psych Flashcards
X linked inheritance. Children of men with condition ? Children of female carriers
All daughters carriers
Sons fine
Daughters 50% carrier
Sons 50% affected
EPS most likely from?
-Parkinsonism an easy one from question but what is described below:
Motor restlessness with inability to sit still?
Involuntary contractions of muscle groups?
Involuntary movements of face (and sometimes trunk) that occur after manny years?
Typical antipsychotics
Akathesia
Dystonia (includes oliguric crisis)
Tardive dyskinesia
Management of dysmorphophobia
CBT
Rarely cosmetic surgery
Presents with lots of symptoms which cannot be medically explained
Somatisation disorder
[Has poor prognosis due to iatrogenic medical / surgical interventions]
Deliberately acts medical symptoms to receive medical treatment or attention / sympathy
Factitious disorder
Deliberately making up symptoms to gain something (e.g opioids) or for the avoidance of work / another type of duty
Malingering disorder
Fear of scrutiny of others (eg people commenting or critisiing) leading to avoidance of social situations? How does this differ from Agoraphobia?
Social phobia
Agoraphobia - Fear of being away from home, crowds or public places rather than the pure fear of social contact. Often has a fear escape would be difficult
Loss of motor control and sensory functions not explained by physiological mechanisms
Conversion disorder (also dissociative disorder)
- often associated with psychological conflict
What is la belle indifference ?
Lack of concern over significant symptoms
What is Ganser syndrome
Psych - amnesia, stupour, possessive disorder, trance
Phys - Motor disorders, anaesthesia / sensory, motor disorders
Generally 4 points for diagnosis
-Approximate answers
-clouded consciousness
-conversion disorder
-Hallucinations
[DONT confuse with conversion disorder]
MRI of conversion disorder may demonstrate …
limbic system overriding sensory
Minimum duration of symptoms for ADHD diagnosis? Age?
Usually methylphenidate but what other drugs?
6 months
-Usually needs (6) symptoms occurring in multiple settings and present by age 12
Adderal - amphetamine
Noradrenalin and serotonin reuptake inhibitors - atomoxetine
Gout, renal problems, poor muscle control, learning difficulty
lesch-nyhan syndrome (x linked)
Short with a big forhead / head / ears and massive testis
fragile x
Screening tool for postpartum depression
Edinburgh postnatal depression scale
When does postpartum blues happen
Early - first week commonly
When does post partum psychosis occur?
Usually about 2 weeks post partum
Structural brain abnormalities on MRI linked to depression
Lesions in subcortical white matter
Reduced glial cells in pre frontal cortex
atrophy of hippocampus
Depression diagnosis
core Sx - low mood, energy and anhedonia
Lasting > 2 weeks
Chronic mild depression symptoms which may be associated with physical/psychological illness
Dysthymia
Depression and thinks dead
cortard syndrome
Key organic causes of depression to exclude
Hypothyroid
Drug induced - Eg benzos / propranolol / POP /
Pathophysiology in FTD
Tau proteins or other protein inclusions
Most common gene in FTD? What else can this gene cause?
C9orf72
-Also causes MND
[Just vaguely remember to recognise the shape of it]
Loss of vocab with maintained fluency of speech. Forget familiar faces but memory and visual spacial skills presented.
Semantic dementia - type of FTD
Slow, hesitant grammatically incorrect speech,
Impaired understanding of complex sentences - though understanding of individual words preserved.
Impairment of orofacial muscles Eg swallow, yawn
Stuttering, repetition inability, difficulty reading/writing
Progressive non-fluent aphasia - Type of FTD
Reversible cause of dementia? Sx?
Normal pressure hydrocephalus
apathy
Inattention
urinary incontinence
gait apraxia
Presents like schitz but with Macrocytoisis, thrombocytopenia and anaemia on bloods
Delerium tremens
Nerve palsy in Wernicke encephalopathy
CN VI - lat rectus
[confusion + nystagmus]
2 parts of korsakovs sx
short term memory loss
confabulation
Which drug makes drinking feel shite? Which reduces alcohol craving?
Disulfiram
Naltrexone
Management of mania in bipolar
Antipsychotics Eg risperidone / olanzapine
Who cant get lithium
Pregnant
Renal / thyroid / cardiac / Addison’s disease
Monitoring in clozapine
weekly blood counts for 18 weeks
Then fortnightly for 1 year
Then monthly
External factors Eg ‘spirits’ or friends controlling ones actions
External locus of control
History of depression + evidence of post-natal depression Rx
SSRI - Sertraline good as only minimal in breast milk
If didn’t have history of depression - CBT is good
Which antihypertensives are bad to take with lithium
thiazides - reduce lithium excretion -> toxicity
Withdrawal from social contact leads to isolation and inability to display feelings/experience pleasure
Schizoid personality disorder
Narcissistic vs histrionic disorder
N - Belief they are perfect / successful
H- Shallow with a tendency to seek attention / excitement
Psychodynamic therapy?
