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Psych Flashcards

1
Q

Management of acute stress reaction in under 18s

A

If is a large shared trauma->group based CBT
If not can consider monitoring or individual CBT

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2
Q

Management of PTSD in under 18s

A

Individual trauma CBT
If after 3 months does not work use EMDR
NO MEDICATION

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3
Q

Management of PTSD in adults

A

Offer trauma focused CBT as first line but can use sertraline or venlafaxine if wants drug first
Second line paroxetine

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4
Q

When can use EMDR for PTSD

A

If 1-3 months after can consider if CBT not worked or has preference
If over 3 months then can offer EMDR alongside CBT

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5
Q

When use risperidone in PTSD

A

Psychotic symptoms present
Severe hyperarousal symptoms that have not responded to other treatments

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6
Q

Back pain and constipation, what psych medication may have caused

A

Lithium due to hyperparathyroidism

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7
Q

What is personality disorder when very strict moral code and ethics

A

Anankastic

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8
Q

Differentiating depression from dementia

A

In depression
- answer I dont know to questions in MMSE
- bothered about low MMSE score
- biological symptoms present
- short history
- global memory loss

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9
Q

What must do for psychosis in elderly

A

CT to rule out organic cause

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10
Q

Which amnesia get in ECT

A

Retrograde most commonly

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11
Q

Difference in malingering and muchausens

A

Malingering- exaggerate or simulate smyptoms
Muchausen- actualy inflict pain upon yourself

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12
Q

Which psych medication can cause renal stones

A

Lithium from hypercalcaemia

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13
Q

What is it when answer a question with excessive details

A

Circumstantiality

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14
Q

What do if patient develops a leukocytosis on lithium

A

Leave them alone just safety net

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15
Q

Causes of personality disorder

A

Genetic
Psychological
Environmental

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16
Q

If someone dependant on alcohol is admitted to hospital for elective procedure what do

A

Give chlordiazepoxide

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17
Q

NT associated with depression

A

Dopamine

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18
Q

How change from fluoxetine to another SSRI

A

Over 20mg- slowly taper over 2 weeks, 4-7 day washout then start again
Under 20mg- stop abruptly then 4-7 day washout

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19
Q

Which lymph nodes do the gynae cancers metasise to

A

Endometrial and ovarian- para-aortic
Cervical- pelvic
Vulval- inguinal and femoral

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20
Q

Do you admit patients after suicide attempts

A

Not always- if low risk then can arrange review by liason psych before discharge

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21
Q

What is atypical anorexia

A

When have all of the criteria for anorexia but is no weight loss

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22
Q

What defines underweight in children vs adults

A

Adults- under 18.5
Children- under 5th centile

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23
Q

Diagnostic criteria for anorexia DSMV

A

Restriction of weight
Intense fear of gaining weight
Disturbance of body image view

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24
Q

If someone escapes from care home, how long do emergency DOLS last

A

7 days

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25
Q

Hypotonia and non-blanching rash 2 days after birth

A

Group B streptococcus

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26
Q

If have test of cure for CIN2< and is negative when is recall

A

3 years regardless of age

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27
Q

How long does section 4 apply

A

72 hours

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28
Q

Features of paranoid personality type

A

Paranoid
Sense of self righteousness (doesnt like to be wrong)
Does not take criticism well
Possessive and jealous of partners
Conspiracy theories common

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29
Q

Which personality disorder most linked to schizophrenia

A

Schizotypal

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30
Q

MOA of procyclidine

A

Blocks cholinergic neurones

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31
Q

Diagnostic criteria for schizophrenia

A

2 psychotic symptoms (delusions, hallucinations or thought disorder) or 1 plus either catatonia or negative symptoms present for 1 month

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32
Q

Elemental illusion vs pareidiollic hallucination

A

Elemental- see flashing lights
Pareidiollic- see something within fire

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33
Q

Brief psychotic disorder vs acute psychotic disorder

A

Brief psychotic disorder DSM5
Acute psychotic disorder ICD-10
- brief psychotic lasts less than 1 month
- acute psychotic disorder under 3 months (onset within 2 weeks)

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34
Q

Anti-psychotics used for sedation

A

Haloperidol- risk of prolonged QT
Olanzapine

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35
Q

Management of NMS

A

Stop drug
Cooling devices
transfer to ITU
Fluids
Benzos- for agitation and to relax muscles
Bromocriptine

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36
Q

What antipsychotic use if prolonged QTC

A

Aripirazole
Zuclopenthixol

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37
Q

PET scan findings- schizophrenia vs OCD

A

Schizophrenia- hypoactivity in prefronatal cortex, enlarged ventricles
OCD- hyperactivity in prefrontal cortex

