Psych Flashcards
What is the criteria for depression?
Symptoms for >2 weeks,
Symptoms not secondary to alcohol, drugs, medication or bereavement
Patient expreiencing >= 5 symptoms which must include either depressed mood and or anhedonia
What are the core symptoms of depression?
Persistently depressed mood, anhedonia and anergia
What are the somatic symptoms of depression?
Loss of emotional reactivity, diurnal mood variation, anhedonia, early morning wakening, GI upset and weight change
What are the psychotic symptoms of depression?
Delusions, hallucinations, catatonic symptoms (e.g. not responding when spoken to, sitting in strage postions, repetitive meaningless motions, mimicking someone elses speech)
What is dysthymic disorder? How can you manage it?
chronic (>2 years) low grade depressive symptoms. Manage with SSRIs and CBT
What is SAD? How can you manage it?
Seasonal Affective Disorder?
Clear seasonal pattern to reccurrent depressive episodes (usually over the january/february).
Mild to moderate depressive symptoms.
Tx = light therapy then SSRIs
What is post-natal depression? How can you manage it?
Depression occuring within 6 months post-partum (peak occurence = 3-4 weeks). Mother will worry about their ability to care for baby
Tx = SSRIs with or without CBT
How can you assess post-natal depression?
Edinbrugh Postnatal Depression Scale
What is the criteria for diagnosing GAD?
Excessive anxiety and worry about everyday events/activities most days for 6 months.
Causes significant distress/impairment of occupational and social functioning
At least 3 associated symptoms
Sx of GAD?
Reslessness, feeling on edge, easily fatigues, difficulty concentrating, irritability, muscle tension and sleep disturbance.
Also somatic Sx = increased sweating, palpitations, dry mouth and chest pain
Define panic disorder?
Recurrent, episodic and severe panic attacks that are unredictable and not restricted to particular situation/circumstance. Symptoms will peak within 10 mins and be associated with intense fear
Why should you not give benzodiazepines in panic disorder?
They can cause depersonalization if used long term
Mx of phobic anxiety?
Behavioural therapy (graded exposure therapy)
Mx GAD and panic disorder?
CBT and SSRIs
What is the classic quadrad of PTSD?
Reliving the situation Avoidance Hyperarousal Emotional numbing. Symptoms must present within 6 months of an event and last for at least 1 month
1st line Mx for PTSD?
Trauma focused CBT and EMDR
Meds are not 1st line but consider sertraline and venlafaxine
What is the criteria for diagnosis of OCD?
Presence of either obsessions, compulsions or both.
Obsessions/compulsions are time consuming or cause clinically significant distress/functional impairment
Patient recognises symptoms as being excessive/unreasonable - egodystonic
Mx of OCD?
CBT and ERP
Sertraline 1st line, Clomipramine 2nd line
Bipolar I vs Bipolar II?
Bipolar I = episodes of depression, mania or mixed states separated by periods of normal mood
Bipolar II = do not experience mania but have periods of hypomania, depression or mixed states
What is cyclothymic disorder?
Reccurring depressive and hypomanic states, lasting for at least 2 years that do not meet teh criteria for a major affective episode
Which drugs can induce mania/hypomania?
TCAs/SNRIs, benzos, antipsychotics, lithium and anti-parkinsons medications
Mx bipolar?
Manic epsiodes = lithium +/- benzos (e.g. clonazepam)
Depressive episodes = SSRIs
Maintenance = lithium or carbamazepine
SEs of lithium?
weight gain, teratogenic (ebstein’s anomoly), renal ipairment, clinical/subclinical hypothyroidism
What tests should be done before starting litium?
FBC, U&Es, TFTs, renal function, baseline weight/BMI, ECG and pregnancy test
How often should you monitor bloods in Lithium?
Check Li levels every 7 days after starting and after change of dose.
Once therapeutic level is reached (0.6-0.8mmol/L) check litium levels and eGFR every 3 months and TFTs every 6 months
Name some RFs for developing schizophrenia?
Family history, abuse, obstetric issues (low birht weight, preterm delivery and asphyxia), substance abuse, cerebral injury, acute psychosis an migraition
Name the positive Sx of schizophrenia?
Auditory hallucinations, delusions, catatonic behaviour, speech issues (pressured, word salad, perseveration etc.), circumstantiality, tangientiality
Name the negative Sx of Schizophrenia?
Anhedonia, asocial behaviours, blunting/incongruity of affect, alogia, depression and avolition
Name the 1st rank Sx of schizophrenia?
formal thought disorder, passitivity phenomenom, delusional perceptions and 3rd person hallucinations
Name the 2nd rank Sx of schizophrenia?
Paranoid, persecutory and referntial delusions. Negative symptoms
Name the atypical antipsychotics?
Risperidone, Quetiapine, Aripirprazole, Olanzapine and Clozapine
Name the typical antipsychotics?
Haloperidol and Chlopromazine
SEs of Risperidone?
Hyperprolactinaemia
SEs of Clozapine?
Constipation (most common), myocarditis, hypersalivation, reduced seizure threshold and agranulocystosis/neutropaenia
Name some non-pharmacological Mx of Schizophrenia?
