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medicine year 3 > psych > Flashcards

psych Flashcards

1
Q

what is the most common endocrine disorder developing as a result of chronic lithium toxicity?

A

hypothyroidism

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2
Q

when does lithium toxicity leading to hypothyroidism usually manifest in the treatment course?

A

between 6 to 18 months after initiation of treatment

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3
Q

what is a possible effect of carbemazapine?

A

steven johnson syndrome

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4
Q

what is akathisia?

A

movement disorder characterized by a subjective feeling of inner restlessness accompanied by mental distress and an inability to sit still.-possible side effect of antipsychotics

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5
Q

what is bigorexia?

A

muscle dysphoria-you are super muscular and think you’re not. often associated with steroid misuse

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6
Q

what is drunkorexia?

A

restricting intake to drink without consuming extra calories

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7
Q

what is orthorexia?

A

obsession with ‘healthy’/’clean’ diets

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8
Q

what is type 1 diabetes eating disorder?

A

omiting insulin, also known as diabulimia.

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9
Q

what is the most important thing to do if you suspect TCA overdose?

A

perform ECG -widens QRS and prolongs QT

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10
Q

what is the safest TCA?

A

lofepramine

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11
Q

what is the most toxic TCA in overdose?

A

dosulepin

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12
Q

which drugs can cause neuroleptic malignant syndrome?

A

most common=1st generation antipsychotics
also 2nd gen antipsychotics, antidepressants, lithium.

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13
Q

what are the classic anticholinergic side effects?

A

dry mouth blurry vision constipation drowsiness sedation

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14
Q

if CBT or EMDR are ineffective in PTSD, what are the first line drug treatments?

A

venlafaxine or an SSRI

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15
Q

what is a common risk of SSRIs?

A

bleeding, can increase risk of GI bleeding if they have any other risk factors and should be prescribed PPI
because they can deplete platelet serotonin , reducing clot formation and increasing risk of bleeding.

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16
Q

what is the first line therapy for children and young people with anorexia nervosa?

A

family based therapy

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17
Q

which antipsychotic should you try if they’re having really bad side effects to do with their prolactin elevation?

A

aripiprazole-has the most tolerable side effect profile of the antipsychotics, esp for prolactin elevation.

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18
Q

for a diagnosis of PTSD, how long should symptoms be present for?

A

4 weeks

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19
Q

what is the most likely SSRI to cause QT prolongation and tdP?

A

citalopram

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20
Q

what is dystonia?

A

uncontrolled and sometimes painful muscle spasms

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21
Q

what are some examples of acute dystonic reactions?

A

torticollis-in neck muscles
opistotonus-back becomes extremely arched due to spasms
dysarthria-difficulty speaking
oculogyric crisis-prolonged upward deviation of eyes

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22
Q

what endocrine abnormalities can lithium cause?

A

hypothyroidism
hyperparathyroidism and resultant high calcium

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23
Q

how do you stop an SSRI?

A

withdraw gradually over a 4 week period

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24
Q

what factors make a paracetomol overdose higher risk to be more damaging?

A

chronic alcohol intake
malnourishment, inc anorexia nervosa
taking P450 inducing drugs like rifampicin, phenytoin, carbamazepine.

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25
Q

what is the indications for memantine use?

A

patients who are intolerant of or have a contraindication to AChE inhibitors or those with severe alzheimer’s.

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26
Q

why can parkinson’s disease lead to postural hypotension?

A

causes autonomic failure

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27
Q

what is the definition of postural hypotension?

A

fall in BP of at least 20 systolic and 10 diastolic within 3 minutes of the upright position

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28
Q

what are the symptoms of sudden SSRI discontinuation?

A

increased mood change
restlessness
difficulty sleeping
unsteadiness
sweating
gastrointestinal symptoms: pain, cramping, diarrhoea, vomiting
paraesthesia

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29
Q

alcohol withdrawal timescale of symptoms?

A

symptoms: 6-12 hours
seizures: 36 hours
delirium tremens: 72 hours

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30
Q

how frequently should lithium levels monitoring take place till concentrations are stable?

A

weekly after initiation and at every dose change till concentrations are stable

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31
Q

how often should you check lithium levels before concentrations are stable?

A

weekly after initiation and after each dose change until dose is stable.

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32
Q

which drug manages acute dystonia secondary to antipsychotics?

A

procyclidine -an anticholinergic.

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33
Q

which SSRIs are associated with increased QT interval?

A

citalopram and escitalopram

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34
Q

if a patient has a good response to antidepressants how long should they stay on it to reduce the risk of relapse?

