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Psych Flashcards

1
Q

Explain the pathophysiology of Wernicke-Korsakoff syndrome:

A

Alcohol can cause thiamine deficiency by:

  • Interfering with the conversion of thiamine to its active form
  • Preventing absorption of thiamine in the duodenum
  • Interfering with storage in the liver due to alcoholic liver cirrhosis or fatty liver

Thiamine is involved in numerous important cellular processes:

  • Glucose metabolism
  • Lipid and carbohydrate metabolism in the brain
  • Maintenance of normal amino acid and neurotransmitter levels in the brain
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2
Q

What is the difference between Wernicke’s encephalopathy and Korsakoff’s syndrome?

A

Wernicke’s encephalopathy = acute, reverisble stage

Korsakoff’s syndrome = chronic and irreverisble, develops from untreated wernicke’s

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3
Q

3 causes of vitamin B1 (thiamine) deficiency:

A
  1. Inadequate intake (malnutrition)
  2. Malabsorption (stomach cancer & IBD)
  3. Alcohol abuse
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4
Q

What is anterograde amnesia?

A

Inability to form new memories after an amnesia inducing event

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5
Q

What is retrograde amnesia?

A

Inability to recall memories prior to an amnesia inducing event

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6
Q

5 psychological symptoms of Wernicke-Korsakoff’s syndrome:

A
  1. Anterograde amnesia
  2. Retrograde amnesia
  3. Hallucinations
  4. Confabulation
  5. Loss of coordination
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7
Q

3 key symptoms of wernicke-korsakoff’s:

A
  1. Nystagmus
  2. Ataxia
  3. Confusion
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8
Q

4 physical signs/symptoms seen in Wernicke-Korsakoff’s:

A
  1. Muscle atrophy
  2. Vision changes (double vision, drooping eyelids)
  3. Signs of liver disease (jaundice, ascites, spider naevi)
  4. Decreased reflexes
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9
Q

What is the emergency treatment for Wernicke’s?

A

Parenteral thiamine for a minimum of FIVE days

e.g. 500mg IV over 30 minutes, oral thiamine from day 5 onwards

NB: high risk of allergic reaction

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10
Q

How do you manage wernicke-korsakoff’s syndrome in the long term? (2)

A
  1. Prophylactic thiamine offered to harmful/dependent drinkers
  2. Treat co-morbidities e.g. heart failure

25% require long term institutionalisation

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11
Q

Give 5 positive symptoms of schizophrenia:

A
  1. Hallucinations
  2. Delusions
  3. Passivity phenomena
  4. Thought alienation
  5. Disturbance of mood
  6. Lack of insight
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12
Q

Give 5 negative symptoms of schizophrenia:

A
  1. Blunting of affect
  2. Poverty of speech
  3. Poverty of thought
  4. Self-neglect
  5. Amotivation/Anhedonia
  6. Poor non-verbal communication
  7. Lack of insight
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13
Q

At what age does schizophrenia typically present?

A

20s or 30s

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14
Q

3 risk factors for schizophrenia:

A
  1. Family hx
  2. Intrauterine and perinatal complications eg.g. low birth weight
  3. Intrauterine infection, particularly viral
  4. Abnormal early cognitive/neuromuscular developement
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15
Q

Criteria for diagnosing schizophrenia:

A

At least ONE first rank symptom OR at least TWO second rank symptoms

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16
Q

Give 4 first rank schizophrenia symptoms:

A
  1. Thought alienation (insertion, withdrawal, broadcasting)
  2. Passivity phenomena
  3. 3rd person auditory hallucinations
  4. Delusional perceptions
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17
Q

Give 3 second rank schizophrenia symptoms:

A
  1. Delusions/hallucinations
  2. Catatonic behaviour (mutusm, posturing, stupour)
  3. Negative symptoms
  4. Thought disorder (incoherence, irrelevance, neologisms)
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18
Q

First line pharmacological treatment for schizophrenia:

A

Atypical antipsychotic e.g. risperidone, olanzapine

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19
Q

What is Belle indifference?

A

A lac of concern and/or feeling of indifference about a symptoms or disability e.g. presents with paralysis in both legs but is indifferent/doesn’t carw

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20
Q

What is conversion?

