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Its the final countdown > Psych > Flashcards

Psych Flashcards

1
Q

what is Russels sign

A

calluses on the knuckles or back of the hand due to repeated self-induced vomiting - due to bulimia

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2
Q

what is the name of the fine hairs associated with an6aemia

A

lanugo hair

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3
Q

what form of memory loss is found in depression

A

global (short, long-term, working memory loss)

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4
Q

Factors suggesting diagnosis of depression over dementia

A

short history, rapid onset

biological sx e.g. weight loss, sleep disturbance

patient worried about poor memory

reluctant to take tests/disappointed with results

mini-mental test score: variable
global memory loss (dementia characteristically causes recent memory loss)

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5
Q

what is the DSM diagnostic criteria for depression

A

5/9 sx, nearly every day for at least 2 weeks:

  1. Depressed mood/ irritability (feels/appears sad or empty or teary)
  2. Anhedonia:
  3. Significant weight or appetite change.
    4.Sleep alterations: Insomnia or hypersomnia.
  4. Activity changes: Psychomotor agitation or retardation.
  5. Fatigue
  6. Guilt /worthlessness:
  7. Cognitive issues: think/ concentrate/ make decisions,
  8. Suicidality:
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6
Q

depression stepwise Mx

A

Mild:
* low-intensity therapy e.g. (CBT).

mod-sev
* higher-intensity CBT/interpersonal therapy

  • and meds 1st line: (SSRI) sertraline.
  • Immediate referral: in active suicidality,
  • Refractory (tx resistant) depression - lithium/ Electroconvulsive Therapy (ECT).
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7
Q

SSRIs should be used with caution in young people, which SSRI is suitable for children/ adolescents

A

fluoxetine

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8
Q

A pt with ``Hx depression6 is on6 sertralin6e, H`e recen6tly b5egan6 takin6g ib5uprofen6 due to a sports in6jury. what further medication n6eeds to b5e prescrib5ed?6

A

PPI

SSRIs commonly cause GI Sx as S/E, so PPI is needed when pt on SSRI & NSAID

(NICE: don’t prescribe SSRI &NSAID but if it has to be done, give PPI)

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9
Q

Give 4 drugs/drug groups which should cause in6teraction6s with `SSRIs

A

NSAIDS-inc aspirin (GI bleed risk)
warfarin/heparin (bleeding risk)
triptans (serotonin syndrome)
MOAIS (e.g. resegiline =- serotonin syndrome)

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10
Q

which SSRI should be avoided in pregnancy

A

Paroxetine

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11
Q

to avoid serotonin syndrome, how long should a pt waiting between stopping & starting MAOIs and SSRIs.

A

To avoid this, patients should be given a 14-day washout period between MAOIs and SSRIs.

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12
Q

what are the metabolic S/E of atypical antipsychotics

A

hyperlipidemia, hypercholesterolemia, hyperglycemia,hyperprolactinemia and weight gain.

typical- mainly EPSE & hyperprolactinaemia
atypical- less EPSE/hyperprolactinaemia, more of the other metabolic effects

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13
Q

give x2 examples of typical & atypical antipsychotics

A

typical: haloperidol, chlorpromazine

atypical: clozapine, risperidone, olanzapine

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14
Q

what 4 features make up EPSE for antipsychotics

A
  • Parkinsonism
  • acute dystonia - sustained muscle contraction (e.g. torticollis)
  • akathisia (severe restlessness)
  • tardive dyskinesia ( abnormal, involuntary, motions - most common is chewing and pouting of jaw)
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15
Q

what are the non- metabolic S/E of antipsychotics (excluding EPSE)

A
  • antimuscarinic: dry mouth, blurred vision, urinary retention, constipation
  • sedation, weight gain
  • neuroleptic malignant syndrome: pyrexia, muscle stiffness
  • reduced seizure threshold (greater with atypicals)
  • prolonged QT interval (particularly haloperidol)
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16
Q

lithium
- therapeutic range
- excreted primarily by…..

A

0.4-1.0 mmol/L
primarily by the kidneys. - has a long plasma half-life being excreted

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17
Q

lithium monitoring: how long after the last dose should the sample be taken?