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38
Q

Questionnaire for psycopathy vs risk to others

A

Psychopathy- PCL-R
Risk to others- HCR-20

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39
Q

Organic causes of psychosis- infective, nutritional, endocrine

A

Infective- toxoplasmosis, enceph/meningitis, neurosyphylis
Nutritional- pellagra, B12, B1
Endocrine- cushings, thyroid

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40
Q

When measure FBC in clozapine

A

Weekly for first 18 weeks
18 weeks- 1 year- fortnightly
Beyond 1 year- monthly

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41
Q

How does FBC testing in clozapine classify patients

A

Red, amber, green
Red- stop immediately
Amber- measure twice weekly until green
Green- continue

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42
Q

What is used to detect/screen delirium

A

Confusion assessment method

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43
Q

Which antipsychotic particularly associated with weight gain and DM

A

Olanzapine

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44
Q

If someone has history of DM and HTN what antipsychotic use

A

Haloperidol or any other typical anti-psychotic

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45
Q

First step in management of neuroleptic malignancy

A

Cooling and fluids

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46
Q

What other than antipsychotics can cause NMS

A

Missed dopamine agonist dose

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47
Q

What typically precipitates NMS

A

Abruptly withholding a dopamine agonist or anti-psychotic

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48
Q

How manage if have long QT evidence on ECG

A

Discuss with cardiology- do not immediately cessate

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49
Q

What is couvade syndrome

A

Where mimic pregnant womans

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50
Q

What is particularly associated with ekbom syndrome

A

B12 deficiency

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51
Q

How does clozapine toxicity present

A

Confusion
Drowsiness
Ataxia
Tachycardia
Often precipiated by infetions

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52
Q

What do for someone with an at risk mental state with a first degree relative who has schizophrenia

A

Refer immediately for CBT

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53
Q

What is difference between thought withdrawal and blocking

A

In both patients randomly stop talking
Withdrawal- stop talking then begin talking about same thing
Blocking- stop talking then start talking about different topic

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54
Q

What do the different antidepressants target

A

SSRI- presynaptic serotonin uptake channel
TCA- blockade of noradrenaline, serotonin and to lesser extent dopamine reuptake channels- also blocks muscarinic and histaminergic
MOA- non selective and irreversible inhibition of MOA A and B
SNRI- presynaptic blockade of both noradrenaline and serotonin (high doses dopamine)
NaSSA- blocks alpha 2 which increases noradrenaline and seorotonin

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55
Q

Serotonin syndrome presentation

A

Physiologically too much serotonin in synapses in brain
Autonomic dysfunction- tachycardia, HTN, diaphoresis, mydriasis
Altered mental state- agitation, confusion
NMJ hyperactivity- tremor, hyperreflexia, myoclo

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56
Q

Management of acute phase mania

A

Trial oral antipsychotic choosing from
- haloperidol
- olanzapine
- quetiapine
- risperidone
If not tolerated then add another from list
If second line not effective lithium may be added, if thats not successful then valproate added unless pre-menopausal woman

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57
Q

MOA of lithium, sodium valproate and carbamezapine

A

Inhibits recycling of neuronal membrane phosphoinositides

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58
Q

Most important thing to monitor- sodium valproate vs carbamezepine

A

Sodium valproate- LFT
Carbamezepine- FBC

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59
Q

Side effects of lithium

A

Weight gain
Tremor
Muscle weakness
GI
Metallic taste
Nephrogenic DI (renal impairment)
T wave inversion
Leucocytosis which is benign
Hypothyrodism and hyperparathyroidism

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60
Q

Management of lithium toxicity

A

Stop drug
Measure levels
Fluids
Osmotic or forced alkaline diuresis may be required
Haemodialysis may be used if severe
- Renal failure and levels over 2.5
- Severe signs- nystagum etc
- Lithium over 4

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61
Q

How are lithium levels checked

A

Every week when increasing the dose
Every 3 months should have levels measured if dose stable
Every 6 momnths BMI, U&Es, calcium, TFTs and eGFR measured

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62
Q

Side effects of lamotrigine

A

Most common is maculopapular rash where must withdraw drug immediately
GI
Headache
Diplopia

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63
Q

Which antidepressants has high chance of death from overdose so avoid in case of suicide risk

A

Venlafaxine
TCAS except lofepramine

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64
Q

How long should someone be on a SSRI for depression before changing dose/drug

A

4 weeks
6 weeks if elderly

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65
Q

Side effects of carbamezapine and how to remember

A

CABRA MEAN
Confusion
Ataxia
Rashes
Blurred vision
Aplastic anaemia
Marrow suppression
Eosinophilia
ADH release
Neutropenia

