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Year 4/5 Revision > Psych > Flashcards

Psych Flashcards

1
Q

Depression: definition and grading (NICE)

A

Persistent low mood, anhedonia and fatigue, associated with biological, cognitive and emotional symptoms.
NICE grades it, using DSM IV -
1. Less severe depression - subthreshold & mild
2. Severe depression - mild & moderate

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2
Q

Grading systems?
DIfferentials?

A

PHQ-9 and HAD
Dx
Dementia
Bipolar disorder type II
Hypothyroidism

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3
Q

Depression - 1st-3rd line management: less severe and severe
Other opt

A

Less severe:
1. guided self-help
2. group CBT/BA
3. individual
Severe:
1. Antidepressant + individual CBT/BA
2. One of the 2 options / BA
Counselling, interpersonal psychotherapy, STPP

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4
Q

What causes serotinergic syndrome?
What two types of antidepressants should never be prescribed together? and how does it present?

A

Overuse of serotinergic drugs: overactivation of 5HT1-a and 5HT2-a receptors.
MAO-I and SSRIs : dangerous levels of serotonin

Sx -

  1. change in mental state (anxiety, agitiation)
  2. autonomic hyperactivity (tachycardia, tachypnoea, hyperthermia)
  3. muscular hyperactivity (tremors, rigitdity, akithesia)
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5
Q

What are the potential AEs of ECT (reserved for sevre L-T depression/ when a rapid response is required or other treatments have failed)

A

Initial: haedache, confusion,
SHort term: mouth damage due to jaw muscle contraction
Long term: Anterograde and retrograde amnesia, personality change, loss of certain skills

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6
Q

Define bipolar - types 1 and 2

A

Bipolar disorder = 1+ episode of mania/hypomania usually WITH 1+ episode of depression
Type 1:Mania +/- depression
Type 2:Hypomania +/- depression.

Not episodes of mania themselves are not diagnostic. The depression is most often major/severe.

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7
Q

Distinguish mania from hypomania

A

Mania - persistent elevated mood/irritability for >=1week (+ 3 of typical sx - decreased fatiguability, increased spending/reckless behaviour, sexual inhibition, psychosis, primary delusions)

Hypomania - elevated mood/irritabilty for >=4 consecutive days (typical sx…increased energy/activity without delusions or hallucinations.

Note - mania most often includes psychosis (grandiose/persecutory delusions or auditory hallucinations) but it doesn’t HAVE to.

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8
Q

Physical problems that could cause mania?

A

Syphillis, HIV, thyroid disease, epilepsy

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9
Q

Management - bipolar type 1 (referral process and treatment options)

A

referral process: urgent to CMHT if mania/severe depression, routine if hypomania
Talking therapies: bipolar psychological intervention
Mania: Antipsychotic + Valproate/Lithium (mood stabiliser)
depression: Talking therapies. If already on an antidepressant (stop it; usually doesn’t help) and consider mood stabiliser.

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10
Q

Define Melancholia

A

Severe depression where biological symptoms are prominent

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11
Q

List 6 causes of psychosis

A
  1. Schizophrenia
  2. Schizoaffective disorder
  3. Bipolar affective disorder (type 1)
  4. Brief psychotic disorder
  5. Persistent delusional disorder
  6. Drug induced
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12
Q

Define psychosis

A
  • Disorder of thought form or content (delusions) and/or perception (hallucinations)
  • causing loss of contact with reality
  • personality change
  • and deterioation of normal social function
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13
Q

Characterise schizophrenia - (3)

A

DIsorder of thought processing
Loss of contact with reality
Loss of emotional responsiveness

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14
Q
  • Definition
  • +ve and -ve sx
  • Schneider’s first rank symptoms
A

Schizophrenia is a chronic disorder characterised by positive, negative and cognitive symptoms, that lead to a loss of contact with external reality and deterioration in social function.
Positive - hallucinations (typically auditory third person and running commentrary), delusions (paranoia, persecutory).
Negative - alogia, anhedonia, anergia, avolition, blunted affect.
First rank symptoms:
1. Auditory hallucinations
2. Thought disroders- insertion/withdrwawal/broadcasting
3. Passivity phenomena - bodily sensations controlled by external influence.
4. Delusional perception - the traffic light is green therefore I am king.

