophrenia of <6 months duration
What is schizoaffective disorder? Which patients are excluded from this diagnosis?
Features of both schizophrenia and affective disorder (e.g. depression, mania, mixed), present in approx. equal proportion - lasting considerable part of at least 1 month
Exclude patients:
With separate episodes of SZP or mood disorders; In the context of substance use or other medical disorder (organic cause)
What is the term for the repetition of someone’s speech?
echolalia
What is the difference between knight’s move and flight of ideas?
Knight’s move thinking there are illogical leaps from one idea to another, flight of ideas there are discernible links between ideas
A 20 y.o. first time mother presents with severe weight loss, anorexia and believes that her husband is interested in killing her and their baby son and feels completely worthless. What is the single most appropriate treatment option?
Clozapine
CBT
fluoxetine
lithium
monitor at home
fluoxetine
A 40 y.o. man has been treated for depression for 3 months. He is now beginning to lose weight and getting suicidal thoughts more frequently than before. What is the single most appropriate treatment option?
ECT
flupnethixol
no action
psychodynamic psychotherapy
sertraline
sertraline
A 29 y.o. woman presents with new-onset inability to sleep, excessive spending and increased libido. What is the single most appropriate treatment option?
behavioural activation
citalopram
counselling
quetiapine
ECT
quetiapine
An 18 y.o. girl with a BMI of 15 complains of three month history of amenorrhoea. She is not on the pill and the pregnancy test is negative. She wants to be a model. What is the single most appropriate next step in management?
assess physical state
citalopram
food diary
olanzapine
supplement drinks
assess physical state
A 20 y.o. man keeps cleaning his hands every time he shakes his partner’s hands. He was a high achiever in high school. What is the single most likely diagnosis?
anakastic personality disorder
borderline personality disorder
dependent personality disorder
avoidant personality disorder
schizoid personality disorder
anakastic personality disorder
what is anankastic personality disorder?
another term for obsessive compulsive personality disorder
A 56 y.o. farmer believes that his neighbour is killing his farm animals despite the local veterinary’s advice that the death is due to an outbreak of anthrax. He spends hours watching his neighbour through pair of binoculars, hoping to catch him in the act. What is the single most likely diagnosis?
anankastic personality disorder
borderline personality disorder
histrionic personality disorder
paranoid personality disorder
schizotypal personality disorder
paranoid personality disorder
A 23 y.o. student presents with insomnia, headaches, sweating, palpitations, chest pain and poor appetite. What is the single most likely diagnosis?
alcohol dependency
generalised anxiety disorder
schizophrenia
social phobia
somatisation disorder
generalised anxiety disorder
A 35 y.o. single woman presents with a 3 month history of weight loss, poor appetite, decreased ability to concentrate and guilt feelings. What is the single most likely diagnosis?
depression
hypomania
obsessive compulsive disorder
post-traumatic stress disorder
schizophrenia
depression
A 19 y.o. female student was at her fathers funeral last week. She presents with sudden onset of blindness. Neurologic examination reveals no abnormality. What is the single most likely diagnosis?
conversion disorder
depersonalisation
hypochondrial disorder
obsessive compulsive disorder
schizophrenia
conversion disorder
A 20 y.o. man presents with disinhibition, hyperactivity, increased appetite and grandiose delusions over the past 2 weeks. What is the single most likely diagnosis?
adjustment disorder
ADHD
depressive episode
mania
schizophrenia
mania
What does disinhibition mean?
can be defined as the inability to withhold a prepotent response or suppress an inappropriate or unwanted behaviour. It can refer to the production of socially inappropriate comments and/or actions
A 31 y.o. man presents with auditory hallucinations, social withdrawal and delusions of persecution. What is the single most likely diagnosis?
alcohol dependency
bipolar affective disorder
depersonalisation
paranoid schizophrenia
persistent delusional disorder
paranoid schizophrenia
A 22 y.o. man presents with compulsions and rituals, which he attempts to resist, but he is unable to do so. What is the single most likely diagnosis?
depersonalisation
dissociative disorder
obsessive compulsive disorder
post-traumatic stress disorder
schizophrenia
obsessive compulsive disorder
A 71 year old retired engineer experiences changes in personality and impaired social skills. His family, who describe him as forgetful and not as sharp, corroborates this. There are no objective features of depression. What is the single most likely diagnosis?