CBT, family therpay, art therapy, lifestyle changes, ECT
What is Cotard’s syndrome? what condition is it seen in?
A delusion belief that the person or part of the person is alread dead (seen in psychotic depression and schizophrenia)
What is Section 2 of the MHA?
Assesment and Treatment Order.
Lasts for 28 days and is non-renewable.
Must be approved by two doctors and one AMHP
What is Section 3 of the MHA?
Long Term Treatment Order.
Lasts for 6 months and is renewable (6 months the second time and 12 months the third time)
Must be approved by two doctors and one AMHP
What is Section 4 of the MHA?
Holding Order (until the patient can be seen by a second doctor). Lasts for 72 hours. Must be approved by one doctor and one AMHP OR S12 approved doctor
What is Section 5 of the MHA?
Holding Order for a paitent already in hospital who whishes to leave.
5(4) = 6 hours, initated by a nurse
5(2) = 72 hours, initated by the patient’s doctor
What is Section 135 of the MHA?
Allows police to entre a patient’s home and be moved to a place of saftey (warrent must be gained from an AMHP)
Lasts for 36 hours
What is Section 136 of the MHA?
Allows police to move a patient with a mental disorder from a public place to a place of saftey.
Lasts for 24 hours
What causes neuroleptic malignant syndrome?
Adverse reaction to dopamine receptor agonists (due to antipsychotics) or the abrupt withdrawal of dopaminergic medications (in Parkinson’s)
Sx of NMS?
Altered mental state, hypertonia (lead pipe rigidity), hyporeflexia, normal pupils and autonomic dysfunction (tachycardia, tachypnoea, urinary incontinence, sweating and hyperthermia etc.)
What drugs can cause serotonin syndrome?
SSRIs, SNRIs, opioid analgesics, MAOIs and lithium.
Sympotms of serotonin syndrome?
Altered mental status, neuromuscular Sx ( clonus, hyperreflexia, hypertonia and tremors), dilated pupils and hyperactive bowel sounds. autonomic Sx (tachycardia, tachypnoea, sweating and hyperthermia)
Name the 4 areas in which a person must demonstrate a pattern in 2 or more of these areas to be diagnosed with a personality disorder?
Cognition, affectivity, interpersonal functioning and impulse control.
Sx of Paranoid PD?
Distrust/suspicion of others, assumes others will dissapoint and manipulate them, reacts badly to negative interactions/feedback, holds long term grudges so is usually isolated
Sx of Schizoid PD?
Social isolation out of choice, do not gain pleasure by physical contact (including sex), emotionally blunted with a flat affect
Sx of Schizotypal PD?
magical thinking (belief that 2 random events are linked), ideas of reference (everything relates to their destiny), over confidence and appears self-centred. Will be isolated but wants social relationships
Sx of Antisocial PD
MUST have a history of conduct disorder!
Patient comes accross as charming but uses this to manipulate others, disregard for social norms and moral values. Poor impuls control and no empathy/remorse = often gets in legal trouble
Sx of EUPD?
unstable moods with extreme intensity, intense relationships which end quickly, fear of abandonment and splitting
Sx of Histrionic PD?
Attention seeking behaviour - inappropriatley flirtacious and dramatic. Has superficial relationships, seen as egocentric by others
Sx of Narcissistic PD?
grandiose self-image, think their ideas are the best and expect to be treated as such. Fraglie self esteem (lashes out at critisism), oblivious to the feeling of others
Sx of Avoidant PD?
Extremley low self-esteem and timidness. Avoids social situations due to shyness and fear but does want relationships. Hyeprsensitive to rejection and negative feedback
Sx of OCPD?
Obsessed with order, perfectionism and rules making them inflexible and easily stressed. Inefficient and inflexible, seen as stubborn. Ego-syntonic
Sx of Dependant PD?
Intense fear of separation and rejection causes pt to cling to people/relationships. Lacks self confidence and feels as though they need someone to care for them
Name the 6 factors, 3 of which may be present to define substance abuse?
Desire for substance, preoccupation with substance use, withdrawal state, incapability to control substance, tolerance to substance, evidence of harmful events
Sx of opiate withdrawal?
Appear 6-12 hours after last dose, last 5-7 days.
Sweating, dilated pupils, tachycardia, high BP, watering eyes/nose, abdo cramps, nausea and vomiting, tremor and muscle cramps
Mx of opiate withdrawal?
Detox = methadone, buprenorphine or dihydrocodeine
Withdrawal Sx relief = lofexidine
Relapse prevention = naltrexone
What are the Sx of alcohol withdrawal?
6-12 hours after last drink = malaise, nausea, tremor, insomnia, transient hallucination and autonomic hypersensitivity
36 hours = seizures
72 hours = delirium tremens
Tx alcohol withdrawals?