A

Transposition of psychological conflict into somatic symptoms which may be of a motor or sensory nature

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21
Q

3 side effects of risperidone:

A

Acute parkinsonism
Elevated prolactin
Weight gain

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22
Q

7 organic causes of delirium:

A 
P - pain
I - infection
N - hypoNatraemia
C - constipation
H - deHydration

M - medication
E - environment

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23
Q

When does delirium tremens present?

A

Begins 24 to 72 hours after alcohol consumption has been stopped/reduced

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24
Q

4 psychiatric and 4 physical symptoms of delirium tremens:

A

Psych:

  1. Hallucinations
  2. Confusion
  3. Severe agitation
  4. Delusions

Physical symptoms:

  1. Seizures
  2. Tachycardia
  3. Tremor
  4. Excessive sweating and other signs of chronic alcohol abuse/liver disease
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25
Q

How do you manage delirium tremens?

A
  1. ABCDE
  2. Check blood sugar
  3. Alert ITU
  4. Long acting benzo e.g. chlordiazepoxide or diazepam
  5. Prophylactic treatment for wernicke’s (thiamine IV)
  6. Supportive tx (fluids, nutrition)
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26
Q

How does alcohol cause feelings of euphoria and reward?

A

Ethanol is a GABA agonist, increasing the inhibitory actions of GABA on the CNS

Ethanol activates opioid receptors and induces the release of endorphins

Ethanol triggers the release of dopamine in the nucleus accumbens

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27
Q

What are the two theories of the pathophysiology of alcohol dependence?

A
  1. GABA, glutamate, dopamine & serotnin receptors become less sensitive to alcohol
  2. Neurons have fewer receptors to alcohol through down-regulation

Desensitization leads to increased drinking to reach previous effect

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28
Q

When do signs of withdrawal typically begin to present? When do they begin to improve?

A

~8 hours after a significant fall in blood alcohol levels

Symptoms peak on day 2 and improve by day 4 or 5

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29
Q

How do you decide who should be offered community assisted alcohol withdrawal?

A

Patients who drink 15 units a day and/or score more than 20 on AUDIT

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30
Q

3 tools for assessing alcohol dependence:

A
  1. CAGE (cut down, annoyed, guilty, eye-opener)
  2. Alcohol use disorder identification test (AUDIT) - 8 or more = harmful drinking
  3. Severity of alcohol dependence questionaire (SADQ)
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31
Q

Criteria for inpatient alcohol withdrawal: (4)

A

Risk of suicide
Lack of social support
Hx of severe withdrawal reactions
Significant co-morbidities

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32
Q

3 contraindications to benzodiazepines:

A
  1. acute pulmonary insufficiency
  2. marked neuromuscular resp weakness
  3. unstable myasthenia gravis
  4. do not use as sole treatment for depression, psychosis, anxiety etc.
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33
Q

2 pharmacological treatments used to help maintain alcohol abstinence:

A
  1. Antabuse/Disulfram: causes a severe and unpleasant reaction to alcohol (risk of death)
  2. Naltrexone: used to reduce cravings (risk of overdose)
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34
Q

How do you calculate number of units?

A

Strength (ABC) x volume /1000

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35
Q

How many units is a pint of beer?

A

2

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36
Q

What effect would a blood alcohol level of 0.16-0.30% cause?

A

Alcohol poisoning, blackouts, vomiting, LOC

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37
Q

What effect would a blood alcohol of about 0.00-0.05% have?

A

Relaxed, happy, slurred speech, unbalance

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38
Q

How might a patient with an acute opioid overdose present? (5)

A
  1. Pinpoint pupils
  2. Respiratory depression
  3. Confusion/decreased consciousness
  4. N&V
  5. Track marks (arms/legs/elsewhere)
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39
Q

Pharmacological management of an acute opioid overdose:

A

400 micrograms naloxone IV or IM
THEN
800 micrograms for up to 2 doses at 1 minute intervals if no response to initial dose

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40
Q

Assessment/management of an acute opioid overdose:

A 
ABCDE
Get an ABG
Get a CXR
Give naloxone
Maintain airway, ventilate if needed
Give IV fluids
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41
Q

5 physical symptoms of acute opioid withdrawal:

A
  1. Runny nose/eyes
  2. Sneezing
  3. N, D&V
  4. Dilated pupils
  5. Tachycardia
  6. HTN
  7. Yawning
  8. Anorexia
  9. Abdominal cramps
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42
Q

5 psychological symptoms of acute opioid withdrawal:

A 
Craving
Guilt
Anxiety
Loss of cognitive skills
Poor memory function
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43
Q

Physical complications/risks of long term opioid use:

A
  1. Abscess and cutaneous infections
  2. Infective endocarditis
  3. Overdose
  4. Infection (HIV, TB, sepsis)
  5. Chronic venous ulcer leading to amputation
  6. Venous and arterial thrombosis
  7. Poor nutrition
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44
Q

How long is methadone detectable in your system for?