A

12 hrs

18
Q

following a change in dose how frequently should lithium levels be checked until the levels are stable

A

weekly

19
Q

once stable, lithium levels should be checked every…. months

A

3

20
Q

how often should thyroid and renal function be checked in a pt on lithium

A

6monthly

21
Q

give x2 long-acting benzos
give x1short acting benzo

A

long acting - diazepam, chlordiazepoxide
short acting - lorazepam

22
Q

Give the Sx of alcohol withdrawal in
6-12 hrs
36 hrs
48-72hrs

A

6-12hrs Sx start: tremor, sweating, tachycardia, anxiety
36hrs: seizures
48-72 hrs: delirium tremens (delrius & trembling : coarse tremor, confusion, delusions, auditory and visual hallucinations, fever, tachycardia)

23
Q

Mx in alcohol withdrwal
1st line
who to Adx

A

long-acting benzo (diazepam/chlordiazepoxide)

Adx
Hx wthdrawal seizures/ delirium tremens

24
Q

deficinency of what vitamin couses Wernickes encephalopathy

A

Thamine - B1
give pabrinex (paBr1nex)

25
Q

what triad suggests wernickes encephalopathy

A

confusion, ataxia, ophthalmoplegia/nystagmus

26
Q

what type of amnesia is associated with korsakoffs syndrome

A

anterograde amnesia ( limited retrograde amnesia & confabulation)

27
Q

give risk factors for schizophrenia

A

FHx - strongest (e.g. 10% if parent/sibling affected)
childhood trauma
heavy cannabis use in childhood
Black Caribbean ethnicity
migration
living in an urban environment

28
Q

give 5 types of Negative sx

A

Remember by 5A’s:

– Affect blunted = restricted emotion with poor emotional display

– Alogia = paucity of speech

– Asociality = social isolation

– Anhedonia = Lack of pleasure

– Avolition = Lack of motivation

29
Q

Schizophrenia Management - what are the 1st, 2nd and 3rd line treatments

mx in acute episodes of dangerous behaviour

A

Antipsychotics
1st line: atypical anti-psychotics (quetiapine, olanzapine, risperidone)­­­

2nd: typical anti-psychotics (haloperidol, chlorpromazine etc.)

3rd line is clozapine only for refractory psychosis

acute episodes, sedatives: lorazepam, promethazine, or haloperidol

30
Q

which thought disorder presents as the formation of new words, which might include the combining of two words.

A

Neologisms

31
Q

which thought disorder is a feature of schizophrenia

A

Knight’s move thinking

32
Q

what 5 factors indicate an increased risk of future suicide attempts

A
  • efforts to avoid discovery
  • planning
  • leaving a written note
  • final acts such as sorting out finances
  • violent method
33
Q

what psych conditions are the following therapies used to manage?
Exposure and response prevention (ERP)

Dialectical Behaviour Therapy (DBT)

Prolonged Exposure Therapy (PE)

A

Exposure and response prevention (ERP) - OCD

Dialectical Behaviour Therapy (DBT) - EUPD (personality disorders in general)

Prolonged Exposure Therapy (PE) - PTSD

34
Q

What scale is used to rate the severity of OCD

A

Y-BOCS scale

severe - >3hrs/da on obsession/compulsion

35
Q

what are the management options in
mild, mod, severe OCD?

A

mild
- low intensity ERP
- if needed, add more intense ERP/ SSRI

mod
- SSRI ( NOT fluoxetine) / intense ERP
- 1st line alternative to SSRI - clomipramine

sev
- secondary care referral
- with SSRI & ERP

36
Q

what are the type A personality disorders

A

paranoid
schizoid
schizotypal

37
Q

what are the type B personality disorders

A

antisocial
borderline (EUPD)
histrionic
narcissistic

38
Q

what are the type c personality disorders

A

obsessive-compulsive
avoidant
dependent

39
Q

whats the difference between schizoid and schizotypal personality disorders>

A

both type A

schizoid 0 indifference, lack of interest

schizotypal - lack of close friends, onlyu family, eccentric behaviour, ideas of reference

40
Q

Mx of GAD ( 1st, 2nd, 3rd line)

A

1st - SSRI ( e.g. sertraline)
2nd - SSRI ( e.g. citalopram)
3rd - switch to SNRI (e.g. duloxetine)

41
Q
A

Its the final countdown (23 decks)

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