Psych Flashcards
When do the main symptoms of alcohol withdrawal occur?
6-12 hours = tremor, anxiety, sweating and tachycardia
36 hrs = seizures
48-72 hrs = Delirium Tremens (coarse tremor, confusion, delusions, hallucination, fever and tachycardia)
What are clang associations?
Ideas only related by rhyme/sounding similar
What is circumstantiality?
Excess and unnecessary detail when answering questions but does return to the original point
What is Tangientiality?
Patient wanders from the topic and does not return to it
What are neologisms?
New word formations e.g. combines 2 words
What is word salad?
Incoherent speech with random words
What is knight’s move thinking?
Unexpected and illogical leaps from one idea to the next. Seen in schizophrenia
What is flight of ideas?
Leaps from one topic to the next but there are links between them. Seen in mania
What is perseveration?
Repetition of ideas/words despite attempts to change the topic
What is Echolia?
Repetition of someone else’s speech including the question that was asked
When should you review patients under 25 starting an SSRI?
In 1 week
When should you review starting CBT?
In 2 weeks
Which SSRIs are associated with dose dependant prolonged QT syndrome? What can this lead to?
Citalopram and Escitalopram
Can lead to Torsade’s de Points
What is the 1st line SSRI in children and adolescents?
Fluoxetine
What is the 1st line SSRI in those with Hx of MI/unstable angina?
Sertraline
What is the strongest RF for psychiatric disorders?
Family history
Name the side effects of lithium?
Fine tremor, nephrotoxicity secondary to DI, hypothyroidism, weight gain, IIH, leucocytosis, hyperparathyroidism (leading to hypercalcaemia) and T-wave flattening
Why should you never prescribe SSRIs and Triptans (e.g. Sumatriptan)/MAOis (e.g. Rasagline) together? How would this present?
This increases the risk of serotonin syndrome (presents with fever, confusion, seizures, renal/hepatic impairment, arrhythmias, increased tone and sweating)
Mx of OCD?
CBT and ERP are first line if mild functional impairment.
If moderate or severe functional impairment offer SSRI also (SSRIs can take 12 weeks to work in OCD)
If SSRI is contraindicated offer clomipramine
What it Schizoid PD?
They are indifferent to praise or criticism, they prefer solitary activities, they lack interest in friendships or sexual partners, they are emotionally cold
What is Schizotypal PD?
They have ideas of reference, odd or magical thinking
Odd/eccentric behaviour
Paranoid ideation/suspiciousness
Lack close friends
Inappropriate affect
What should you do with someone presenting with hypomania?
Routinely refer to the community mental health team. An urgent referral is indicated if there is deemed to be a risk to self or others
Mx of PTSD?
1st line = Trauma focused CBT or EMDR
2nd line = Venlafaxine or SSRIs
3rd line = Risperidone
What should you give to a patient on an SSRI and a NSAID?
PPIs
Type 1 vs Type 2 bipolar disorder?
Type 1 bipolar disorder is associated with depression and mania (lasts at least 7 days and associated with psychotic symptoms)
Type 2 bipolar disorder is associated with depression and hypomania (lasts for <7 days and not associated with psychotic symptoms)
Mx Obsessive Compulsive PD?
Dialectical Behavioural Therapy
What type of drug are clomipramine and imipramine? What side effects do they commonly cause?
Tricyclic antidepressant.
SEs = dry mouth, blurred vision, weight gain, constipation, drowsiness, urinary retention and prolonged QT
What is a normal MMSE score?
> = 25
What should you consider as the diagnosis in global memory loss?
Depression!
Dementia would typically cause recent memory loss first
What are the risks associated with SSRIs in pregnancy?
1st trimester = increased risk of congenital heart defects
2nd trimester = increased risk of persistent pulmonary hypertension
Paroxetine = increased risk of congenital malformations particularly in the first timester
How can we manage alcohol withdrawal if there is alcoholic liver disease?
Lorazepam is preferred over chlordiazepoxide or diazepam
What is catatonia?
Stopping voluntary movements or staying in an unusual position. This is seen in scizophrenia
Define Obsession and Compulsion?
Obsession = an intrusive, unpleasant and unwanted thought
Compulsion = a senseless action used to reduce anxiety caused by an obsession
Mx of acute stress disorder?
Trauma focused CBT
How long should you withdraw SSRIs over?
4 weeks
How can SSRIs affect sodium?
They can cause hyponatraemia
SEs of Mirtazipine?
Sedation and increased appetite
What should you do if leucocytosis occurs when beginning lithium therapy?
Nothing, this can be normal. Just monitor
What are the core depressive symptoms?
Anhedonia, Anergia and Low mood
What are the somatic depressive symptoms?