A

7 to 9 days

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45
Q

How long is codeine/morphine/heroin dectable for?

A

48 hours

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46
Q

How long is cocaine detecable for?

A

2 to 3 days

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47
Q

Prescibing methadone for opioid addiction:

A

1mg in 1ml oral solution
Initial dose 10-30mg
Increase incrementally up to 60-120mg /day

NB: it may take several weeks to reach the desired dose so that the patient feels comfortable no longer using heroin

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48
Q

What is buprenorphine?

A

A potent opioid agonist used to assist opiate withdrawal

Has a lower risk of overdose in the induction phase than methadone

May interact with HIV medication

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49
Q

A pregnant women is keen to stop using heroin before her baby is born, what can be done to help?

A

You MUST prevent withdrawal during pregnancy, withdrawal can cause foetal demise and preterm labour

You can give methadone or buprenorphine to substitute heroin but it must be at the exact right level to avoid withdrawal

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50
Q

Give two examples of typical antipsychotics:

A

Haloperidol

Chlopromazine

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51
Q

Give three adverse effects of antipsychotics:

A
  1. Extrapyramidal side effects
  2. Hyperprolactinaemia
  3. Increased risk of stroke/thromboemobolism in elderly patients
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52
Q

Give 4 extra-pyramidal side effects:

A
  1. Parkinsonism
  2. Acute dystonia
  3. Akathisia (severe restlessness(
  4. Tardive dyskinesia
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53
Q

Extrapyramidal effects and hyperprolactinaemia are side effects of both typical and atypical antipsychotics - are these side effects more common in typical or atypical antipsychotics?

A

Typical antipsychotics are more frequently associated with these side effects

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54
Q

Give 3 examples of atypical antipsychotics:

A

Clozapine
Risperidone
Olanzapine

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55
Q

What is an oculogyric crisis

A

Spasmodic movements of the eyeballs into a fixed position (usually upwards)

Occurs in acute dystonia

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56
Q

Criteria for mania: (6)

A

At least 3 of the following, lasting for more than one week:

  1. Grandiosity
  2. Decreased need for sleep
  3. Flight of ideas
  4. Distractability
  5. Psychomotor agitation
  6. Excessive involvement in pleasurable activities without thought for consequences

Psychotic symptoms are also common (believes they have superpowers)

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57
Q

DSM-V criteria for bipolar disorder:

A

One episode of mania without depression
OR
One episode of hypomania with a single episode of major depression

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58
Q

What is the difference between bipolar I and II?

A

I: mania and depression (or sometimes only mainia)

II: more episodes of depression, mild hypomania, rapid cycling

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59
Q

What is hypomania?

A 
A less intense version of mania, lasts <4 days:
- Elevated mood
- Increased energy
- Poor concentration
- Increased talkativeness
- Mild reckless behaviour
- Decreased need for sleep
- NO psychotic symptoms
etc.
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60
Q

Alternative causes of mania other than bipolar disorder:

A 
Infection
Hyperthyroidism
Stroke
Drugs 
etc.
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61
Q

Treatment of acute moderate-severe mania:

A

Olanzapine 10mg PO

Then adjust to 5-20mg/day

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62
Q

Long term pharmacological management of bipolar disorder:

A

First line mood stabiliser = lithium

If lithium not tolerated give sodium valproate (but never to a woman of child bearing potential)

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63
Q

6 signs of lithium toxicity:

A 
T - tremor
O - oliguric renal failure
X - ataxia
I - increased reflexes
C - convulsions
C - coma/reduced consciousness
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64
Q

How often should you monitor someone taking lithium?