Examines ways events are perceived by a person -> develop adaptive mode of response
CBT
Explores how people think and allows to reformulate behaviour
Borderline personality disorder therapy
Dialectical behaviour therapy - develop coping skills and impulse control
Lithium monitoring
1 week after starting / dose change
Once stable 1-2monthly for 6 months
Then every 3-6 months
Thyroid and renal function before starting and every 6 months
Narcolepsy gene
HLA DQ0602
Who gets sudden loss of muscle tone (cataplexy) and hypnagogic/hypnopompic hallucinations ? Rx? Rx if cataplexy?
Narcolepsy
Modafinil
sodium oxybate
[get hallucinations as early REM sleep]
GAD treatment + length
SSRI - continued for at least 1 year
CBT
Monitored every 2 weeks for 3 months then every three months
-Treatment continued for a minimum of 1 year
Most common cause of death in schitx
CV disease - unhealthy lifestyle and effects of antipsychotics
Delirium in parkinsons
Lorazapam
Most common trait in antisocial personality disorder
neglect for rights of others
Mild mod severe profound learning difficulty IQ
Mild <70
mod <50
severe< 35
Profound <20
Body dysmorphic disorder 1st line is CBT
If severe which is 1st line choice of SSRI
Fluoxetine
[worried they are Fat Fux-]
Clomipramine is second line
Called when separate ones thoughts from emotion. Eg staying calm and no emotion if a child suddenly dies?
isolation
What is a haptic hallucination
Flase sensory perception
- Eg being touched / strangled / insects crawling under skin
What is dissociative amnesia
amnesia when trying to avoid current stressors
Eg unable to remember name/job/address after a marriage breakdown
When do delta waves begin to occur in sleep? Which stage is deepest?
Stage 3
stage 4 is deep sleep and has the most delta waves
Most toxic ssri in overdose
Citalopram
Which ssri has particularly problems with withdrawal
paroxetine
->isomnia, anxiety, agitation…
Differentiate lewy body and Alzheimer’s
Fluctuating cognitive function
Excessive somnolence
Visual hallucinations
Parkinsonism
[Both get auditory hallucinations, lewy body gets more visual]
What are lewy bodies made of
a-synuclein
Buspirone class? used for? most common side effect
Partial Serotonin reuptake inhibitor - used for anxiety
Nasal congestoin
How long symptoms GAD for diagnosis
6 months minimum
Mild learning difficulty (IQ<70) - most common cause
Idiopathic
Only absolute CI to ECT
Raised ICP
What is st johns wot used for?
mild depression
Characteristic on CT of wernike/korsakov
Loss of neurones in mamillary body
(eventually -> cerebral atrophy though this is less specific)
visual loss pattern in conversion disorder
spiralling loss
seen in 50% of people taking lithium in first month
fine tremor
How many people get hypothyroid with lithium?
20%
Why no lithium in pregnancy
Babies born with ebstein’s anomaly
-Malformed tricuspid valve
(especially in early preg)
4 features of ganser
HACC (not a good hack)
-Hallucinations
-Approximate answers
-clouded consciousness
-conversion disorder
Cortisol in anorexia
Raised due to stress response to starvation
Class is clozapine
atypical
Which antipsychotic most linked with high prolactin
risperidone
Genetic disorder with severe learning difficulty, wheelchair bound and often aggressive / self-injuring behaviour ? Caused by what
lesch-nyhan syndrome
X-linked recessive
Disorder of purine metabolism -> high uric acid / xanthine
<18 depression rx?
CBT only as high risk of suicide with SSRIs
What % of PTSD recover spontaneously? Rx otherwise ?
80-90%
Trauma focused CBT
eye movement desensitisation and reprocessing
SSRI/venlafaxine
What BMI for anorexia
<18.5
Pathological findings hungtintons
Neuronal loss in caudate and putamen
Picks disease pathological finding? what are they?
Pick bodies
-Round silver staining inclusions (contain hyperphosphorylated tau protein)
Chronic traumatic encephalopathy usually called? Seen on pathology?
