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Medicine > Psych > Flashcards

Psych Flashcards

1
Q

Def Section 5 (4) + 5 (2)

A

Section 5 (4): inpatient kept for 6 hours for assessment

Section 5 (2): inpatient kept for 72 hours for MHA completion

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2
Q

Def Section 2, 3, 136

A

Section 2: detained for 28 days for assessment and treatment

Section 3: detained for six months for treatment

Section 136: police remove person for 72 hours for assessment

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3
Q

Def Section 17, 117, CTO

A

Section 17: patient allowed leave while under section 2/3

Section 117: patient entitled to after-care from local council after section 2/3

CTO: Community treatment order (patient allowed to live w/in community whilst being treated)

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4
Q

Def Depression + Sx

A

(Persistent low mood occurring on most days for > 2 weeks):

Low Mood,
Low Energy,
Low Enjoyment (Anhedonia)

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5
Q

Conditions to Excl for Depression

A 
bereavement/adjustment disorder, 
dementia, 
mania/BPD, 
substance misuse, 
medical/organic cause
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6
Q

Somatic + Cog Sx of Depression

A

Somatic Sx:
Sleep/Weight changes,
Reduced libido,
Psychomotor Retardation/Agitation

Cog Sx: 
Guilt, 
Hopelessness, 
Suicidiality, 
Hypochondrical thoughts, 
Poor concentration/attention
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7
Q

Def Mania + Hypomania

A

Hypo:
Sx present > 4 days

Mania:
Sx present > 7 days w/ marked Impairment or Psychotic features

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8
Q

Def BPD 1 + 2

A

BPD 1:
1 episode of Mania/Mixed w/ 1 episode of Depression

BPD 2:
1 episode of Hypomania w/ 1 episode of Depression

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9
Q

BPD Mx

A

(Avoid Anti-D +/- => Mania),
Mood Stabilisers,
Anti-psychotics

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10
Q

Mood D Ddx - 6

A 
(Normal fluctuations in mood)
Adjustment D, Bereavement, PTSD
Dementia (Cog decline)
Personality D
Anxiety D
Substance Misuse
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11
Q

Mood D Mx:
Bio
Psycho
Social

A

Bio:
Meds (Anti-D, Mood stabilisers, Anti-psychotics, Anxiolytics),
ECT,
rTMS (Repetitive Trans-cranial Magnetic Stim),
tDCS (Trans-cranial DC Stim)

Psycho: 
Psych Ed (Illness, Relapse, Mx)
Mindfulness,
CBT,
IPT (Interpersonal Therapy),

Social:
General coping strategies,
Targeted Interventions (Work, Family, Housing, Finance)

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12
Q

ECT Indications

A

Failed Medical Mx
Prolonged/Severe Mania
Stupor, Catatonia, Psychomotor Retardation
High-risk of Suicide

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13
Q

ECT Contraindications
Anaesthetic risk - 3
CVS risk - 8

A

Anaesthetic risk
(Resp Inf, Heart D, Electrolyte Imbalance)

CVS risk
(MI < 3mo, Cerebral/Aortic Aneurysm, Raised ICP, Uncontrolled HF, DVT, CVA < 1mo, Unstable #, Uncontrolled Phaeochromocytoma)

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14
Q

Psychosis Def + Sx

A

(Experience of reality different to everyone else) =>

Hallucinations (Perception of object w/out Ext Stimuli)
Delusions (Fixed, firmly-held beliefs despite evidence)
Formal Thought D
Disorder of Self (Thought broadcast/insertion, Passivity phenomena)
Lack of Insight

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15
Q

Schizophrenia Patho + (+) Sx

A

(Abnormal Act of Dopamine R => Early-onset, Gradual Mental Decline):

(+) Sx:
Hallucinations (3rd Person),
Delusions (Bizarre, Persecutory),
Disorganised Thoughts

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16
Q

Schizophrenia (-) Sx

A 
Anhedonia (Lack of Enjoyment), 
Ambivalence (Flat Affect), 
Asociality (Lack of social interest), 
Avolition (Lack of motivation), 
Attention Def, 
Alogia (Lack of speech)
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17
Q

Schizophrenia Mx:
Bio
Psycho
Social

A

Bio
Anti-psychotics,
(Excl Organic causes: MRI/CT, Blood Cult, Endo Screen)

Psycho:
Supportive counselling,
Family Tx

Social:
Social Care/Carers,
Finance,
Housing

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18
Q

Anxiety Mx

A

Psycho-Ed, CBT
Anti-D (SSRi, SNRi)
Pregabalin
(Crises: Benzos)

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19
Q

PTSD Criteria

A

(Sx occurring > 4wks)

Re-experience (Flashbacks, Memories)
Avoidance (People, Situations)
Hyperarousal (Restlessness/Hypervigilance/OCD)

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20
Q

Self-harm Screening

A

SADPERSONS

Edinburgh Scale

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21
Q

Def Parity of Esteem

A

Valuing MH as much as Physical Health to close inequalities in mortality, morbidity and Delivery of care

