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3A > Psych > Flashcards

Psych Flashcards

1
Q

What is the criteria for depression?

A

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

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2
Q

What are the core symptoms of depression?

A

Persistently depressed mood, anhedonia and anergia

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3
Q

What are the somatic symptoms of depression?

A

Loss of emotional reactivity, diurnal mood variation, anhedonia, early morning wakening, GI upset and weight change

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4
Q

What are the psychotic symptoms of depression?

A

Delusions, hallucinations, catatonic symptoms (e.g. not responding when spoken to, sitting in strage postions, repetitive meaningless motions, mimicking someone elses speech)

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5
Q

What is dysthymic disorder? How can you manage it?

A

chronic (>2 years) low grade depressive symptoms. Manage with SSRIs and CBT

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6
Q

What is SAD? How can you manage it?

A

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

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7
Q

What is post-natal depression? How can you manage it?

A

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

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8
Q

How can you assess post-natal depression?

A

Edinbrugh Postnatal Depression Scale

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9
Q

What is the criteria for diagnosing GAD?

A

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

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10
Q

Sx of GAD?

A

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

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11
Q

Define panic disorder?

A

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

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12
Q

Why should you not give benzodiazepines in panic disorder?

A

They can cause depersonalization if used long term

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13
Q

Mx of phobic anxiety?

A

Behavioural therapy (graded exposure therapy)

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14
Q

Mx GAD and panic disorder?

A

CBT and SSRIs

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15
Q

What is the classic quadrad of PTSD?

A 
Reliving the situation
Avoidance
Hyperarousal
Emotional numbing.
Symptoms must present within 6 months of an event and last for at least 1 month
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16
Q

1st line Mx for PTSD?

A

Trauma focused CBT and EMDR

Meds are not 1st line but consider sertraline and venlafaxine

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17
Q

What is the criteria for diagnosis of OCD?

A

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

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18
Q

Mx of OCD?

A

CBT and ERP

Sertraline 1st line, Clomipramine 2nd line

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19
Q

Bipolar I vs Bipolar II?

A

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

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20
Q

What is cyclothymic disorder?

A

Reccurring depressive and hypomanic states, lasting for at least 2 years that do not meet teh criteria for a major affective episode

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21
Q

Which drugs can induce mania/hypomania?

A

TCAs/SNRIs, benzos, antipsychotics, lithium and anti-parkinsons medications

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22
Q

Mx bipolar?

A

Manic epsiodes = lithium +/- benzos (e.g. clonazepam)
Depressive episodes = SSRIs
Maintenance = lithium or carbamazepine

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23
Q

SEs of lithium?

A

weight gain, teratogenic (ebstein’s anomoly), renal ipairment, clinical/subclinical hypothyroidism

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24
Q

What tests should be done before starting litium?

A

FBC, U&Es, TFTs, renal function, baseline weight/BMI, ECG and pregnancy test

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25
Q

How often should you monitor bloods in Lithium?

A

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

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26
Q

Name some RFs for developing schizophrenia?

A

Family history, abuse, obstetric issues (low birht weight, preterm delivery and asphyxia), substance abuse, cerebral injury, acute psychosis an migraition

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27
Q

Name the positive Sx of schizophrenia?

A

Auditory hallucinations, delusions, catatonic behaviour, speech issues (pressured, word salad, perseveration etc.), circumstantiality, tangientiality

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28
Q

Name the negative Sx of Schizophrenia?

A

Anhedonia, asocial behaviours, blunting/incongruity of affect, alogia, depression and avolition

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29
Q

Name the 1st rank Sx of schizophrenia?

A

formal thought disorder, passitivity phenomenom, delusional perceptions and 3rd person hallucinations

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30
Q

Name the 2nd rank Sx of schizophrenia?

A

Paranoid, persecutory and referntial delusions. Negative symptoms

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31
Q

Name the atypical antipsychotics?

A

Risperidone, Quetiapine, Aripirprazole, Olanzapine and Clozapine

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32
Q

Name the typical antipsychotics?

A

Haloperidol and Chlopromazine

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33
Q

SEs of Risperidone?

A

Hyperprolactinaemia

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34
Q

SEs of Clozapine?

A

Constipation (most common), myocarditis, hypersalivation, reduced seizure threshold and agranulocystosis/neutropaenia

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35
Q

Name some non-pharmacological Mx of Schizophrenia?

A

CBT, family therpay, art therapy, lifestyle changes, ECT

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36
Q

What is Cotard’s syndrome? what condition is it seen in?

A

A delusion belief that the person or part of the person is alread dead (seen in psychotic depression and schizophrenia)

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37
Q

What is Section 2 of the MHA?

A

Assesment and Treatment Order.
Lasts for 28 days and is non-renewable.
Must be approved by two doctors and one AMHP

38
Q

What is Section 3 of the MHA?

A

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

39
Q

What is Section 4 of the MHA?

A 
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
40
Q

What is Section 5 of the MHA?

A

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

41
Q

What is Section 135 of the MHA?

A

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

42
Q

What is Section 136 of the MHA?

A

Allows police to move a patient with a mental disorder from a public place to a place of saftey.
Lasts for 24 hours

43
Q

What causes neuroleptic malignant syndrome?

A

Adverse reaction to dopamine receptor agonists (due to antipsychotics) or the abrupt withdrawal of dopaminergic medications (in Parkinson’s)

44
Q

Sx of NMS?

A

Altered mental state, hypertonia (lead pipe rigidity), hyporeflexia, normal pupils and autonomic dysfunction (tachycardia, tachypnoea, urinary incontinence, sweating and hyperthermia etc.)

45
Q

What drugs can cause serotonin syndrome?

A

SSRIs, SNRIs, opioid analgesics, MAOIs and lithium.