A
  1. Check Li+ levels weekly, 12 hours post-dose, until the dose has been consistent for 4 weeks
  2. Then check monthly for 6 months
  3. Then check 3 monthly
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65
Q

What are the therapeutic ranges and toxicity level for lithium?

A

Therapeutic range: 0.4 to 1

Toxticity = >1

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66
Q

Other than Li+ levels, what else should you monitor in someone onlithium?

A

Plasma creatinine, U&Es and TFTs (every 6 months)

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67
Q

What complications can arise from taking lithium?

A

Affects thyroid and kidney function, can lead to hypothyroidism and nephrogenic diabetes insipidus

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68
Q

Is there a gender difference in the rates of bipolar I and II?

A

Yes, lifetime rates of bipolar I are higher in males

Lifetime rates of bipolar II are higher in females

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69
Q

Diagnostic criteria for depression:

A

At lesat 2 of the 3 core symptoms for at least two weeks, persistently and pervastively:

  1. Low mood
  2. Loss of energy (anergia)
  3. Loss of pleasure (anhedonia)
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70
Q

What are the three core symptoms of depression?

A
  1. Low mood
  2. Loss of energy
  3. Loss of pleasure
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71
Q

Give 3 biological symptoms of depression:

A
  1. Change in sleep (early morning waking - ~2hrs before normal time)
  2. Change in appetite
  3. Change in libido
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72
Q

Give 5 cognitive symptoms of depression:

A
  1. Agitation
  2. Loss of confidence
  3. Guilt
  4. Loss of concentration
  5. Hopelessness
  6. Suicidal ideation
  7. Diurnal mood variation
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73
Q

How do you classify depression as mild/moderate/severe?

A

Mild: core symptoms & 2-3 others

Moderate: core symptoms, 4 others, functioning affected

Severe: as above but with suicidal ideation and marked loss of functioning

OR

Severe: with psychotic symptoms

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74
Q

4 psychotic symptoms seen in depression:

A

Psychotic symptoms in depression are mood congruent:

  1. guilty delusions
  2. derogatory voices
  3. nihilistic delusions e.g. believe they are dead or rotting away from the inside
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75
Q

NICE guidelines for mild/moderate depression (first, second, third line);

A

First line: low intensity psychological intervention e.g. group activity program

Second line: high intensity psychological intervention e.g. individual CBT

Third line: antidepressant therapy and/or escalation to psych services

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76
Q

Name 3 SSRIs:

A

Sertraline
Citalopram
Fluoextine

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77
Q

What kind of antidepressant is citalopram?

78
Q

5 side effects/complications of SSRIs:

A
  1. Nausea and indigestion
  2. Worsening of sexual dysfunction
  3. Suicidal thoughts in younger people
  4. Serotonin syndrome
  5. Hyponatreamia
79
Q

Name two SNRIs:

A

Venlafaxine

Duloxetine

80
Q

What kind of antidepressants are venlafaxine and duloxetine?

81
Q

Venlafaxine is contraindicated in which group of patients?

A

Those with heart disease, it raises their BP

82
Q

Name two tricyclic antidepressants:

A

Amitriptyline

Dosulepin

83
Q

What type of antidepressant is dosulepin?

84
Q

5 side effects of TCAs:

A
  1. dry mouth
  2. tachycardia
  3. constipation
  4. sleepiness
  5. weight gain
85
Q

Name 2 monoamine oxidase inhibitors:

A

Phenelzine

Moclobemide

86
Q

What type of antidepressant is phenelzine?

87
Q

What type of antidepressant is moclobedmide?

88
Q

Side effects of MAOIs:

A

Can cause extremely high BP if taken with tyramine (found in aged cheese, cured meets, broad beans(

89
Q

Name an atypical antidepressant:

A

Mirtazepine

90
Q

Give 2 side effects of mirtazepine:

A

drowsy

weight gain

91
Q

How long might a patient need to stay on antidepressants for? When might they start to feel their effect?

A

Continue for at least 6 to 9 months following recovery to prevent relapse

Antidepressants can take up to 4 weeks to have an effect and the dose may need titrating

92
Q

3 symptoms of PTSD:

A
  1. Re-experiencing: flashbacks, nightmares, sensory impressions
  2. Avoidance or rumination: avoidance of triggers/reminders, suppression of memories, ruminanting excessively (‘why me?’)
  3. Hyperarousal or emotional numbing
93
Q

Management of PTSD:

A

Pharmacological:
- Do NOT offer benzos

Psychological:

  • Trauma focused CBT
  • Narrative exposure therapy
  • EMDR
94
Q

Which antidepressants are safer to use if a patient drinks alcohol?