A

at least 6 months

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35
Q

what is cotard syndrome?

A

rare mental disorder where the affected patient believes that they (or in some cases just a part of their body) is either dead or non-existent
associated with severe depression and psychosis

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36
Q

what are the short term side effects of ECT?

A

headache
nausea
short term memory impairment
memory loss of events before ECT
cardiac arrythmias

37
Q

what is circumstantiality?

A

inability to answer a question without giving excessive, unnecessary detail, however, the patient eventually returns to the original point and it is addressed.

38
Q

what is conversion disorder?

A

psychiatric condition where psychological stress is unconsciously manifested as physical neurological symptoms-typically involves loss of motor or sensory function.

39
Q

what is charles bonnet syndrome?

A

seeing things that are not real ( hallucinations) after losing a lot of your sight -eg associated with ARMD, cataracts. patient usually understands the symptoms aren’t real.

40
Q

what are the symptoms of TCA overdose?

A

anticholinergic poisoning -dry mouth, dilated pupils, urinary retention
cardiac conduction defects, arrhytmias
hypothermia, hypotension, convulsions, respiratory failure
hyperreflexia and extensor plantar response

41
Q

what are the symptoms of lithium OD?

A

delayed onset -12h or more
intially: apathy, restlessness
then: D+V, ataxia, tremor, weakness, dysarthria, muscle twitching
severe: electrolyte imbalance, dehydration, convulsions, renal failure, hypotension, coma

42
Q

what are the symptoms of benzo OD?

A

drowsiness, dysarthria, ataxia, nystagmus, resp depression

43
Q

what are the symptoms of amphetamine OD?

A

initially: excessive activity, wakefulness, hallucinations, paranoia, hypertension
later: convulsions, hyperthermia, exhaustion, coma

44
Q

what are the symptoms of cocaine OD?

A

agitation, hypertension, tachycardia, dilated pupils, hyperthermia, hyperreflexia, hypertonia, hallucinations
cardiac effects-chest pain, arrhythmias, MI

45
Q

what are the symptoms of opioid OD?

A

drowsiness, coma, resp depression, pinpoint pupils

46
Q

what is the management of social anxiety disorder?

A

individual CBT
self help
SSRI-sertraline or escitalopram

47
Q

what is avolition?

A

decrease in the ability to initiate and persist in self-directed purposeful activities

48
Q

what is schizoaffective disorder?

A

schizophrenia symptoms +manic, depressed, or mixed episode symptoms happening together in the same episode (either together or within a few days of eachother) for at least 1 month.

49
Q

what is schizotypal disorder?

A

at least several years and affecting functioning of:
eccentricities in behaviour, appearance and speech

+

cognitive and perceptual distortions, unusual beliefs, and discomfort with— and often reduced capacity for— interpersonal relationships

50
Q

what is acute and transient psychotic disorder?

A

acute onset of psychotic symptoms.
reach max severity within 2 weeks, lasts anywhere from a few days to max 3 months.

51
Q

how long does agoraphabia need to be present to be diagnosed?

A

several months

52
Q

what is the management for specific/isolated phobias?

A

computerised CBT
self help
SSRI/beta blockers if severe

53
Q

what mental disorders are in the category of disorders specifically associated with stress?

A

PTSD
C-PTSD
prolonged grief disorder
adjustment disorder
reactive attachment disorder
disinhibited reactive attachment disorder

54
Q

what is the drug treatment of panic disorder?

A

SSRI-1st line
TCA -2nd line
beta blockers

55
Q

what is trichotillomania?

A

when someone cannot resist the urge to pull out their hair -type of body focussed repetitive behaviour disorder.

56
Q

what is dermatillomania?

A

disorder where you cannot stop picking at your skin -type of body focussed repetitive behaviour disorder.

57
Q

what is in the group of obsessive compulsive related disorders?

A

obsessive compulsive disorder
body dysmorphic disorder (BDD)
olfactory reference disorder
body focussed repetitive behaviour disorders
hypochondriasis (health anxiety disorder)
hoarding disorder

58
Q

what is olfactory reference disorder?

A

persistent false belief and preoccupation with the idea of emitting abnormal body odors which the patient thinks are foul and offensive to other individuals

59
Q

how are anxiety disorders grouped in the ICD11?

A

primary fear disorders:
generalised anxiety disorder
panic disorder
agoraphobia
specific phobia
social anxiety disorder
separation anxiety disorder
selective mutism

60
Q

what are the features of binge eating disorder?