46
Q

Sympotms of serotonin syndrome?

A

Altered mental status, neuromuscular Sx ( clonus, hyperreflexia, hypertonia and tremors), dilated pupils and hyperactive bowel sounds. autonomic Sx (tachycardia, tachypnoea, sweating and hyperthermia)

47
Q

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?

A

Cognition, affectivity, interpersonal functioning and impulse control.

48
Q

Sx of Paranoid PD?

A

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

49
Q

Sx of Schizoid PD?

A

Social isolation out of choice, do not gain pleasure by physical contact (including sex), emotionally blunted with a flat affect

50
Q

Sx of Schizotypal PD?

A 
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
51
Q

Sx of Antisocial PD

A

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

52
Q

Sx of EUPD?

A

unstable moods with extreme intensity, intense relationships which end quickly, fear of abandonment and splitting

53
Q

Sx of Histrionic PD?

A

Attention seeking behaviour - inappropriatley flirtacious and dramatic. Has superficial relationships, seen as egocentric by others

54
Q

Sx of Narcissistic PD?

A

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

55
Q

Sx of Avoidant PD?

A

Extremley low self-esteem and timidness. Avoids social situations due to shyness and fear but does want relationships. Hyeprsensitive to rejection and negative feedback

56
Q

Sx of OCPD?

A

Obsessed with order, perfectionism and rules making them inflexible and easily stressed. Inefficient and inflexible, seen as stubborn. Ego-syntonic

57
Q

Sx of Dependant PD?

A

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

58
Q

Name the 6 factors, 3 of which may be present to define substance abuse?

A

Desire for substance, preoccupation with substance use, withdrawal state, incapability to control substance, tolerance to substance, evidence of harmful events

59
Q

Sx of opiate withdrawal?

A

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

60
Q

Mx of opiate withdrawal?

A

Detox = methadone, buprenorphine or dihydrocodeine
Withdrawal Sx relief = lofexidine
Relapse prevention = naltrexone

61
Q

What are the Sx of alcohol withdrawal?

A

6-12 hours after last drink = malaise, nausea, tremor, insomnia, transient hallucination and autonomic hypersensitivity
36 hours = seizures
72 hours = delirium tremens

62
Q

Tx alcohol withdrawals?

A

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)

63
Q

Briefly describe what causes the 3 commonest types of dementia

A

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

64
Q

Name 2 ways on differentiating the 3 main types of dementia?

A

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

65
Q

Name 3 dementia screening tools?

A

MMSE, ACE III, MoCA

66
Q

Name the 4 alcohol misuse questionnaires?

A

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

67
Q

What investigations should you do before diagnosing dementia?

A

FBC, U&Es, B12, LFTs, BM, urinalysis and CT/MRI head

68
Q

Name 3 acetylcholinesterase jnhibitors that can be used to treat Dementia?

A

Donepezil, Galantamine and Rivastigmine.

69
Q

Name the causes of Delirium?

A

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

70
Q

Name the 3 types of delirium?

A

Hyperactive – restlessness, agitation, delusion/hallucination
Hypoactive – lethargy, sedation, slow to respond
Mixed – hyperactive + hypoactive

71
Q

What might be symptoms of agranuloscytosis?

A

Fever, chills, tacycardia, tachypnoea and hypotension

72
Q

Delirium Tremens symptoms and treatment?

A

Delirium Tremens = hallucinations, confusion, agitiation, paranoid delusions, tachycardia, tachypnoea, hypertension and sweating/tremor = treat with PO lorazepam

73
Q

Wernicke’s Encepalopathy symptoms and treatment?

A

Wernicke’s = ataxia, delirium, hypothermia, nystagmus and opthalmopleagia. Tx with IV Thiamine

74
Q

What is Korsakoff’s syndrome?

A

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

75
Q

Sx of Korsakoff’s syndrome?

A

Anterograde and Retrograde amnesia, confabulation, apathy, demenita - patients are UNAWARE of their own illness!
Senses are normal

76
Q

How can you differentiate between Bulimia and binge/purge Anorexia?

A

Bulima is associated with normal weight, binge/purge anorexia is associated with very low body weight

77
Q

Sx of Bulimia?

A

Eroded teeth enamel, russels sign, sialadenosis (parotid gland swelling), Halitosis (bad breath), Amenorrhoea, hypotension and increased risk of Malloy-weiss syndrome or DM.

78
Q

Sx of Anorexia?

A

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

79
Q

Mx of Anorexia and Bulimia?

A

SSRIs
CBT (family therapy often used in anorexia in young patients)
Weight management and nutrition

80
Q

What are anorexia and Bulimia commonly associated with?

A

OCD, depression and anxiety

81
Q

What are the blood tests like in Anorexia and Bulimia?

A

Hyponatraemia, Hypokalaemia, low urea, low cretinine

82
Q

What is refeeding syndrome? How can we prevent?

A

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

83
Q

What is Mild Cognitive Impairment?

A

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

84
Q

Which type of parkinson’s medications have been to the development of compulsive or inappropriate behaviour (e.g. gambling and sexual disinhibition)

A

Dopamine agonists e.g. Ropinirole

85
Q

How long must schizophrenia symptoms have been present for to diagnose?

A

6 months

86
Q

What are hypnogogic hallucinations?

A

Occur when individuals are falling asleep

87
Q

What are hypnopompic hallucinations?

A

Occur when individuals wake up from sleep

88
Q

Which SSRI can cause prolonged QT syndrome?

A

Citalopram

89
Q

What is the first line SSRI for under 18s?

A

Fluoxetine

90
Q

What is de Cleraumbault’s syndrome?

A

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.

91
Q

What is delusional mood?

A

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.

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