adjustment disorder
fronto-temporal dementia
late onset schizophrenia
panic attacks
social phobia
fronto-temporal dementia
A 20 y.o. man is noted to be withdrawn, isolated and peculiar. He has persecutory beliefs gangsters are out to get him and says he hears them talking about him, when no one else can hear them. What is the single most likely diagnosis?
delirium
depression with psychotic symptoms
hypomania
panic disorder
paranoid schizophrenia
paranoid schizophrenia
An 80 y.o. widow is noted by her family, over the past 3 months, to be restless and often crying. She frequently says she wants to die. What is the single most likely diagnosis?
alcohol dependence
Alzheimers dementia
delirium
depression
generalised anxiety disorder
depression
A 40 y.o. cyclist complains of frequent episodes of chest pains, sweating, palpitations, a sense of impending doom and trembling that lasts for minutes at a time. What is the single most likely diagnosis?
angina
generalised anxiety disorder
hypochondrial disorder
panic disorder
social anxiety disorder
panic disorder
A 25 y.o. man presents with miosis, slurred speech, disorientation, and respiratory depression. What is the single most likely diagnosis?
alcohol intoxication
amphetamine overdose
opiate overdose
paracetamol overdose
opiate overdose
A 70 y.o. man presents with progressive forgetfulness and mood changes. He has a shuffling gait and visual hallucinations at night. These have been present for 1 year. The head CT scans shows cortical atrophy and enlarged ventricles. What is the single most appropriate treatment option?
co-beneldopa
diazepam
procyclidine
risperidone
rivastigmine
rivastigmine
A 60 y.o. man presents with a disturbance of voluntary motor function. His face is expressionless. On examination he has cogwheel rigidity and bradykinesia. He has no cognitive impairment. What is the single most appropriate treatment option?
co-beneldopa
diazepam
procyclidine
risperidone
rivastigmine
co-beneldopa
A 40 y.o. accountant presents with acute confusion. He is seeing spiders crawling on his arms and has a broad based gait on physical examination. What is the single most appropriate treatment option?
acamprosate
chlordiazepoxide
diazepam
disulfiram
pabrinex
pabrinex
what is in pabrinex and what is it used for?
Thiamine and ascorbic acid
used for treatment of suspected or established Wernicke’s encephalopathy
A 23 y.o. female presents with constant low mood and irritability. She thinks regularly about suicide. She has trouble sleeping and has lost her appetite. Her father died four weeks ago. What is the single most likely diagnosis?
abnormal grief reaction
adjustment disorder
depressive disorder
dysthymia
PTSD
abnormal grief reaction
A 30 y.o. female complains of depression, lethargy, constipation, and weight gain. She also suffers from menorrhagia. What is the single most likely diagnosis?
alcohol abuse
bipolar affective disorder
bulimia nervosa
hypochondrial disorder
hypothyroidism
hypothyroidism
A 40 y.o. woman presents with depression and weight gain. She complains of back pain and excessive thirst. Her menstrual period lasts for three days and sometimes she skips a cycle. On examination she is obese with acne and peripheral oedema. What is the single most likely diagnosis?
Addison’s disease
Cushing’s syndrome
hyperparathyroidism
porphyria
recurrent depressive disorder
Cushing’s syndrome
A 30 y.o. female on the OCP presents with colicky abdominal pain, vomiting, and depression. She is noted to be hypertensive. She reports that her urine turns deep red if left to stand during these episodes. What is the single most likely diagnosis?
Cushing’s syndrome
drug abuse
hyperthyroidism
hypothyroidism
porphyria
porphyria
A 33 y.o. female presents to the GP with chronic feelings of isolation and hopelessness. She struggles to maintain relationships and finds the only effective coping method to relieve her distress is to make superficial cuts to her forearm. What is the single most likely diagnosis?
anankastic personality disorder
borderline personality disorder
dependent personality disorder
histrionic personality disorder
narcississtic personality disorder
borderline personality disorder
A 42 y.o. man insists that his wife is unfaithful and sleeping with most of the local neighbourhood. He is hypersensitive, argumentative and litigious. His wife has left him due to his behaviour. He functions well at work. What is the single most likely diagnosis?
Capgras syndrome
Cotards syndrome
De Clerambault syndrome
Foliea deux
Othello syndrome
Othello syndrome