A

citalopram or sertraline

95
Q

Define generalised anxiety disorder:

A

Excessive anxiety across different situations for >6 months

96
Q

First line management of GAD:

A

Pyshcological intervention e.g. CBT, mindfullness

SSRI e.g. escitalopram 10mg OD

97
Q

A to D DSM-V criteria for OCD:

A

A. Presence of obsessions, compulsions or both
B. Obsessions or compulsions are time-consuming, cause significant distress or impair functioning
C. Symptoms are not attributable to effects of a substance
D. Disturbance is not better explained by another mental disorder

98
Q

OCD management:

A

Mild functional impairment:
- individual CBT and exposure and response prevention (ERP)
Moderate:
- high intensity psychological intervention AND an SSRI

99
Q

DSM-V definition of a personality disorder (6):

A
  1. An enduring pattern of inner experience and behaviour
  2. Deviates from cultural expectations
  3. Pervasive and inflexible
  4. Onset in adolsences/early adulthood
  5. Stable over time
  6. Leads to distress
  7. Impairments in self and interpersonal functioning
100
Q

Which is the most common type of personality disorder seen in mental health settings?

A

Emotionally unstable personality disorder (EUPD)

101
Q

4 common features of EUPD:

A
  1. Attachment issues
  2. Trauma
  3. Any experience of deprivation/distress as a child/baby
  4. Frequent co-mobidities e.g. anxiety, depression, PTSD, substance abuse
102
Q

5 psychological symptoms of EUPD:

A
  1. Impulsivity - capricious mood, acting without thinking of consequences
  2. Fear of abandonment
  3. Uncertainty regarding self image, aims, preferences
  4. Thoughts of self-harm/suicide
  5. Intense/unstable relationships
103
Q

What is the gold standard psychological intervention for personality disorders?

A

Dialectal behaviour therapy (DBT)

104
Q

What is DBT?

A

A third wave CBT included group and individual sessions over 12 months. Helps patients with 4 areas of skill:

  1. emotional regulation
  2. distress tolerance
  3. interpersonal effectiveness
  4. mindfullness
105
Q

What is delirium?

A

An acute confusional state that fluctuates in severity and is usually reversible

106
Q

What is dementia?

A

A syndrome of acquired, chronic, global impairment of higher brain function, in an alert patient, which interferes with the ability to cope with daily living

107
Q

Name 8 causes of dementia:

A
  1. Alzheimer’s dementia
  2. Vascular dementia
  3. Pick’s disease
  4. Creutzfeld-jakob
  5. Parkinson’s disease
  6. Huntington’s disease
  7. HIV dementia
  8. Lewy body dementia
108
Q

What is creutzfeld-jakob disease?

A

A neurodegenerate illness caused by the accumulation of small infectious pathogens contained protein but lacking nucleic acid

Indentified by a triphasic EEG pattern and extensive motor involvement

109
Q

What is Pick’s disease?

A

A rare front-temporal dementia that causes slow changes to character, intellect, memory and language

Parietal lobes are unaffected so full orientation and good skills are maintained until very late stage

110
Q

At what age does huntington’s disease typically onset?

A

30s to 40s

111
Q

Three features of Huntington’s disease:

A
  1. Choriform movements (facial twitching)
  2. Slurred speech
  3. Distinctive gait: walking on heels, wide base
112
Q

What is lewy body dementia?

A

Death of dopamine producing neurones and acetylcholine producing cells resulting in movement and cognitive symptoms of dementia

113
Q

How might the progression/presentation of dementia vary by type? (alzheimers, lewy-body, frontotemporal, vascular)

A

Alzheimers: onset in 70s, gradual deterioration

Lewy-body: initial progress is more rapid than Alzheimers, hallucinations, personality changes

Fronto-temporal: slow progression

Vascular: step-wise deterioration, onset in mid to late 60s

114
Q

What is memantine?

