Psych Flashcards
(98 cards)
1
Q
What is the duration of a section 2?
A
28 days
2
Q
What is the duration of a section 3?
A
6 months
3
Q
What is the duration of a section 4?
A
72 hours
4
Q
What is the purpose of section 2?
A
Assessment in hospital
5
Q
What professionals are required for section 2?
A
2 doctors (one s12 approved), AMHP
6
Q
What is required for a section 2?
A
- Evidence of a mental disorder and…
- Risk to themselves/others is enough to warrant assessment in hospital
7
Q
What is the purpose of section 3?
A
Treatment
8
Q
What professionals are required for section 3?
A
2 doctors, AMHP
9
Q
What is the purpose of section 4?
A
Emergency order when waiting for a second doctor would lead to ‘undesirable delay’
10
Q
What professionals are required for section 4?
A
1 doctor, AMHP
11
Q
When are sections 5(4) and 5(2) relevant?
A
When patients are already admitted to hospital
12
Q
What professionals put in place section 5(4)?
A
Nurses
13
Q
What professionals put in place section 5(2)?
A
Doctors
14
Q
What is the duration of section 5(4)?
A
6 hours
15
Q
What is the duration of section 5(2)?
A
72 hours
16
Q
What is the medical management of bipolar disorder?
A
- Lithium
- Antipsychotics
- Benzos
- Other mood stabiliser
- SSRIs for depressive episodes
17
Q
What is bipolar I?
A
Both mania + depression OR just mania
18
Q
What is bipolar II?
A
Mainly depression + mild hypomania
19
Q
What is OCD?
A
Obsessive thoughts + compulsive acts
20
Q
What is the management of OCD?
A
Psychotherapy and high dose SSRIs
21
Q
What is required to diagnose schizophrenia?
A
> 1 first rank symptom OR >2 second rank symptoms
22
Q
What are the first rank symptoms of schizophrenia?
A
- Thought alienation
- Passivity phenomena
- 3rd person auditory hallucinations
- Delusional perception
23
Q
What are 3 types of thought alienation?
A
- Thought insertion
- Thought withdrawal
- Thought broadcasting
24
Q
What is passivity phenomena?
A
When individuals feel that some aspect of themselves is under the control of others
25
What is the stepwise management of acute distress/psychosis?
1. Verbal descalation
2. Physical restraint
3. If ECG status known - 5mg Haloperidol + 25 mg Promethazine
4. If ECG status unknown - lorazepam/aripiprazole/olanzapine
26
What is the management of acute dystonic reaction?
- Airway
- Stop offending drug
- IM procyclidine
27
What drug is used to treat oculogyric crisis
Clonazepam
28
What is serotonin syndrome?
Psychiatric emergency caused by drugs that increase 5-HT (serotonin)
29
Which drugs increase 5-HT
SSRIs
30
How does serotonin syndrome present?
3 As
- Activity (clonus, hyperreflexia, hypertonia, tremors, seizures)
- Autonomic instability
- Altered mental state
31
What is the management of serotonin syndrome?
- ABC
- Stop offending drugs
- Cyproheptadine
32
What receptors do atypical antipsychotics work on?
D2, D3, D4, 5-HT
33
What is acute dystonic reaction?
Sustained muscle contraction (e.g. torticollis, oculogyric crisis)
34
What screening tool is for depression?
PHQ-9
35
What are the core symptoms of depression?
Low mood
Low energy (anergia)
Low enjoyment (anhedonia)
36
What is an important differential of anxiety?
Hyperthyroidism
37
What is the first line medication in GAD?
SSRI - sertraline
38
What's the Dx if a pt has psychotic symptoms + depression that are not linked?
Schizoaffective disorder
39
What's the Dx if a pt has depression and is hearing voices telling them to commit suicide?
Depression with psychosis
40
What is the management of PTSD?
CBT + EMDR
41
How to remember how cluster A, B and C are described?
Mad, bad and sad
42
What are the cluster A personality disorders?
Paranoid, schizoid, schizotypal
43
What are the cluster B personality disorders?
Antisocial, borderline, histrionic, narcissistic
44
What are the cluster C personality disorders?
Obsessive-compulsive, avoidant, dependant
45
What alcohol withdrawal symptoms do you get at:
1) 6 hrs
2) 36 hrs
3) 72 hrs
1. Malaise, tremor, nausea
2. Seizures
3. Delirium tremens
46
What are the 2 causes of neuroleptic malignant syndrome?
- Adverse reaction to antipsychotics
- Abrupt dopaminergic withdrawal (levodopa)
47
What's the management of neuroleptic malignant syndrome?
1. Stop antipsychotic
2. Dantolene (relaxant)
3. Bromocriptine (DA agonist)
4. BZD
5. IV fluids (stop renal failure)
48
What are the clinical features of neuroleptic malignant syndrome?
- Confusion
- Hyperthermia
- Tachycardia
- HTN
- Hypotension
49
Give 6 causes of serotonin syndrome
- SSRI
- SNRI
- MAOi
- Opiods
- Lithium
- TCA
50
What is the general management of serotonin syndrome? What is the management of SSRI overdose?
- Stop med + supportive treatment
- Activated charcoal
51
What is the WWC in neuroleptic syndrome vs serotonin syndrome?
- WWC is high in NMS
- WCC is normal in SS
52
What's the management of Wernicke's encephalopathy?