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22
Q

Organic Psychoses Types

A 
Type 1 (Hallucinations): 
Epilepsy, Migraines 
Type 2 (Delirium): 
Drugs, Hypoxia, Metabolic changes, Head Injury/Lesions, CVA 
Type 3 (Dementia): 
Dementia, PD, Huntington’s Chorea 
Type 4 (Delusions): 
Head Injury, Stroke
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23
Q

Difference btw Somatization D, Conversion D, Hypochondriasis

A

Somatization D:
Multiple physical complaints w/ no med explanation
(Onset < 30yo, Sx last years, Excl all other DDx)

Conversion D:
Single physical complaint (Loss of Funct) w/ Psych explanation

Hypochondriasis: 
Illness Anxiety (Fear of having D w/ no evidence)
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24
Q

SSRi Examples + SE

A

(Sertraline, Citalopram, Fluoxetine, Paroxetine)

Restlessness/Agitation 
N+V, GI disturbance 
Headaches 
Weight changes 
Sexual dysfunction
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25
Q

SNRi Examples + SE

A

(Duloxetine, Venlafaxine)

Sedation
N+V
Sexual dysfunction

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26
Q

Mirtazapine MOA + SE

A

(Nor-A/Histamine/Serotonin Antag)

Sedation
Weight gain

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27
Q

TCA Indication + SE

A

(Neuropathic Pain)

Musc (Dry mouth, Urin retention, Hot dry flushed skin)
Hist (Sedation, N+V)

28
Q

MAOi Examples + SE

A

(Rasagiline, Selegiline)

Significant D-D Interactions 
Tyramine React (Cheese/Meat/Wine => Migraines + HT)
29
Q

Discontinuation Synd Examples, Patho + Sx (SPINTH)

A

Interruption/reduction/discontinuation of Anti-D meds (Paroxetine, Venlafaxine) following continuous use > 1 month

Sweating
Paraesthesia
Insomnia
N+V
Tremors
Headaches
30
Q

Discontinuation Synd Mx

A

Switch to Fluoxetine + Titrate slowly

31
Q

Serotonin Synd Patho + Sx

A

(Excess Fluoxetine/Serotonin)

Sweating
Myoclonus
Tremors
TachyC
Hyperthermia 
Hyperreflexia
Headaches
Hypomania
32
Q

Serotonin Synd Mx

A

Reduce Fluoxetine,

Fluids and monitoring

33
Q

Typical Antipsychotics Examples + SE

A

(Haloperidol, Chlorpromazine)

Musc (Dry mouth, Urin retention, Hot dry flushed skin)
Hist (Sedation, N+V)
Sexual dysfunction
EPSE (PD: Bradykinesia, Rigidity, Tremors)

34
Q

Atypical Antipsychotics Examples + SE

A

(Clozapine, Olanzapine, Risperidone)

Sero (Restlessness/Agitation, N+V, Headaches, Weight changes, Sexual dysfunction)
Weight gain, Dyslipidaemia, DM

35
Q

Clozapine MOA + Indication

A

(Dopamine/Serotonin Antag)

Indication:
2 Failed Anti-psychotics (Each for 6-8wks, > 1 Atypical) in Schizophrenia

36
Q

Clozapine SE

A

Hypersalivation
Urin Incontinence
GI Hypermobility (=> Constipation/Obstruction)
Agranulocytosis (Req weekly FBC for 18wks)
Myocarditis (Baseline ECG)

37
Q

Neuroleptic Malignant Synd Patho + Sx

A

(Excess Anti-psychotics – High potency Dopamine Antag)

Sweating, 
Fever, 
Muscle rigidity, 
Rhabdomyolysis (+/- => Renal Fail), 
Seizures
38
Q

Neuroleptic Malignant Synd Mx

A

Stop Anti-psychotic,
Fluids,
Anti-Inflamm

39
Q

EPSE Patho + Sx

A

(Excess ACh compared to Dopamine w/in Nigostriatal pathway => Dystonic React)

PD: Bradykinesia, Rigidity, Tremors
Hot dry flushed skin
Dilated pupils
Delirium

40
Q

EPSE Mx

A

Anti-cholinergics (Procyclidine, Benzatropine)

41
Q

Mood Stabiliser (Li) MOA + SE + Contras

A

(Increase Serotonin synthesis, Decrease Nor-A release) =>

Dry mouth/Metallic taste, 
Polydipsia/Polyuria, 
Weight gain, 
Fine Tremor 
(LT: HypoTh, Renal Fail – Req annual TFTs + U+Es)

Contras:
NSAIDs, ACEi (Loop D safest)

42
Q

Mood Stabiliser (AED) Examples + SE

A

(Na+Valproate, Carbamazepine, Lamotrigine, Pregabalin)

Sedation,
Weight gain,
Thrombocytopenia (Check FBC)