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15
Q

Features of PTSD and duration according to DSM-V

A
  1. Re-experiencing: flashbacks/nightmares
  2. Hyperarrousal: anger, insomina, hypervigilance etc
  3. Emotional numbing
  4. Avoidance; of things/people that remind them

For > 1 month

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16
Q

Side effects of tricyclic antidepressants (and name 3)

A

“Drycyclics” - blurred vision, urinary retention (or overflow incontience), constipation, dry mouth, drowsiness, and lengthening of QT interval (A drug).
Amitryptiline, Imipramine, Clomipramine.
Used less for depression and more for neuropathic pain.

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17
Q

Define the syndromes (disorders of thought)
* Capgras
* Fregoli
* Othello
* De Clerambault (Erotomania - specific form of delusion disorder)
* Folies e deux
* Cotard

A
  • belief that someone in their life has been replaced by an imposter
  • belief that people are **following **them and changing appearance
  • belief that partner is cheating on them (Keaton)
  • belief that person is in love with them, normally a famous person
  • between 2 people - identical disorder with shared delusions
  • belief they are dead/non-existent
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18
Q

When should Lithium levels be checked?

A

12 hours after dose, every 3 months.
ALso check thyroid and renal function.

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19
Q

Self-harm hx - 5 key questions (the cut drips….)

A
  • Before, during, after the episode
    Death wish? - what was their intention
    Relief - on being found?
    Influence - did it have an effect on someone else?
    Punishment - to themselves for what reason?
    Seeking help - did you tell anyone afterwards/seek medical attention? How has mindset changed now?

+ suicide screen - intentions, methods, future plans
+ PMHx of suicide/self-harm
+ risk factors and protective factors
+ risk assess (self, to others, from others)

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20
Q

3 key aspects of screening for mental illness

A
  1. Depression /anxiety- persistent low mood / worries
  2. Psychosis - delusions & hallucinations
  3. Alcohol dependence - CAGE questionnaire
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21
Q

MUS can be split into conscious (malingering, factitious) and unconscious (somatoform, conversion, dissociative, functional syndromes). Name the 4 main times of somatoform disorders?

A

PUS(B)H(B)y
* Persistant somatoform pain disorder / autonomic disfunction
* Undifferentiated
* Somatisation disorder (Briquet’s)
* Hypochondriacal (inc. Body dysmorphia)

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22
Q

What is the difference between somatisation disorders, dissociativ, conversion disorders and functional syndromes?

A
  • Somatisatio- physical symptoms as a manifestation of psychological distress.
  • Dissociative - act of dissociating a memory/event from consciousness; involves psychiatric symptoms (fugue, amensia, stupor)
  • Conversion - conversion of distressing events into physical symptoms, typically CNS dysfunction - paralysis or blindness
  • Functional syndrome - persistent complaints unexplained by pathology (IBD, CFE, non-epileptic seizures)
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23
Q

Schizophrenia - define (3 aspects)

A

A severe mental illness, characterised by
1. disorders of thought and/or perception (+ve sx)
2. lack of emotional responsiveness (-ve sx)
3. loss of contact with external reality

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24
Q

Schneider’s first rank symptoms of schizophrenia (4)

A
  1. Auditory hallucinations
  2. Passivity phenomena
  3. Thought disorder (insertion, withdrawal, broadcasting)
  4. Delusional perception (roses are red therefore i am god)
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25
Q

5 As of Negative symptoms in schizophrenia

A

Anhedonia
Avolition
Alogia
Anergia
Flat Affect

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26
Q

Theories behind schizophrenia involve defective glutaminergic, serotinergic and dopaminergic mechanisms. What is the the premise for the dominergic theory behind schizophrenia?

A
  • Lack of dopamine in mesocortical sysytem = negative sx (associated with emotion and cognition)
  • Excess of dopamine in mesolimbic sysytem = postiive sx (associated with reward & reinforcement)
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27
Q

Prognosis for people with schizophrenia, suicide risk and reduced life span?

A

1/3 recover, 1/3 have recurrent episodes, 1/3 chronic.
10% suicide risk.
10 Yr reduced life span - note high risk of CVS disease (antipsychotic medication & high smoking rates)

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28
Q

Generalised anxiety disorder (ICD11) and 2 main presentations:

A

Anxiety that persists for at least several months for more days than not.
1. “Free-floating anxiety” - not circumstantial
2. “Apprehensive expectation” - excessive worry

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29
Q

GAD definition
Diffs

A

Excessive worries occuring more days than not for 6 months, with associated biological, cognitive and emtoional symptoms.
Biological - tachycardia, nausea, palpitations, fatigue
Cognitive- concentration problems
Emotional - distress –> impaired functioning.
Generalised - the worries can be about any event, and are not linked to a particular trigger.
Medican inducced anxiety, hyperthryoidism, angina.