Punch drunk syndrome [first described in boxers]
Neurofibrinilary tangles
Lithium is first line for bipolar. What is second
Valproate
What is cyclothymia
Chronic mild bipolar with less severe symptoms either side
Most common cause of inherited learning difficulty? Gene?
Fragile X
FMR1 gene
[long face, big ears, autism…]
Class are antipsychotics
Dopamine antagonists
Rx of dystonic reaction eg oculogyric crisis
Anticolinergics
Eg procyclidine / benztropine
Pt had read passage in bible which refers to him having special powers. Now has ability to control other peoples movements.. What is this
Delusion of reference
[Delusion of control is that of people controlling your thoughts/movements]
What is bathophobia
Fear of depths
Fear of open spaces, crowds and unfamiliar settings?
Agoraphobia
[Social phobia is fear of interacting with people]
How does dilsufiram work
Inhibits Acetylealdehyde dehydrogenase
Acamprosate class
GABA-like drug that acts on glutamatergic NMDA receptor
[same receptor as alcohol to reduce craving]
which antidepressants cause anticholinergic side effects?
Tricyclics
Which infection is associated with development of OCD
B-haemolytic strep
First line pharma rx for OCD
Citalopram
Lack of interest in social relationships, solitary lifestyle, emotional coldness / apathy
Schizoid personality disorder
Indicator of poor prognosis in schitz
Negative symtoms predominate - Eg long history of social withdrawal
Screening tool for eating disorders
SCOFF
[Do you make yourself SICK because you feel uncomfortably full?
Do you worry you have lost CONTROL over how much you eat?
Have you recently lost more than ONE stone in a 3 month period?
Do you believe yourself to be FAT when others say you are too thin?
Would you say that FOOD dominates your life?]
What is main indication for ECT
Depression with life threatening features
(Eg psychotic - auditory hallucination ‘worthless and deserve to die’
Pseudo dementia key features ? And differentiate from dementia
Depression with relatively acute onset cognitive impairment
Often complain about cognitive difficulties
How to move from a MAOinhibitor to SSRI
Stop MAO wait 14 days then start SSRI
[Otherwise risk of serotonin syndrome]
Complains one person cunning bad, selfish…
And another kind, helpful and generous
What is this? How is it different from idealisation?
Splitting
-Splits people into Good or bad
In idealisation there is over-emphasis on good persons qualities
What is fabricated or induce illness commonly called
Munchausens by proxy
Buspirone used for? Class
Acute anxiety
Partial serotonin receptor agonist
Which stage of sleep for sleepwalking
Stage 3 NREM
What is sublimation
Filtering of behaviour so only socially acceptable forms displayed
What is altruism
acting in a selfless manner to benefit others
Nephrogenic DI which osmolalities are low/high
Urine low
Serum high
When are SSRIs not first line for depression
Bleeding risk Eg on warfarin / heparin
->mirtazapine
Rx of diarrhoea if opiate withdrawal and don’t know how much methadone been taking?
Loperamide
How long continue antidepressants after recovery? if multiple relapses?
6 months
2 years if recurrent relapses
Erectile dysfunction. Still getting morning erections 1st line Rx
Psychosexual counciling
How many CAG repeats for huntingtons
> 37
Strange thing which is a good prognostic factor for shitz
History of a mood disorder or
FHx of mood disorder
Buproprion used for
Antidepressant used for smoking cessation
Insomnia, low mood, delusions (eg of guilt) and psychomotor agitation
Major depression
belief your actions are being controlled by external source
Made actions
Streetlights came on because the spies are watching them
Delusion of perception
Feelings controlled by external source
Made feelings
Sensations being imposed on by a outside force
Somantic passivity
Motor or sensory deficit with no organic cause
Conversion disorder
Increased risk of suicide in depression when
Feeling of hopelessness
Difference between alcohol abuse and dependence
Dependence - symptoms of withdrawal and tollerance
When does benzo withdrawal start
Paroxetine withdrawal
48-72hrs
24-48hrs
Socially withdrawn, eccentric behaviour / beliefs, paranoia, possible some mild “psychotic” symptoms
Schitzotypal
what is key aspect of a phobia
The patient believes it is irrational
Unpredictable behaviour.
chronic loneliness or boredom.
Self-harm. Poor relationships
Borderline personality disorder
Key risks for young person suicide
Parental divorce
Anorexic with poor wound healing, hair loss and glositis is deficient in what?
Zinc deficiency
[Vit C (scurvy) causes the same but less common in anorexic
Panic disorder if no option for CBT in q
SSRI eg citalopram
What social factors are assoc with completed suicide
Loss of job
Homelessness
Low socioeconomic status
[living along is not one]