A

An NMDA antagonist used to help with the psychological symptoms of dementia in those with severe impairment or who cannot tolerate acetylcholinesterase inhibitors

115
Q

Name 3 acetylcholinesterase inhibitors used in the management of dementia:

A

Donepezil
Galantamine
Rivastigmine

116
Q

3 side effects of AChEis:

A

Bradycardia
Diarrhoea
Headache

117
Q

5 features of hyperactive delirium:

A
  1. agitation
  2. delusions
  3. hallucinations
  4. wandering
  5. aggression
118
Q

5 predisposing factors for hyperactive delirium:

A
  1. Fracture neck of femur
  2. past hx of delirium
  3. significant comorbidities
  4. change in environment
  5. dementia
119
Q

What is hypoactive delirium often misdiagnosed as?

A

depression

120
Q

4 symptoms of hypoactive delirium:

A
  1. lethargy
  2. slowness with everyday tasks
  3. excessive sleeping
  4. inattention
121
Q

What is mixed delirium?

A

A combination of hyper and hypoactive delirium within 24 hours

122
Q

6 causes of pseudo-dementia/congnitive decline:

A

D - drugs (inc. benzos)
E - emotional illness (depression, anxiety)
ME - metabolic (hyponatremia)
N - nutrition
T - tumour/trauma/normal pressure hydrocephalus
I - infection
A - alcoholism

123
Q

What is ARBD?

A

alcohol related brain damage

124
Q

What is included in confusion screen bloods?

A 
FBC
LFTs
U&Es
TFTs
Calcium
Glucose
Folate
Cultures
125
Q

3 tools used to assess cognitive impairment/dementia:

A

ACE3: score of ≤83
MSE: score of ≤24
MOCA

126
Q

What is catatonia?

A

A state of apparent unresponsiveness to external stimuli in a patient who appears to be awake

Occurs in a number of conditions, may be episodic, triggered by medication or other circumstances

127
Q

3 main features of catatonia:

A
  1. Motoric immobility: catalepsy, waxy flexibility, stupor
  2. Mutism: verbally minimally responive
  3. Negativism: involuntary resistance to passive movement or involuntary oppositional behaviour
128
Q

What is catalepsy?

A

An extreme form of posturing. The patient keeps an uncomfortable, rigid and fixed posture despite external stimulus or resistance

129
Q

What is stupor?

A

Extreme hypoactivity, minimal response to stimuli, including painful ones

130
Q

How do you manage catatonia

A

the majority of patients will respond to benzos

those who do not respond might be treated with ECT

131
Q

What is acute dystonic reaction?

A

Sustained muscle contraction caused by starting a new drug or in rare cases increasing the dose

132
Q

How does acute dystonic reaction present? (2)

A
  1. Torticollis (wry neck, twisted, tilted)

2. Oculogyric crisis (involuntary upwards deviation of both eyes)

133
Q

What is serotonin syndrome?

A

A potentially life threatening drug induced condition caused by too much serotonin in the synapses of the brain

134
Q

Name 5 drugs that can cause serotonin syndrome:

A

Most cases involve two drugs that increase serotonin overlapping or an overdose of one drug.

  1. MAOIs
  2. SSRIs
  3. Ilicit drugs (cocaine, MDMA, amphetamines, LSD)
  4. Antiemetics (metoclopramide)
  5. Analgesics (tramadol)
  6. Herbal remedies
135
Q

Triad of serotonin syndrome:

A
  1. Autonomic hyperactivity: HTN, sweating, hyperthermia, hyperactive bowels
  2. Neuromuscular abnormality: tremor, clonus, hyperreflexia, hypertonia
  3. Mental status change: confusion, coma
136
Q

How do you treat serotonin syndrome?

A
  1. Stop causative drug(s)
  2. Supportive measures - fluids, benzos for agitation

Mild cases usually resolve within 24 hours

137
Q

What is tardive dyskinesia?

A

Involuntary repetitive movements in response to medication

Tardive = delayed as onset is usually months after commencing the medication

138
Q

Risk factors for tardive dyskinesia:

A
  1. > 6 months tx with neuroleptics
  2. Prolonged use of antipsychotics
  3. Advancing age
139
Q

How does tardive dyskinesia present? (4)

A
  1. Orofacial mouthing with lip smacking, tongue protrusion, grimacing, excessive blinking
  2. Body rocking
  3. Distal chorea
  4. Decrease in voluntary movement
140
Q

How do you manage tardive dyskinesia?