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30
Q

Stepwise management for GAD (1-4)

A
  1. Education and active monitoring
  2. Low intensity psych intervention (self-help or groups)
  3. High intensity “ (CBT, applied relaxation) or drug treatment (Sertraline 1st line)
  4. Specialty - psychiatrist input
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31
Q

Personality - ICD 11 definition

A

An individual’s characteristic way of behaving, experiencing life, perceiving and interpreting themselves/other people/events/situations

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32
Q

Classification of personality disorder (according to ICD 11)

A
  1. Severity of impaired interpersonal functioning (mild/moderate/severe)
    • trait domain specifiers, or, borderline pattern

Trait domain specifiers include negative affectivity, detachment, dis-sociality, disinhibition and anankastia.

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33
Q

Management of personality disorders

A

Dialectical behavioural therapy
(long-term, similar to CBT, involves mindfulness, emotional regulation, distress tolerance and interpersonal effectiveness)

34
Q

SSRIs - risks in first and 3rd trimester pregnancy

A

1 - congenital heart defects
3 - persistent pulmonary hypertension of ewborn

35
Q

Diagnostic criteria for intellectual disability

A
  1. IQ <70 (Wechsler Adult Intelligence Scale)
  2. Significant adaptive/social impairments (ABAS II)
  3. Onset <18 yrs
36
Q

Most common cause of LD

A

Fragile X syndrome

37
Q

Distinguish mild/moderate/severe/profound based on IQ score

A

Mild 50-69
Moderate 35-49
Severe 20-34
Profound <20

38
Q

Tourette’s can involve motor and vocal sx - describe these?

A

Motor - echopraxia and copropraxia
Vocal - coprolalia and echolalia

39
Q

Tourette’s - management

A

Behavioural management
Topiramate (anticonvulsant) - if severe

40
Q

Classify sleeping problems into 2 categories.
Insomnia includes …

A

Dysomnia- problems with quality and quantity (insomnia, hypersomnia, narcolepsy)
Parasomnia - abnormalities during sleep (night terrors, sleep paralysis)
* 2ndary insomnia - due to other cause, e.g. OSA, pain, COPD/CF, diabetes, medications

41
Q

Definition and management (2) of primary insomnia.
If >55 what treatment would you consider?

A

Difficulty initiating/maintaing sleep, either acute (<1 month) or chronic (>3 months).
Management:
* Sleep hygeine methods
* Relaxation therapy, CBT
* Medical management= BDZ, antidepressants or Z drugs
* >55 - melatonin

42
Q

Narcolepsy - diagnosis and mangement

A
  • daytime sleepiness, >3x/wk, > 3mo
  • and 1 of cateplexy, hypocretin deficiency or short REM sleep
  • SSRIs

Cateplexy - collapse after strong emotions

43
Q

Restless leg syndrome - describe presentation, investigation and management

A
  • Strong urge to move legs while resting, unpleasant sensations (burning, tingling, itching).
  • Nerve conduction studies, polysomnogram, needle electromyogram
  • Dopamine agonists/BDZ/Gabapentin/Iron replacement
44
Q

Child psych - what are the 4 classes of attatchment disorder (A-D)

A

Insecure avoidant
Secure
Insecure ambivalent
Disorganised

Between 6 and 36 months - Ainsworth Strange Situation Procedure

45
Q

Autism is a neurodevelopmental disorder diangosed before the age of 3. What are the 3 typical symptom clusters?

And what is mindblindness

A
  1. Communication (note ehcolalia and neologisms, fail to regulate with non-verbal cues)
  2. Social interraction (note mindblindness)
  3. Restricted interests & ritualistic behaviours (routines, repetitive actions, inflexibility_

Mindblindness - inability to have an awareness of what others are thinki

46
Q

Psychosocial support for children with autism (4)

A

* ABA - Applied behavioural analysis: positive reinforcement; ABC (antecedent, behaviour and consequence)
* TEACHH - Treatment and education of autistic and communication related handicapped children
* JASPER - joint attention symbolic play engagment and regulation
* ESDM - early start Denver Model
+ parental education / family support/ counselling
+ ASD preschool programme
+ antipsychotics for aggression/self-injury

47
Q

What psychiatric/neuro conditions are also common with autism?

