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3a > Psych > Flashcards

Psych Flashcards

1
Q

What is the duration of a section 2?

A

28 days

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2
Q

What is the duration of a section 3?

A

6 months

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3
Q

What is the duration of a section 4?

A

72 hours

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4
Q

What is the purpose of section 2?

A

Assessment in hospital

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5
Q

What professionals are required for section 2?

A

2 doctors (one s12 approved), AMHP

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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
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7
Q

What is the purpose of section 3?

A

Treatment

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8
Q

What professionals are required for section 3?

A

2 doctors, AMHP

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9
Q

What is the purpose of section 4?

A

Emergency order when waiting for a second doctor would lead to ‘undesirable delay’

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10
Q

What professionals are required for section 4?

A

1 doctor, AMHP

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11
Q

When are sections 5(4) and 5(2) relevant?

A

When patients are already admitted to hospital

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12
Q

What professionals put in place section 5(4)?

A

Nurses

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13
Q

What professionals put in place section 5(2)?

A

Doctors

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14
Q

What is the duration of section 5(4)?

A

6 hours

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15
Q

What is the duration of section 5(2)?

A

72 hours

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16
Q

What is the medical management of bipolar disorder?

A
  1. Lithium
  2. Antipsychotics
  3. Benzos
  4. Other mood stabiliser
  5. SSRIs for depressive episodes
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17
Q

What is bipolar I?

A

Both mania + depression OR just mania

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18
Q

What is bipolar II?

A

Mainly depression + mild hypomania

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19
Q

What is OCD?

A

Obsessive thoughts + compulsive acts

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20
Q

What is the management of OCD?

A

Psychotherapy and high dose SSRIs

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21
Q

What is required to diagnose schizophrenia?

A

> 1 first rank symptom OR >2 second rank symptoms

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22
Q

What are the first rank symptoms of schizophrenia?

A
  1. Thought alienation
  2. Passivity phenomena
  3. 3rd person auditory hallucinations
  4. Delusional perception
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23
Q

What are 3 types of thought alienation?

A
  • Thought insertion
  • Thought withdrawal
  • Thought broadcasting
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24
Q

What is passivity phenomena?

A

When individuals feel that some aspect of themselves is under the control of others

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25
Q

What is the stepwise management of acute distress/psychosis?

A
  1. Verbal descalation
  2. Physical restraint
  3. If ECG status known - 5mg Haloperidol + 25 mg Promethazine
  4. If ECG status unknown - lorazepam/aripiprazole/olanzapine
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26
Q

What is the management of acute dystonic reaction?

A
  • Airway
  • Stop offending drug
  • IM procyclidine
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27
Q

What drug is used to treat oculogyric crisis

A

Clonazepam

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28
Q

What is serotonin syndrome?

A

Psychiatric emergency caused by drugs that increase 5-HT (serotonin)

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29
Q

Which drugs increase 5-HT

A

SSRIs

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30
Q

How does serotonin syndrome present?

A

3 As
- Activity (clonus, hyperreflexia, hypertonia, tremors, seizures)
- Autonomic instability
- Altered mental state

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31
Q

What is the management of serotonin syndrome?

A
  • ABC
  • Stop offending drugs
  • Cyproheptadine
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32
Q

What receptors do atypical antipsychotics work on?

A

D2, D3, D4, 5-HT

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33
Q

What is acute dystonic reaction?

A

Sustained muscle contraction (e.g. torticollis, oculogyric crisis)

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34
Q

What screening tool is for depression?

A

PHQ-9

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35
Q

What are the core symptoms of depression?

A

Low mood
Low energy (anergia)
Low enjoyment (anhedonia)

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36
Q

What is an important differential of anxiety?

A

Hyperthyroidism

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37
Q

What is the first line medication in GAD?

A

SSRI - sertraline

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38
Q

What’s the Dx if a pt has psychotic symptoms + depression that are not linked?

A

Schizoaffective disorder

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39
Q

What’s the Dx if a pt has depression and is hearing voices telling them to commit suicide?