Detox = chlordiazepoxide and IV thiamine
Maintenance and relapse prevention = acamprostate (reduces cravings), naltrexone (reduces pleasurable effects of alcohol) or disulfiram (causes unpleasent symptoms when drinking)
Briefly describe what causes the 3 commonest types of dementia
Alzheimer’s disease – senile plaques (beta amyloid proteins), neurofibrillary tangles, neuronal loss
Vascular dementia – micro infarcts in cerebral blood vessels -> poor blood supply
Lewy body dementia – abnormal deposits of alpha synuclein -> Lewy bodies
Name 2 ways on differentiating the 3 main types of dementia?
Alzheimer’s: Gradual onset + progressive. No insight to condition
Vascular: Stepwise progression. No personality changes. Insight into condition
Lewy body: Hallucinations common. Parkinsonian signs – hypertonia, bradykinesia, resting tremor
Name 3 dementia screening tools?
MMSE, ACE III, MoCA
Name the 4 alcohol misuse questionnaires?
AUDIT: Alcohol Use Disorders Identification Test - most comprehensive
CAGE: cut down, annoyed when questioned, guilty drinking, eye-opening event
SADQ: severity of alcohol dependence questionnaire
FAST: fast alcohol screening test
PAWS = measures severity of alcohol withdrawal
What investigations should you do before diagnosing dementia?
FBC, U&Es, B12, LFTs, BM, urinalysis and CT/MRI head
Name 3 acetylcholinesterase jnhibitors that can be used to treat Dementia?
Donepezil, Galantamine and Rivastigmine.
Name the causes of Delirium?
Pain – MI, surgery, iatrogenic, neurological problem
Infection – meningitis, UTI, fever, pneumonia, sepsis
Nutrition – decreased oral intake, metabolic abnormalities
Constipation
Hydration – dehydration
Medication – polypharmacy, change in medication, withdrawal (benzo, alcohol)
Environment – dementia, use of restraints, catheter
Name the 3 types of delirium?
Hyperactive – restlessness, agitation, delusion/hallucination
Hypoactive – lethargy, sedation, slow to respond
Mixed – hyperactive + hypoactive
What might be symptoms of agranuloscytosis?
Fever, chills, tacycardia, tachypnoea and hypotension
Delirium Tremens symptoms and treatment?
Delirium Tremens = hallucinations, confusion, agitiation, paranoid delusions, tachycardia, tachypnoea, hypertension and sweating/tremor = treat with PO lorazepam
Wernicke’s Encepalopathy symptoms and treatment?
Wernicke’s = ataxia, delirium, hypothermia, nystagmus and opthalmopleagia. Tx with IV Thiamine
What is Korsakoff’s syndrome?
Occurs as a result of untreated Wernicke’s due to vitamin B1 (thiamine) deficiency.
Causes chronic irreversible enecepalopathy due to damage to the mamillary bodies and medial temporal lobes
Sx of Korsakoff’s syndrome?
Anterograde and Retrograde amnesia, confabulation, apathy, demenita - patients are UNAWARE of their own illness!
Senses are normal
How can you differentiate between Bulimia and binge/purge Anorexia?
Bulima is associated with normal weight, binge/purge anorexia is associated with very low body weight
Sx of Bulimia?
Eroded teeth enamel, russels sign, sialadenosis (parotid gland swelling), Halitosis (bad breath), Amenorrhoea, hypotension and increased risk of Malloy-weiss syndrome or DM.
Sx of Anorexia?
Muscle loss (leads to low creatinine and muslce weakness => difficulty breathing and bradycardia), amenorrhoea, lunugo hair, dry skin, oedema, bloating, nausea and constipation, bone marrow failuire and osteoporosis
Mx of Anorexia and Bulimia?
SSRIs
CBT (family therapy often used in anorexia in young patients)
Weight management and nutrition
What are anorexia and Bulimia commonly associated with?
OCD, depression and anxiety
What are the blood tests like in Anorexia and Bulimia?
Hyponatraemia, Hypokalaemia, low urea, low cretinine
What is refeeding syndrome? How can we prevent?
Insulin secretion upon refeeding causes dropping levels of serum potassium, magnesium and phosphate (as these forced into the cells). This can lead to arrhythmias and death.
Patients should be re-fed slowly and ECG and U&Es should be closely monitored
What is Mild Cognitive Impairment?
The stage between normal cognition and dementia. There may be forgetfullness, impulsivity/poor judgement, mood changes etc.
Mild impairment is seen on MMSE and MoCA.
Some recover, some stay the same, some progress to dementia
Which type of parkinson’s medications have been to the development of compulsive or inappropriate behaviour (e.g. gambling and sexual disinhibition)
Dopamine agonists e.g. Ropinirole
How long must schizophrenia symptoms have been present for to diagnose?
6 months
What are hypnogogic hallucinations?
Occur when individuals are falling asleep
What are hypnopompic hallucinations?
Occur when individuals wake up from sleep
Which SSRI can cause prolonged QT syndrome?
Citalopram
What is the first line SSRI for under 18s?
Fluoxetine
What is de Cleraumbault’s syndrome?
Delusion of love (with a celebrity). The patient is certain that another is in love with them, even if they have never met them before.
What is delusional mood?
The patient feels there is something going on around them but cannot describe what. It usually becomes clearer and more specific when the delusional idea or perception occurs.