A

frequent binges
distressing
accompanied by negative emotions (guilt/disgust)
not associated with compensatory behaviours
33-50% will become obese

61
Q

what do you need to specifically ask in social history if they’re presenting with cognitive impairment?

A

high risk hobbies/jobs like boxing, rugby-stuff that could cause head trauma

62
Q

what is hepatic encephelopathy?

A

altered level of consciousness as a result of liver failure -can be gradual or sudden. thought to be due to ammonia buildup.

63
Q

what can episodes of hepatic encephalopathy be triggered by?

A

infections
GI bleeds
constipation
electrolyte imbalances
medications

64
Q

what medication can decrease ammonia levels in the body?

A

lactulose

65
Q

what is hypertensive encephelopathy?

A

type of hypertensive emergency where end organ damage happens in the brain-less common than other hypertensive emergencies (usually people who get it have BPs >220/110)

66
Q

which test is the most widely used one to assess intellectual disability and capabilities?

A

wais test -weschler adult intelligence scale -most widely used intelligence and cognitive ability

67
Q

what are the ranges of intellectual disability?

A

mild -2-3 SDs below mean. most are relatively independent, master self care, can communicate
moderate -3-4 SDs below mean. most require considerable +consistent support to achieve independent living
severe -4 or more SDs below mean. v limited communication, usually daily support in supervised environment.
profound: approximately less than 0.003rd percentile but tests can’t test lower. v limited skills -need a lot of support.

68
Q

what do you need to do to a patient before ECT?

A

neuroimaging (CT/MRI)

69
Q

how long does heroin stay in the urine?

A

up to 48h

70
Q

how long does methadone stay in the urine?

A

7-9 days

71
Q

how long does cannabis last in the urine?

A

1-3 weeks of occasional use, 4-6 weeks if heavy use

72
Q

when do you do drug testing in someone on methadone?

A

do frequent testing at the start and do regular testing (4-6 times a year) once the person is stabilised to monitor use of additional drugs.

73
Q

what are the indications for ECT?

A

short term and rapid improvements of severe sx after adequate trials of other treatments are ineffective/it is life threatening, in people with:
catatonia
severe depression
prolonged or severe manic episode

74
Q

how does ECT work?

A

uses electric current to create a generalised cerebral seizure -causes changes in cerebral blood flow and regional metabolism, increases DA, hippocampal, frontal lobes, hippocampus, parahippocampal gyri, amygdala, and white matter activity and function

75
Q

what are 2 absolute contraindications for ECT?

A

phaeochromocytoma
raised ICP with mass effect

76
Q

what is echopraxia?

A

involuntary repetition or imitation of another person’s actions

77
Q

what are the features of multiple system atrophy?

A

parkinsonism
autonomic disturbance -erectile dysfunction (often early feature), postural hypotension, atonic bladder
cerebellar signs (danish)

78
Q

what are 2 examples of parkinsons plus syndromes?

A

multiple system atrophy
progressive supranuclear palsy

79
Q

which drugs do you use for drug induced extrapyramidal symptoms?

A

procyclidine -acute dystonia
tardive dyskinesia -tetrabenazine or valproate
akathisia -propranolol or cyproheptadine
NMS -dantrolene

80
Q

what is the difference between circumstantiality and tangientality?

A

circumstantiality -go off on tangents but come back to answer the question
tangentiality -go off on tangents and don’t go back to answer the question

81
Q

which 2nd gen antipsychotic is the most likely to prolong the QTc?

A

risperidone

82
Q

which blood tests for monitoring antipsychotics in wriske?

A

Hba1c
fasting BM
blood lipid
prolactin

83
Q

what is a characteristic side effect of mirtazapine?

A

increase in apetite

84
Q

what is a side effect of methylphenidate that you need to monitor?

A

decrease in appetite -can lead to stunted growth -patients <10 need to have their weight and height plotted at regular intervals

85
Q

what are the big bloods changes in refeeeding syndrome and why?

A

glycogen/fat/protein synthesis and transport of glucose into cells requires phosphate, magnesium, potassium, and thiamine -these rapidly get depleted

86
Q

tell me about tremors and lithium

A

fine tremor is normal when taking lithium
if tremor becomes course, suspect lithium toxicity

87
Q

what are the 3 big systemic side effects of lithium to watch out for?

A

renal dysfunction
hypothyroidism
benign intracranial hypertension (BIH)

88
Q

how does BIH present?

A

persistent headaches, visual disturbances

medicine year 3 (21 decks)

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