Early morning wakening, change in appetite, loss of libido and diurnal mood variation
What is an important side effect of SNRIs to be aware of?
HTN - monitor BP!
How can you interpret a PHQ-9 score?
<16 = less severe depression, manage with guided self help, CBT or SSRIs
>= 16 = moderate/severe depression, manage with CBT and SSRIs
If a patient describes all 3 core Sx of depression and at least 3 other symptoms they are said to have moderate-severe depression
How long should antidepressants be continued for after the remission of symptoms?
6 months, this reduces relapses
True or false patients with schizotypal PD have distorted views of reality including unfounded suspicions and unusual behaviours?
True
They do NOT have psychotic symptoms though
Mx of borderline personality disorder?
Dialectical Behavioural Therapy
Sx of SSRI discontinuation?
Mood changes, restlessness, difficulty sleeping, unsteadiness, dizziness, sweating, GI disturbance and paraesthesia (often described as electric shock sensations)
Sx of Paranoid PD?
Hypersensitive to the actions/words of others, unforgiving when insulted, question the loyalty of friends, are reluctant to confide in others, perceive actions of others as an attack on their character
Sx of Avoidant PD?
Have very low self-esteem, they have an intense fear of being criticised/rejected, avoidance of social situations for fear of embarrassment
Mx of schizophrenia?
Antipsychotics and CBT
What can happen to those on MAOIs if they consume tyramine rich foods (e.g. cheese)?
Hypertensive crisis
What drug class are duloxetine/venlafaxine?
SNRIs
What should you do if clozapine dose is missed for more than 48 hours?
Restart it again slowly (re-titrate the dose)
What is disulfiram?
A deterrent drug used in managing alcoholism
It causes nausea, vomiting and facial flushing after consuming alcohol
What is acamprostate?
An anti-craving drug which assists in the prevention of relapse in alcoholics
What is somatisation disorder?
Patients present with multiple symptoms which are present for at least 2 years, they refuse to accept negative test results
What is hypochondriasis?
Patient persistently believes they have an underlying serious disease e.g. cancer, they refuse to accept negative test results
What is conversion disorder?
The loss of motor or sensory function, often secondary to stress - they are not doing this intentionally
What is dissociative disorder?
Separating memories from normal consciousness, dissociative personality disorder (aka multiple personality disorder) is the most extreme form
What is factitious disorder?
AKA Munchausen syndrome
Individuals intentionally present with physical or mental health problems without having a health problem. They are evidently deceptive in the absence of any external rewards
What is Malingering?
Fraudulent production of symptoms for financial gain (e.g. to claim benefits)
True or false, patients with OCD are unaware that their compulsions are illogical?
FALSE
Patients with OCD are aware that their compulsions are illogical but still can not stop
This separates OCD from OCPD
Mx of GAD?
1st line = SSRIs
2nd line = switch SSRI (e.g. to escitalopram) or start SNRI (e.g. venlafaxine or duloxetine)
1st rank symptoms of schizophrenia
Though disorder, auditory hallucinations (2nd or 3rd person), passivity phenomenon, delusions/delusional perceptions
How old must a patient be for us to diagnose a personality disorder?
At least 18 years old
What is Hoover’s sign?
Pressure felt under the paretic leg when lifting the non-paretic leg against resistance. This implies a non-organic cause of paresis
Which type of anti-psychotics are most associated with acute dystonic reactions?
First generation e.g. Haloperidol and Chlorpromazine
What is Cortard syndrome?
A belief that the patient is dead or does not exist
What is Capgras syndrome?
A belief that a friend or family member has been replaced my an identical imposter
What should you do if a patient presents with threatening or violent behaviour in public?
Call the police
How do we assess alcohol withdrawal severity?
The clinical institute withdrawal assessment for alcohol
What should you do if 2 SSRIs have failed to help with anxiety Mx?
Start and SNRI e.g. duloxetine
True or false anti-psychotics increase the risk of PE/DVT/Stroke in the elderly?
TRUE
What is brief psychotic disorder?
Psychosis lasting <1 month with a return to baseline function after
What is the risk of developing schizophrenia if one monozygotic twin is affected?
50%
What is akathasia?
Severe restlessness caused by anti-psychotics
What is post-concussion syndrome?
Headache, fatigue, anxiety or depression and dizziness which can be seen after even mild head trauma
Many anti-psychotics can cause hyperprolactinaemia. Which is least likely to cause this?
Aripirazole
What should you always rule out in patients with ?anxiety
Hyperthyroidism
What is a common side effect of clozapine to alert patients of?
Constipation - may lead to bowel obstruction
What condition is flight of ideas seen in?
Mania