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66
Q

Secondary causes of mania

A

Steroids
Levo dopa
Hyperthyroid
Illicit drugs
Organic damage to right side of brain in elderly

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67
Q

Serotonin syndrome management

A

Stop meds
Supportive- cooling and fluids
Benzos for muscle rigidity
Can use cyproheptadine which is a serotonin antagonist

68
Q

Management of mania if already on lithium or sodium valproate

A

If on lithium- check levels, optimise treatment and consider adding antipsychotic depending on preference and previous response
If on sodium valproate- increase dose, if no improvement then add antipsychotic

69
Q

Depression management in BPAD if not on drug

A

If not on drug- offer olanzapine/quetiapine and fluoxetine or just olanzapine or lamotrigine
If no response use lamotrigine

70
Q

Depression management in BPAD if on lithium or valproate

A

Optimise dose of lithium
If unsuccessful then add olanzapine/quetapine with fluoxetine or olanzapine if prefers
If unsuccessful use lamotrigine

71
Q

Management of mania in children

A

If under 14 refer to CAMHS
14 or older refer to EIP or CAMHS centre with expertise in psychosis
Can start aripiprazole if over 13 in severe cases

72
Q

Maanagement of BPAD depression in children

A

First line - CBT for 3 months

73
Q

How stop lithium or valproate

A

Slowly stop over 4 weeks

74
Q

Best antipsychotic if want to not put on weight

A

Quetiapine

75
Q

Which drugs can cause depression

A

Beta blockers, methylopda, CCB
H2 anti-histamine
Chemo
Oestrogen
Psychiatric conditions

76
Q

Low versus high intensity psych interventions for depression

A

Low
- Self-help
- Group physical activity
- Computerised CBT
- Group CBT

High
- CBT
- behaviorual activation
- interpersonal therapy

77
Q

What is done before ECT

A

Examination
Bloods- FBC, U&Es, LFTs
ECG- over 50 or medical indication
CXR- over 55 or medical indication
NBM for 8 hours

78
Q

How are patients assessed after ECT

A

Assess congnition and rating scale
Cognition- MMSE
Rating scale- montgomery asberg depression rating scale (MADRS)

79
Q

ECG effects of TCAs

A

QT prolongation
ST elevation

80
Q

What is important diagnostic criteria for depression or mania with psychosis

A

That psychosis not present when euthymic

81
Q

How do you switch between SSRI and SNRIs (not from fluoxetine)

A

Direct switch

82
Q

How do you switch from fluoxetine to a TCA, SSRI or SNRI

A

Reduce dose of fluoxetine then start next drug 1 week later

83
Q

How do you switch from TCA to fluoxetine

A

Halve the TCA then add fluoxetine
Slowly withdraw TCA

84
Q

How to switch from TCA to SNRI or non-fluoxetine SSRI

A

Slowly reduce dose by 25mg then start new one
Remove TCA over next week

85
Q

What are trazodone and dosulepin

A

TCA

86
Q

Who need to use venlafaxine with caution in

A

HTN

87
Q

What use as second line to lithium if sodium valproate CI for BPAD

A

Olanzapine

88
Q

Medication for GAD

A

1st line: sertraline
2nd line: citalopram/ paroxetine or venlafaxine

89
Q

Criteria for OCD

A

Intrusive obsessions and compulsions prsent for 1 hour a day

90
Q

How is mild, moderate and severe OCD managed

A

Mild- refer for CBT with ERP
Moderate- 1 of CBT with ERP or SSRI (if unsuccessful after 12 weeks change SSRI or to clomipramine)
Severe- refer to specialist with CBT with ERP plus SSRI

91
Q

Withdrawal from benzos

A

Insomnia
Anxiety
Loss of appetite
Tremor
Weight loss
Sweating
Tinnitus

92
Q

Which benzos give for insomina

A

Tamezapam

93
Q

How to withdraw a benzoQ

A

Reduce the dose by 1/8th every forntight
Can consider switching to longer term from short term

94
Q

What is management of a panic disorder

A

Rule out
- thyroid
- alcohol- ECG
Then management
CBT/relaxation techniques
Can use SSRI/venlafaxine

95
Q

What is flumenazil

A

A GABA antagonist
Used for benzo OD

96
Q

What tool is used to screen for social phobia

A

SPIN
Social phobia inventory

97
Q

What is it called when start repeating actions of a dead person

A

Identification

98
Q

What is fear of
- heights
- pain

A

Pain= algophobia
Heights= acrophobia

99
Q

What is technique used in psychotherapy for dissociative disorders

A

Abreaction
Used as part of psychotherapy

100
Q

Medications used for agoraphobia

A

1st line- Sertraline
2nd line- venlafaxine
If either of these are CI then use pregabalin