A

Depression with psychosis

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40
Q

What is the management of PTSD?

A

CBT + EMDR

41
Q

How to remember how cluster A, B and C are described?

A

Mad, bad and sad

42
Q

What are the cluster A personality disorders?

A

Paranoid, schizoid, schizotypal

43
Q

What are the cluster B personality disorders?

A

Antisocial, borderline, histrionic, narcissistic

44
Q

What are the cluster C personality disorders?

A

Obsessive-compulsive, avoidant, dependant

45
Q

What alcohol withdrawal symptoms do you get at:
1) 6 hrs
2) 36 hrs
3) 72 hrs

A
  1. Malaise, tremor, nausea
  2. Seizures
  3. Delirium tremens
46
Q

What are the 2 causes of neuroleptic malignant syndrome?

A
  • Adverse reaction to antipsychotics
  • Abrupt dopaminergic withdrawal (levodopa)
47
Q

What’s the management of neuroleptic malignant syndrome?

A
  1. Stop antipsychotic
  2. Dantolene (relaxant)
  3. Bromocriptine (DA agonist)
  4. BZD
  5. IV fluids (stop renal failure)
48
Q

What are the clinical features of neuroleptic malignant syndrome?

A
  • Confusion
  • Hyperthermia
  • Tachycardia
  • HTN
  • Hypotension
49
Q

Give 6 causes of serotonin syndrome

A
  • SSRI
  • SNRI
  • MAOi
  • Opiods
  • Lithium
  • TCA
50
Q

What is the general management of serotonin syndrome? What is the management of SSRI overdose?

A
  • Stop med + supportive treatment
  • Activated charcoal
51
Q

What is the WWC in neuroleptic syndrome vs serotonin syndrome?

A
  • WWC is high in NMS
  • WCC is normal in SS
52
Q

What’s the management of Wernicke’s encephalopathy?

A

Pabrinex

53
Q

What are two 1st line treatment options for delirium tremens? What should you give if psychotic features?

A
  • Pabrinex/Lorazepam
  • IM haloperidol
54
Q

What blood lithium level indicates lithium toxicity?

A

> 1.5 mol/L

55
Q

What are the symptoms of lithium toxicity?

A

TOXICCC
- Tremor (coarse)
- Oliguric renal failure
- AtaXia
- Increased reflexes
- Convulsions
- Coma
- Consciousness reduced

56
Q

What’s the management of lithium toxicity?

A
  • Stop lithium
  • High fluid - IV NaCl
  • Renal dialysis if severe
57
Q

How does lithium cause renal damage?

A

Lithium -> parathyroid -> increase PTH -> increase Ca2+ -> kidney damage

58
Q

What happens in the body with alcohol abuse? What does alcohol withdrawal cause?

A
  • Up regulation of NMDA receptors + down regulation of GABA receptors
  • CNS hyperexcitability
59
Q

What triad do you get in PTSD?

A
  • Hyperarousal
  • Avoidance
  • Re-experiencing
60
Q

How long do symptoms need to be ongoing when dx schizophrenia?

A

> 1 month and all the time

61
Q

Which psych drugs are contraindicated when breastfeeding?

A
  • Carbamazepine
  • Lithium
  • Clozapine
62
Q

What is cyclothymia?

A

Hypomania + depression over 2 years or more

63
Q

What is rapid cycling?

A

4 or more episodes of hypomania/depression in a year

64
Q

Can you get psychotic symptoms in hypomania?

A

No

65
Q

How long does mania need to be ongoing?

A

At least 7 days

66
Q

How long does hypomania need to be ongoing?

A

At least 4 days

67
Q

How long do anxiety symptoms need to be ongoing to diagnose GAD?

A

6 months

68
Q

Which tricyclic antidepressant is the safest?

A

Lofepramine

69
Q

According to ICD-10 how many symptoms indicate…
1. Mild depression
2. Moderate depression
3. Severe depression

A
  1. 4
  2. 5-6
  3. 7
70
Q

What indicate a medication change in the management of OCD? What should they be switched to?