43
Q

Mood Stabiliser (Quetiapine) SE

A

Sero (Restlessness/Agitation, N+V, Headaches, Weight changes, Sexual dysfunction)
Weight gain, Dyslipidaemia, DM

44
Q

M2M Dementia Mx + SE

A

Acetylcholinesterase Inhib:
(Donepazil, Galantamine, Rivastigmine)

N+V, Diarrhoea, Anorexia
Insomnia
M cramps
BradyC (ECG + HR)

45
Q

M2S Dementia Mx + SE

A

Glutamate/NMDA Antag: (Memantine => Reduces challenging behaviour)

Headaches,
N+V,
Insomnia,
Drowsiness

46
Q

ADHD Mx + SE + Monitoring

A

(CNS Stim): Methylphenidate, Dextroamphetamine
+/- Dependence, (Monitor Weight, Height, HR)

(Nor-A Reuptake Inhib): Atomoxetine

47
Q

ADHD Criteria

A

Poor Attention/Concentration, Inattention
Physical Overactivity, Impulsivity

Occurs in > 1 environment, Sx > 6yrs

48
Q

ASD Criteria

A

Social Diff,
Comm Diff,
Rigid Thinking/Behaviour

Occurs in > 1 environment, Sx > 3yrs

49
Q

LD Criteria

A

Sub-average IQ Funct (< 85)

2 areas of Adaptive Funct Skills limited/impaired concurrently

Disability occurred before 18yo

50
Q

LD Mx

A

Acute Liaison Nurse (Adjust Reasonable Adjustments),
Primary Care Liaison Nurse

Health Action Plan
(Annual health check, Immunisations, Screening/Monitoring, Healthy Lifestyle)

51
Q

Def Diagnostic Overshadowing

A

Believing current Sx is due to LD rather than another cause (Must seek alt DDx)

52
Q

AN Features

A

(BMI < 17.5): Body-shape disturbance +/- Amenorrhoea, Osteoporosis

Intense fear of gaining weight/Refusal to maintain ideal body weight

53
Q

AN Types

A

Restrictive:
Food avoidance, Eating rules, Calorie limits

Binge w/ purging:
Laxatives, Self-induced vomiting, Meds (Diuretics, Amphetamines)

54
Q

BN Features

A

(Normal BMI): Self-perception of fatness

Binging (Recurrent Overeating) and Cravings (Persistent strong desire to eat) +/- Purging

55
Q

BN Types

A

Purging (Compensatory behaviour):
Vomiting, Laxatives

Non-purging:
Fasting, Excess Exercise

56
Q

Binge-eating Features

A

(Loss of control):

Associated w/ guilt (Secretive, Isolating)

Large amount, Calorie-laden, Forbidden foods

57
Q

Refeeding Synd Patho

A

Rebuild of body => Reduced minerals/vitamins/electrolytes

=> Def of Phosphate, Potassium, Magnesium, Folate/B12

+/- => Organ failure

58
Q

Refeeding Synd Mx

A

Specialist Mx (Refer if BMI < 13)

Daily monitoring (U+Es)

PO/IV Supplements

59
Q

Eating D (AN/BN) Mx + Referral Criteria

A

CBT, Guided Self-help, Family Tx

AN: Restore to healthy weight

BN: Regular Eating w/ Binge Analysis

Referrals:
Pt wants to change but cannot progress,
No adequate local Tx,
Pt in immediate danger

60
Q

Opiate Abuse Sx + Mx

A

Miotic (Constricted) Pupil,
Reduced consciousness,
Reduced RR

Mx:
Naloxone,
Mech Vent

61
Q

Opiate w/drawal Sx + Mx

A

Dil Pupil (w/ Lacrimation/Rhinorrhoea),
Persistent yawning,
TachyC,
Restlessness

Mx:
Methadone,
Buprenorphine (Agon-Antag),
Detox (Come off) + Rehab (6 months Tx)

62
Q

Anti-D Choices

A

1st line: SSRi, SNRi​

Major Weight loss/Insomnia: Mirtazepine​

Neuropathic pain: TCA (Amitriptyline)​

63
Q

Anti-D Switching

A

SSRi/SNRi should be continued for 4wks
If no benefit at typical dose: Switch​
If partial benefit: Titrate up​
(If used in Anxiety + no benefit: Titrate up)​
(If significant SE’s: Switch +/- Continue for few wks)​

64
Q

Anti-psychotic Monitoring - 7

A

Baseline:​

FBC, Lipids, LFTs, HbA1c, Weight, ECG, BP/HR​

65
Q

Anxiolytics MOA

A

Pregabalin/Benzodiazepines

Increase in GABA (=> Reduced excitability of N)​

66
Q

Def Oppositional D + Conduct D

A

Oppositional D:​
Uncooperative/Unwilling to comply (frequent tantrums)​
Wilful, Defiant +/- Aggressive​

Conduct D:​
Lying, Stealing, Truanting, Violence​
Socialised (Less serious, phasic)​
Unsocialised (+/- => Crime, ASBOs)​

Medicine (13 decks)

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