Pabrinex
53
What are two 1st line treatment options for delirium tremens? What should you give if psychotic features?
- Pabrinex/Lorazepam
- IM haloperidol
54
What blood lithium level indicates lithium toxicity?
>1.5 mol/L
55
What are the symptoms of lithium toxicity?
TOXICCC
- Tremor (coarse)
- Oliguric renal failure
- AtaXia
- Increased reflexes
- Convulsions
- Coma
- Consciousness reduced
56
What's the management of lithium toxicity?
- Stop lithium
- High fluid - IV NaCl
- Renal dialysis if severe
57
How does lithium cause renal damage?
Lithium -> parathyroid -> increase PTH -> increase Ca2+ -> kidney damage
58
What happens in the body with alcohol abuse? What does alcohol withdrawal cause?
- Up regulation of NMDA receptors + down regulation of GABA receptors
- CNS hyperexcitability
59
What triad do you get in PTSD?
- Hyperarousal
- Avoidance
- Re-experiencing
60
How long do symptoms need to be ongoing when dx schizophrenia?
>1 month and all the time
61
Which psych drugs are contraindicated when breastfeeding?
- Carbamazepine
- Lithium
- Clozapine
62
What is cyclothymia?
Hypomania + depression over 2 years or more
63
What is rapid cycling?
4 or more episodes of hypomania/depression in a year
64
Can you get psychotic symptoms in hypomania?
No
65
How long does mania need to be ongoing?
At least 7 days
66
How long does hypomania need to be ongoing?
At least 4 days
67
How long do anxiety symptoms need to be ongoing to diagnose GAD?
6 months
68
Which tricyclic antidepressant is the safest?
Lofepramine
69
According to ICD-10 how many symptoms indicate...
1. Mild depression
2. Moderate depression
3. Severe depression
1. 4
2. 5-6
3. 7
70
What indicate a medication change in the management of OCD? What should they be switched to?
- If have trialled SSRI + CBT for 12 weeks with no benefit
- Switch to different SSRI or Clomipramine (TCA) if can't tolerate SSRI
71
What PHQ-9 score /27 indicates...
1. Mild depression
2. Moderate depression
3. Moderately severe depression
4. Severe depression
1. 5-9
2. 10-14
3. 15-19
4. 20-27
72
What are symptoms of serotonin withdrawal?
- GI upset
- Dizziness
- Flu like symtoms
- Insomnia
- Hyperarousal
73
What are egosyntonic thoughts?
Thoughts in keeping with ones beliefs and values
74
What are egodystonic thoughts?
Thoughts that are very different to patients normal beliefs and values
75
Are obsessive thoughts usually egosyntonic or egodystonic?
Egodystonic
76
When does acute stress reaction become PTSD
After 4 weeks
77
What is the management of acute stress reaction vs PTSD?
- Acute stress reaction = trauma focussed CBT
- PTSD = eye movement desensitisation and processing
78
How long would an episode of hypomania last?
<7 days
79
What is visual hallucinations involving small people typical of?
Alcohol withdrawal
80
What are some features of opioid toxicity?
- Pin point pupils
- Respiratory depression
- Bradykinesia
81
Can opioid withdrawal kill you?
No
82
What can help establish the severity of GAD?
GAD-7 anxiety questionnaire
83
When is NAC indicated in the Rx of paracetamol overdose?
If <8 hrs from ingestion
84
When is activated charcoal indicated in the Rx of paractemal overdose?
If <1hr from ingestion
85
How would paranoid personality disorder typically present?
- Anger
- Jealousy
- Holding grudges
- Creating conflict
86
What are dynamic risk factors for suicide?
- Substance misuse
- Financial problems
- Relationship problems
87
What's the Rx of someone is status who has had...
- 2 doses of PR diazepam
- 1 dose of PR diazepam
- IV phenytoin
- Another dose of benzodiazepine (PR diazepam or IV lorazepam)
CAN ONLY GIVE MAX TWO DOSES OF BENZO
88
What is the only absolute contraindication to ECT?
Raised ICP
89
What the time course of serotonin syndrome vs neuroleptic malignant syndrome?
- Serotonin syndrome - occurs over 24 hrs
- NMS - overs over days/weeks
90
What screening tool is used for...
1. assessing the severity of depression
2. screening for post natal depression
3. briefly screening for depression + anxiety
4. diagnosing depression and the severity of symptoms
1. Beck depression inventory
2. Edinburgh scale
3. PHQ-4
4. PHQ-9
91
What is the FEVER mnemonic for neuroleptic malignant syndrome?
- Fever
- Encephalopathy
- Vitals unstable
- Elevated enzymes
- Rigidity
92
What is the MMSE useful for?
Indicating the presence of cognitive impairment
93
What is the MMSE out of? What score indicate normal, mild, moderate and severe impairment?
1. 30
2. Normal - 25-30
3. Mild - 21-24
4. Moderate - 10-20
5. Severe - <10
94
What needs to be ruled out in order to make a diagnosis of dementia?
Delirium
95
Is acute onset a feature of dementia/delirium?
Delirium
96
Which of dementia/delirium is reversible?
Delirium
97
What are the 2 types of delirium?
Hyper/hypoactive delirium
98
What is the 1st and 2nd line treatment of Alzheimer's disease?
1st - Acetylcholinesterase inhibitor treatment (Donepezil)
2nd - N-methyl-D-asparate antagonists (Memantine)