A
  • If have trialled SSRI + CBT for 12 weeks with no benefit
  • Switch to different SSRI or Clomipramine (TCA) if can’t tolerate SSRI
71
Q

What PHQ-9 score /27 indicates…
1. Mild depression
2. Moderate depression
3. Moderately severe depression
4. Severe depression

A
  1. 5-9
  2. 10-14
  3. 15-19
  4. 20-27
72
Q

What are symptoms of serotonin withdrawal?

A
  • GI upset
  • Dizziness
  • Flu like symtoms
  • Insomnia
  • Hyperarousal
73
Q

What are egosyntonic thoughts?

A

Thoughts in keeping with ones beliefs and values

74
Q

What are egodystonic thoughts?

A

Thoughts that are very different to patients normal beliefs and values

75
Q

Are obsessive thoughts usually egosyntonic or egodystonic?

A

Egodystonic

76
Q

When does acute stress reaction become PTSD

A

After 4 weeks

77
Q

What is the management of acute stress reaction vs PTSD?

A
  • Acute stress reaction = trauma focussed CBT
  • PTSD = eye movement desensitisation and processing
78
Q

How long would an episode of hypomania last?

A

<7 days

79
Q

What is visual hallucinations involving small people typical of?

A

Alcohol withdrawal

80
Q

What are some features of opioid toxicity?

A
  • Pin point pupils
  • Respiratory depression
  • Bradykinesia
81
Q

Can opioid withdrawal kill you?

A

No

82
Q

What can help establish the severity of GAD?

A

GAD-7 anxiety questionnaire

83
Q

When is NAC indicated in the Rx of paracetamol overdose?

A

If <8 hrs from ingestion

84
Q

When is activated charcoal indicated in the Rx of paractemal overdose?

A

If <1hr from ingestion

85
Q

How would paranoid personality disorder typically present?

A
  • Anger
  • Jealousy
  • Holding grudges
  • Creating conflict
86
Q

What are dynamic risk factors for suicide?

A
  • Substance misuse
  • Financial problems
  • Relationship problems
87
Q

What’s the Rx of someone is status who has had…
- 2 doses of PR diazepam
- 1 dose of PR diazepam

A
  • IV phenytoin
  • Another dose of benzodiazepine (PR diazepam or IV lorazepam)
    CAN ONLY GIVE MAX TWO DOSES OF BENZO
88
Q

What is the only absolute contraindication to ECT?

A

Raised ICP

89
Q

What the time course of serotonin syndrome vs neuroleptic malignant syndrome?

A
  • Serotonin syndrome - occurs over 24 hrs
  • NMS - overs over days/weeks
90
Q

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

A
  1. Beck depression inventory
  2. Edinburgh scale
  3. PHQ-4
  4. PHQ-9
91
Q

What is the FEVER mnemonic for neuroleptic malignant syndrome?

A
  • Fever
  • Encephalopathy
  • Vitals unstable
  • Elevated enzymes
  • Rigidity
92
Q

What is the MMSE useful for?

A

Indicating the presence of cognitive impairment

93
Q

What is the MMSE out of? What score indicate normal, mild, moderate and severe impairment?

A
  1. 30
  2. Normal - 25-30
  3. Mild - 21-24
  4. Moderate - 10-20
  5. Severe - <10
94
Q

What needs to be ruled out in order to make a diagnosis of dementia?

A

Delirium

95
Q

Is acute onset a feature of dementia/delirium?

A

Delirium

96
Q

Which of dementia/delirium is reversible?

A

Delirium

97
Q

What are the 2 types of delirium?

A

Hyper/hypoactive delirium

98
Q

What is the 1st and 2nd line treatment of Alzheimer’s disease?

A

1st - Acetylcholinesterase inhibitor treatment (Donepezil)
2nd - N-methyl-D-asparate antagonists (Memantine)

3a (34 decks)

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