101
Q

What is sexual side effect of trazodone and chlorpromazine

A

Priapism- anti histamines have this effect

102
Q

Which NT most associated with anxiety

A

GABA

103
Q

What is it when binge eat and then period of long sleep

A

Kleine-levin syndrome

104
Q

Diagnostic criteria for bulimia nervosa

A

Binge eating episodes with compensatory behaviour to prevent weight gain at least once a week for 3 months
Feel as if have no control over episodes
Physical signs may be present

105
Q

Management of bulimia nervosa

A

Refer immediately to eating disorder specialist
First line is BN focused guided self help for 4 weeks
If ineffective then ED-CBT
Can cosider high dose fluoxetine

106
Q

MOA of naltrexone and disulfiram

A

Acamprosate- Modulates NMDA to reduce glutamergic transmission
Naltrexone- Mixed opiod antagonist with high affinity for u-opiod receptor
Disulfiram- Acetaldehyde inhibitor

107
Q

How can spice use present

A

Psychosis
Confusion
Aggression
Vomiting

108
Q

How is benzo withdrawal managed

A

Contact addiction services
Convert to diazepam equivalent dose
Slowly reduce by 10% every 2 weeks
Talking therapies

109
Q

How manage OST in acute hospital care

A

Check with GP/drug service the drug and date of last collection

110
Q

Rating scale for opiate withdrawal

A

Clinical opiate withdrawal scale

111
Q

Difference between withdrawal syndrome and complex withdrawal

A

Withdrawal includes typical symptoms expected
Complicated involves delirium, seizures or psychosis

112
Q

What questionnaire for severity of dependance

A

SADQ- severity of alcohol dependance questionnaire

113
Q

Management based on AUDIT and SADQ outcome

A

Over 20 on AUDIT- refer to alcohol services
Over 30 on SADQ- refer for inpatient withdrawal

114
Q

Principles of managing opiate withdrawal

A

Test for blood borne viruses and offer vaccinations
Detoxification regime- methadone or buprenorphine (will lessen symptoms of withdrawal)
Treat symptomatically
Refer to drugs and alcohol services
- key worker
- talking therapies

115
Q

What do you assume are units in a pint, glass of wine and a shot

A

Pint- 2
Glass of wine- 1.5
Shot- 1

116
Q

How are cocaine induced myocardial infarctions managed

A

Benzos

117
Q

What murmur can be heard in anorexia

A

Mid systolic murmur with a click due to mitral valve prolapse from loss of cardiac muscle

118
Q

When is lofexidine indicated in opiate withdrawal

A

Want to avoid methadone and buprenorphone
Want to do it quickly

119
Q

What do excoriation marks after an overdose suggest

A

Opiods as relesaes histamine

120
Q

What drug can be given to help with anorexia nervosa treatment

A

Olanzapine as can reduce obsessions with food as well as increase appetite

121
Q

First clinical signs of refeeding

A

Tachycardia
Oedema
Confusion

122
Q

Drugs for dementia

A

Anticholinesterase inhibitor- rivastigmine, donepezil, galamantine
NMDA antagonist- memantine

123
Q

Which antipsychotics do women respond better to

A

Typical

124
Q

Best antidepressants in pregnancy

A

Sertraline is first line
Second line- TCAs
- amitryptylline
- imipramine
- nortriptylline

125
Q

Bipolar management if get pregnant

A

Slowly reduce lithium and switch to antipsychotic
Can remain on lithium but must have levels monitored every 4 weeks

126
Q

If pregnant what is advised for depression in BPAD

A

Olanzapine and fluoxetine

127
Q

First line for LBD

A

Donepezil or rivastigmine

128
Q

What drugs are contraindicated in LBD

A

Levodopa
Antipsychotics

129
Q

Management of post natal depression

A

Assess with PHQ9 or edinburgh post natal depression tool
If mild/moderate
- facilitated self help
- if history of severe depression still give medication

If moderate/severe
- offer CBT or antidepressant if does not want CBT and understands risk
- sertraline/paroxetine first line then TCA

130
Q

Management of post natal depression

A

Assess with PHQ9 or edinburgh post natal depression tool
If mild/moderate
- facilitated self help
- if history of severe depression still give medication

If moderate/severe
- offer CBT or antidepressant if does not want CBT and understands risk
- sertraline first line then TCA

131
Q

Imaging findings of fronto-temporal dementia

A

CT normal
PET or SPECT (single photon emission computerised topography) will show hypometabolism in frontal lobe