A
  1. Assess using the abnormal involuntary movement scale (AIMS)
  2. Stop and switch to a different medication (avoiding withdrawal)
141
Q

What might trigger lithium toxicity in a patient on a stable dose of lithium? (4)

A
  1. Taking a higher dose (e.g. accidently taking it twice(
  2. Dehydration
  3. Interaction with other medication e.g. NSAIDs, anti-HTN, AEDs
  4. Decreased sodium intake in diet
142
Q

What is neuroleptic malignant syndrome?

A

A rare but potentially life threatnening reaction to neuroleptic drugs

143
Q

What causes neuroleptic malignant syndrome? (5)

A
  1. Withdrawal of parkinson’s medication
  2. use of neuroleptic drugs and genetic/metabolic susceptibility
  3. high doses and depot preparations
  4. high ambient temp and dehydration
  5. previous episode
144
Q

Diagnostic criteria for neuroleptic malignant syndrome:

A 
Neuroleptics commenced within 1 to 4 weeks
Hyperthermia (above 38)
Muscle rigidity
And 5 of the following:
- changed mental status
- tachycardia
- hypo or hypertension
- incontinence
- excessive sweating
- & more....
145
Q

How do you manage neuroleptic malignant syndrome?

A 
ABCDE
IV benzos
IV fluids
Antipsychotics
Refer to ITU
146
Q

What might you include in a physical examination of a patient with a possible eating disorder? (5)

A
  1. Sit and squat test
  2. Peripheral circulation exam
  3. Lying and standing BP
  4. Core temperature
  5. Skin & nail changes
147
Q

Diagnostic definition of binge eating disorder:

A

Recurrent episodes of binge eating with no purging or compensatory behaviour
Rapid eating, uncomfortably full and feeling unable to stop
Feelings of embarrassment, depression, guilt
Occurs at least once a week for 3 months or more

148
Q

5 possible physical symptoms of an eating disorder:

A
  1. Amenhorroea >3 months
  2. GI disturbance
  3. Delay in secondary sexual development
  4. Fatigue
  5. Abdo pain

& many more

149
Q

Severe signs in an eating disorder requiring urgent intervention and referal: (5)

A 
BMI <13
Rate of weight loss more than 0.5kg/week
Pulse <40 bpm
Postural drop >10mmHg
Failed squat and/or sit test
150
Q

5 complications/risks of an eating disorder:

A
  1. refeeding syndrome
  2. mallory-weiss tear
  3. malnutrition causing pancreatitis
  4. cardiac complications inc. sudden death
  5. intestinal obstruction/perforation/infection
151
Q

What is refeeding syndrome?

A

A potentially fatal shift of electrolytes and water into the cells in response to refeeding after malnutrution

152
Q

Presentation of refeeding syndrome:(7)

A
  1. Rhabdomyolysis
  2. Resp or cvs failure
  3. Low BP
  4. Arrhythmia
  5. Seizure
  6. Coma
  7. Sudden death
153
Q

What is Russel’s sign?

A

Calluses on the knuckles or back of the hand due to repeated self-induced vomiting seen in bulimia nervosa

154
Q

A patient is prescribed sertraline, what is it important to look out for in their drug history?

A

Any use of NSAIDs. SSRIs increase the risk of GI bleeding, a PPI must also be prescribed if the patient is taking an NSAID.

155
Q

Why might a patient taking benzos become worried that they are suffering with dementia?

A

Benzos can cause anterograde amnesia

156
Q

Which type of antidepressants can cause urinary retention?

157
Q

What is hoover’s sign?

A

Hoover’s sign is a quick and useful clinical tool to differentiate organic from non-organic leg paresis. In non-organic paresis, pressure is felt under the paretic leg when lifting the non-paretic leg against pressure, this is due to involuntary contralateral hip extension

158
Q

How do you manage an acute dystonic episode?

A

Give an anti-cholinergic: procyclidine

159
Q

What baseline and monitoring tests are needed when taking clozapine? Why?

A

FBC due to adverse effect of agranulocytosis and neutropenia

ECG due to risk of myocarditis

160
Q

What is ‘word salad’ and what is it commonly associated with?

A

Disorganised speech associated with psychosis and mania

161
Q

What are neologisms?

A

Made up new words

162
Q

What is the maximum dose of sertraline per day?