A
  1. Intellectual disability (50%)
  2. Depression & Anxiety (40%)
  3. Dyspraxia (70%)
  4. ADHD (35%)
  5. Eplepsy (18%)
48
Q

What is required for a diagnosis of ADHD?

A

Persistent impairment in attention and/or hyperactivity/impulsitivity.
If <16 = 6 features to be present from DSM-V table.
(If 17+, 5)

49
Q

Management for ADHD:
When to refer?
1st line drug for children?
2nd line for chhildren?
Adults?
Note which toxicity?

A
  1. Watch & Wait (10-week) before referral to paeds/CAMHS.
  2. Methylphenidate (>5yrs only) - dopamine and noradrenaline reuptake inhibitor.
  3. Lisdexamfetamine
  4. Either of the 2.
  5. Cardiotoxicity (baseline ECG reqd).
50
Q

What is conduct disorder?

A
  • repetitive and persistent antisocial/aggressive or defiant behaviour (ICD 10: >6 mo).
  • the most common type of behavioural disorder in adults and children
  • treated with CBT (children, 7 yrs+), parental training
51
Q

Distinguish anorexia nervosa from bulimia nervosa

A
  • Anorexia is an eating disorder characterised by intentional weight loss, distorted body image (body dysmorphia) + associated endocrine disturbance (F - amenorrhoea, M - lack of libido)
    * Bulimia is an eating disorder assoicated with repeated binges followed by compensatory behaviours (excessive exercise/laxative use). Purging vs non purging types.
    Binge-eating disorder - frequent binges w/o episodes of purging, associated

Eating disorders, F:M (10:1)

52
Q

Taking a hx for anorexia: questionnaire

A

SCOFF
- sick from feeling full
- worry of loss of control on eating habits
- > **one ** stone in 3 months
- believing to be fat despite what others say
- does food dominate your life

2+ indicates likely anorexia/bulimia nervosa

53
Q

Diagnostic criteria for weight loss in anorexia

A

> 15% below expected
or BMI <17.5kg/m2

54
Q

Describe refeeding syndrome and the typical electolyte findings

A

After a period of starvation (2-4wks) refeeding too quickly can result in a dramatic rise in insulin (in attempt to move glucose into cells) –> increased cellular uptake of electrolytes.
This causes reduced serum PO4, K+, Mg, glucose, H20 -
1**. Reduced phosphate **- seizures, paraesthesia, rhabdo, cardiomyopathy
**2. Reduced potassium **- muscle cramps, weakness, fatigue, arrhythmia
3. Reduced magnesium - oedema, arrythmia, hypotension
4. Reduced glucose and water - dehydration

55
Q

What metabolic side effects are associated with antipsychotics (typically atypical)?

A

Hyper:
* - cholesterolaemia
* - lipidemia
* - glycaemia
+ weight gain.
Metabolic syndrome
* obesity
* diabetes
* htn

56
Q

Presentation of SSRI discontinuation syndrome

GI, psych & neuro sx

and hence need to taper down SSRI dose if wish to come off it

A
  1. Dizziness
  2. Electric shock sensation (paraesthesia)
  3. Anxiety/restlessness
57
Q

What happens to GABA/NMDA in alcohol withdrawal?

A

Decreased GABA (reduced CNS inhibition) and increased NMDA (increased excitatory mechanisms).

58
Q

Progression of alcohol withdrawal at 6-12hr, 36, 72 hr

A
  • 6-12hr: sx (sympathetic overactivity)
  • -36 - seizures
  • 48-72 delirium tremens - tremor, confusion, hallucination/delusion
  • onwards - Wernicke-korsikoff syndrome
59
Q

Management - acute alcohol withdrawal

A

Chlordiazepoxide (long-acting BZD) or Diazepam
+ admit to hospital for monitoring

60
Q

Indications for ECT:
1. T-R D
2. L-T C
3. Man-
4. Mod-

A
  • Treatment resistant depression
  • Life-threatening catatonia
  • Manic episodes
  • Moderate depression previously treated with ECT in past (with good response)
61
Q

Antipsychotics in the elderly increase the risk of (2)