132
Q

When do you use memantine

A

Contraindication/ intolerance to acetylcholinesterase inhibitor in mild/moderate dementia
Can add to acetylcholinesterase inhibitor in moderate dementia
Severe dementia first line

133
Q

How are behavioural and psychiatric disorders in dementia screened for

A

Neuropsychiatry inventory questionnaire (NPI-Q)

134
Q

Management of depression/anxiety in dementia

A

Same as normal person
Only use SSRI if severe

135
Q

What drugs used for severe agitation or hallucinations in dementia

A

Haloperidol
Risperidone- preferred and what use in lecture

136
Q

How is bipolar depression treated in elderly

A

Quetiapine or lamotrigine

137
Q

Management of anxiety in elderly

A

SSRI/CBT first line
Second line- venlafaxine or mirtazapine second line

138
Q

In elderly what is most common psychotic disorder diagnosis

A

Delusional disorder

139
Q

What must be done before starting an anti-cholinesterase

A

ECG to rule out long QT or bradycardia

140
Q

What Edinburgh post natal score suggests a depressive illness

A

13

141
Q

What antidepressant should be used if on MAOi

A

Mirtazapine
As increased risk of serotonin syndrome

142
Q

Anxiety disorders seen in different ages

A

Under 3
- separation
3-6
- phobias
- monsters
6-12
- performance
12-18
- social

143
Q

Mild depression management in children

A

Can offer 2 weeks watchful waiting
or
3 months low intensity psychological therapy, digital CBT, group CBT

144
Q

Moderate- severe depression management in children

A

Reviewed by CAMHS
3 months of higher intensity psychological therapy- family therapy, individual therapy, brief psychosocial intervention
2nd line- switch psychological therapy or add fluoxetine

145
Q

Management of anxiety in a child

A

1st line- psychoeducation, Group CBT
Second line- fluoxetine or sertaline if OCD
Liaise with school if pertinent to presentation

146
Q

When is only time use sertraline in a child

A

OCD

147
Q

Management principles of behaviour disorders

A
  1. Rule out physiological cause
  2. Behavioural therapy based around conditioning and positive behaviour rewards
    - eg if sleeping disorder look at sleep environment and hygiene, if encopresis look at using toilet after meals
  3. Last line medication like melatonin for sleep and desmopressin for enuresis
148
Q

Imaging findings in ADHD

A

Pathology behind ADHD= hypoactivity of frontal cortex
Frontal cortex atrophy
Reduced blood flow fMRI

149
Q

Management of ADHD

A

Refer to specialist to make diagnosis
First line is family education and training
Second line methyphenidate if symptoms still severe
Third line if does not work- lisdexamfetamine
Fourth line if does not work- dexamfetamine
Can also consider Atmoxetine
If medication unsuccessful use CBT
MLD

150
Q

When admit for CAMHS depression

A

High risk to self
Poor home supervision
Intensive assessment required

151
Q

What tests can you use to test prefrontal cortex in ADHD

A

Wisonsin card sorting
Stroop
- colours written out but colour of text different

152
Q

How is intellectual impairment measured

A

Wechsler adult intelligence scale

153
Q

How is adaptive/social functioning assessed

A

Adaptive behaviour assessment system II (ABAS) in a clinical interview

154
Q

How is learning diability assessed in children

A

Clinical interview
School reports

155
Q

How is autism diagnosed

A

Autism diagnostic inventory

156
Q

How is irritability managed in autism pharmacologically

A

Risperidone and aripiprazole

157
Q

How are obsessional behaviours treated pharmacologically in autism

A

SSRIs

158
Q

How are stereotypical motor behaviours treated in autism

A

Risperidone

159
Q

Management of tourettes

A

If mild
- Self help- education about them and identifying triggers
If debilitating
- risperidone
- exposure with response prevention

160
Q

How does methylphenidate OD present

A

HTN
Tachycardic
High fever
Restless
Cant sleep

161
Q

What do if develop tics on methylphenidate

A

Switch medications

162
Q

What are techniques used in psychodynamic therapy

A

Free association- Ask patient just to say everything that comes to mind
Transferance- Where one applies all emotions and thoughts they have for someone else to the psychiatrist
Recognising resistance- Demonstrating to patient things they are doing which is preventing the therapy from carrying on

163
Q

What is jamais vu

A

When experience something have many times but think is new

164
Q

What is derailment

A

Thought disorder where no meaningful connections between what talking about

165
Q

What is it when repeat last syllable of a word over and over

A

Logoclonia

166
Q

What you like arranging objects in a particular order

A

Punding

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