163
Q

A patient with GAD has been taking sertraline for 3 months and feels no improvement, what medication should you try next?

A

A different SSRI or an SNRI

164
Q

What is echolalia?

A

Repetition of someon else’s speech

165
Q

What is echopraxia?

A

Echopraxia is the meaningless repetition or imitation of the movements of others

166
Q

What is palilalia?

A

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

167
Q

What is copropraxia?

A

Involuntary performing of obscene or forbidden gestures or inappropriate touching

168
Q

What are ‘z drugs’?

A

Drugs with a similar effect to benzos but a different structure, they act on alpha-2 subunit of the GABA receptor

169
Q

Adverse effects of z drugs e.g. zolpidem, zopiclone: (1)

A

Increased risk of falls in the elderly

170
Q

4 adverse effects of atypical antipsychotics:

A

Weight gain

Clozapine causes agranulocytosis

Hyperprolacinaemia

Long term use can cause glucose dysregulation and diabetes

171
Q

How do you differentiate between acute stress disorder and PTSD?

A

Acute stress disorder = reaction to a traumatic event in the first four weeks

PTSD = diagnosed after 4 weeks

172
Q

What is malingering?

A

Fraudulent simulation or exaggeration of symptoms for financial or other gain

173
Q

Criteria for somatisation disorder:

A

Multiple symptoms present for at least 2 years

Patient does not accept reassurance or negative test results

174
Q

Short term side effects of ECT:

A 
Headache
Nausea
Short term memory loss
Memory loss of events prior to ECT
Cardiac arrhythmia
175
Q

What is Cotard syndrome?

A

A rare subset of nihilistic delusions in which the patient believes they are dead or do not exist

Most commonly seen in severe depression

176
Q

What is considered a normal MMSE score?

A

25 to 30/30

177
Q

What is delusional parasitosis?

A

Patient with a fixed, false belief (delusion) that they are infested by ‘bugs’

178
Q

Discontinuations symptoms with SSRIs:

A
  1. GI symptoms (D&V, pain, cramping)
  2. Increased mood change
  3. Reslessness
  4. Sweating
  5. Unsteadiness
  6. Paraesthesia
179
Q

Risks to pregnancy when taking an SSRI in the first and third trimester:

A

1st trimester:

  • small increase in risk of congenital heart defects
  • increased risk of congenital malformations with paroextine

3rd trimester:
- increased risk of persistent pulmonary hypertension of the newborn

180
Q

5 factors associated with poor prognosis in schizophrenia:

A
  1. Strong family hx
  2. Gradual onset
  3. Low IQ
  4. Prodromal phase of social withdrawal
  5. Lack of obvious precipitant
181
Q

Name 6 things raised by anorexia:

A 
Gs & Cs:
Growth hormone
Glucose
salivary Gland activity
Cortisol
Cholesterol
Carotinaemia
182
Q

What is the SSRI of choice in children and adolescents?

A

fluoxetine

183
Q

What is a delusional perception?

A

a true perception, to which a patient attributes a false meaning. For example, a perfectly normal event such as the traffic lights turning red may be interpreted by the patient as meaning that the martians are about to land

184
Q

What is a section 5(2) used for?

A

Section 5(2) gives doctors the ability to detain someone in hospital for up to 72 hours, during which time you should receive an assessment that decides if further detention under the Mental Health Act is necessary

185
Q

How long can someone be detained for under section 2?

A

28 days (cannotbe renewed)

186
Q

What is a section 2 used for?

A

An ‘assessment section’ used to detain someone for up to 28 days whilst they require an assessment in hospital

187
Q

What is a section 3 used for?

A

A ‘treatment section’ used to detain someone for 6 months whilst they receive treatment. Can be renewed as often as needed.

188
Q

What is a section 4 used for?

A

An emergency order to detain someone for 72 hours whilst waiting for a second doctor to become available to implement a longer section.

189
Q

When do you use a section 5(2)?

A

To detain a patient who is already admitted but wants to leave.

190
Q

What section is used by the police to detain someone in public or in their own home?

A

S136 - public

S135 - home

191
Q

How can you remove a section? (3)

A

3 different ways:

  1. Consultant in charge removes it
  2. Mental health review tribunal
  3. Patient’s nearest relative removes it

3a (8 decks)

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