A

STROKE and VTE

62
Q

3 scoring systems to assess alcohol-related disorders

A
  1. SADQ (Severity of alcohol dependence)
  2. AUDIT (alcohol use disorders identification test)
  3. CAGE(initially screening during hx)
63
Q

Maintenance treatments for alcohol abuse - describe class/MOA?
Acomprosate
Disulfiram
Naloxone
+ oral thiamine

A

Acomprosate - GABA agonist (reduces craving)
Disulfiram - aldehyde dehydrogenase inhibitor (promotes abstinence by causing a severe reaction to alcohol)
Naltrexone - opioid antagonist (reduces pleasure)
Thiamine - vitamin B1 if diet is deificient

64
Q

psychological mngmnt for alcohol abuse

A

motivational interviewing - breaking the habit cycle

65
Q

Schizophrenia risk factors

A
  • Male sex
  • FHX - genetic component (polygenic - multigple genes)
  • Age (30-40)
  • Substance abuse such as cannabis
  • Antenatal complications
  • Social - stressful life events
  • Structural brain abnormalities - enlarged ventricles
66
Q

Schizophrenia risk factors

A
  • Male sex
  • FHX - genetic component (polygenic - multigple genes)
  • Age (30-40)
  • Substance abuse such as cannabis
  • Antenatal complications
  • Social - stressful life events
  • Structural brain abnormalities - enlarged ventricles
67
Q

Acute stress reaction
Adjustment disorder
Complicated grief (abnormal grief reaction)

A

Acute reaction to a stressful event (<72 hrs, or within a few weeks).
Adjustment disorder - 3-6mo from tigger.
The event causing the acute stress reaction is normally more traumatic.
Grief - denial, anger, bargaining, depression, acceptance.
Delayed - (more than 2 weeks before grieving begins). or prolonged (cannot define exactly).
Complicated - more than 6 months; difficult to define.

68
Q

Acute stress reaction - management

A

Trauma-focused CBT

69
Q

OCD
Management
- Mild
- Moderate
- Severe

A

Mild:
CBT + ERP
Moderate:
CBT + ERP + SSRI
Severe:
Above + referral to specialsit

70
Q

Specific SSRI for body dysmorphia

A

Fluoxetine

71
Q

Alternative SSRI for OCD

A

Tricyclic = Clomipramine

72
Q

What does ERP involve?

A

Exposure and Response Prevention - patients are deliberately exposed to anxiety-provoking situation, and then stopped from engaging in their safety mechanism. With the aim of confronting anxiety and habituation –> extinction of response

73
Q

Risk of Lithium

A

Alters calcium homeostasis.
Hyperparathyroidism –> hypercalcaemia –> moans, groans, stones, bones:
abdo pain
psychosis
back pain
kidney stones

74
Q

Stopping SSRIs: key points (2)

A
  1. Continue for 6 months past point of “resolution” - prevent relapse
  2. Wean for 4 weeks to reduce risk of discontinuation syndrome
75
Q

Typical antispychotics:
Examples (2)
MOA:
Side effects:

A

Haloperidol and Chlorpromazine
Antagonist at D2 receptors in mesolimbic pathways.
Extrapyramidal sx (parkinsonism, dystonias) and hyperprolactinaemia (breast pain, lactation)

76
Q

Atypical antipychotics:
Examples (3)
MOA:
Side effects:

A

Risperidone, Olanzapine, Clozapine.
Antagonist at dopamine, histamine & serotinergic receptors (D2, D3, D4, 5-HT, H2)
Metabolic effects: weight gain, QT prolongation, hyperprolactinaemia but less common

77
Q

Management of acute dystonias (oculogyric crisis, oromandibular dystonia, torticollosis)

A

Procyclidine (anticholinergic)

78
Q

Distinguish Knight’s move thinking from flight of ideas

A

KM: illogical leaps from one idea to the next (schizophrenia)
FOI: discernible links between ideas (associated with rapid and pressured speech; mania)

79
Q

Side effects: CLozapine

A

weight gain
excessive salivation
agranulocytosis
neutropenia
myocarditis
arrhythmias
reduces seizure threshold

80
Q

What psychotropic drug can cause a benign leucocytosis

A

Lithium

Safetynet and conitnue monitoring as normal - no need to treat if no symptoms of infection

81
Q

Best antipsychotic for negative symptoms of schizophrenia

A

Clozapine (atypical)

82
Q

Treatment for tardive dyskinesia

A

Tetrabenazine

Year 4/5 Revision (21 decks)

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