Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

AKT > psych > Flashcards

psych Flashcards

1
Q

PHQ-9 score - what are NICE cut-offs for
(a) less severe depression
(b) more severe depression

and first-line Rx

A

(a) <16 - refer to CBT
(b) > or = 16 - SSRI and refer to CBT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what needs to be checked before starting venlafaxine

A

blood pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

A patient taking chlorpromazine develops a bilateral resting tremor. What side-effect of antipsychotic medication is this an example of?

A

Parkinsonism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

sustained muscle contraction (e.g. torticollis, oculogyric crisis) is what side effect

A

acute dystonia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what is the treatment of acute dystonia (sustained muscle contraction - torticollis, oculogyric crisis)

A

procyclidine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

severe restlessness caused by anti-psychotics is called what?

A

akathisia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Abnormal, involuntary choreoathetoid movements e.g. chewing and pouting of jaw

A

tardive dyskinesia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

2 adverse effects/warnings of increased risk of when antipsychotics are used in elderly patients

A

Increased risk of stroke and VTE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

acute stress disorders has a timeframe of what period after the traumatic event

A

acute stress reaction in first 4 weeks

PTSD is after 4 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

acute stress disorder management

A

trauma-focused CBT first line
benzodiazepines for acute symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

SSRIs are associated with what electrolyte abnormality

A

hyponatraemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what is the most common side effect of SSRIs

A

GI symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What should be prescribed if a patient is taking SSRIs and NSAID

A

PPIs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Which two SSRIs have a higher propensity for drug interactions

A

Fluoxetine
Paroxetine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Citalopram main adverse effect

A

Prolongs QT interval

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Interaction between warfarin/heparin and SSRIs

What other medication can be considered instead

A

NICE advises avoiding SSRIs
Consider mirtazapine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What 4 medications should you be cautious of with SSRIs

A
  1. NSAIDs - give PPI
  2. Triptans - avoid SSRIs
  3. Aspirin
  4. Warfarin/heparin - give mirtazapine instead
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

After starting antidepressant therapy, patients should be reviewed after…

A

2 weeks

For patients under age of 30 or increased risk of suicide after 1 week

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

If a patient makes a good response to antidepressant therapy they should continue on treatment for at least how long

A

6 months to reduce risk of relapse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

When stopping SSRI, dose should be gradually reduced over how long?

A

4 week period

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What SSRI has the highest incidence of discontinuation symptoms

A

Paroxetine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Somatisation definition

A

Multiple physical SYMPTOMS
At least for 2 years

Patient refuses to accept reassurance or negative test results

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Conversion disorder definition

A

Loss of motor or sensory function

Patients may be indifferent - la belle indifference

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Muchausen’s syndrome is also known as

A

Factitious disorder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

ICD-10 criteria requires depressive symptoms to be present for at least..

A

2 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

HAD scale - what are the score thresholds

A

0-7 normal
8-10 borderline
11+ anxiety/depression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

PHQ-9 scoring thresholds

A

<16 less severe depression
>16 severe depression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Cluster A personality disorder

A

Odd or eccentric

Paranoid
Schizoid
Schizotypal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Cluster B personality disorder

A

Dramatic, emotional, erratic

Antisocial
Borderline
Narcissistic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Cluster C personality disorder

A

Anxious and fearful

Obsessive-compulsive
Avoidant
Dependent

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Management of personality disorders

A

Dialectal behaviour therapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

jealousy where a person is convinced their partner is cheating on them

what condition

A

Othello syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

3 adverse effects of atypical antipsychotics

A
  1. weight gain
  2. clozapine - agranulocytosis
  3. hyperprolactinaemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

what is the first line SSRI for generalised anxiety disorder

A

sertraline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Generalised anxiety disorder, first line treatment is sertraline. If this is ineffective, what can be offered?

A
  1. offer alternative SSRI or SNRI (duloxetine, venlafaxine)
  2. if cannot tolerate SSRIs or SNRIs, offer pregabalin
  3. weekly follow up is recommended for under 30s for the first month
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

management of panic disorder

A
  1. CBT or drug treatment
  2. SSRIs are first line.
  3. If contraindicated or no response after 12 weeks then imipramine or cloipramine should be offered
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

5 factors associated with poor schizophrenia prognosis

A
  1. Strong family history
  2. Gradual onset
  3. Low IQ
  4. Prodromal phase of social withdrawal
  5. Lack of obvious precipitant
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

first-line treatment for children and young people with anorexia nervosa

A

family based therapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

diagnosis of anorexia is now based on the DSM5 criteria and BMI and amenorrhoea are no longer specifically mentioned.
what are the 3 criteria?

A
  1. restriction of energy intake relative to requirements leading to low body weight
  2. intense fear of gaining weight or becoming fat even though underweight
  3. disturbance in way weight or shape is experienced or denial of seriousness of current low body weight
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

NICE recommend adults with anorexia should have one of which three treatments

A
  1. individual eating disorder focused CBT (CBT-ED)
  2. Maudsley anorexia treatment for adults (MANTRA)
  3. specialist supportive clinical management (SSCM)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

To screen for depression, which two questions are most useful to ask?
‘During the past month, have you been bothered by ….’

A

feeling down, depressed, or hopeless
and
having little interest or pleasure doing things

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

when checking lithium levels, the sample should be taken how many hours post-dose

A

12 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

how often should lithium levels be monitored?

A

weekly, after starting lithium or after each dose change, until concentrations are stable

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

In patients who take lithium, what other things need to be checked (other than lithium levels) and how often?

A

BMI, serum electrolytes, eGFR, (renal function) and thyroid function every 6 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Venlafaxine and other SNRIs are associated with the development of what condition

A

Hypertension

46
Q

what needs to be monitored at initiation and dose titration of venlafaxine and other SNRIs ?

A

Blood pressure

associated with hypertension!

47
Q

For people presenting with mild to moderate symptoms of PTSD of less than 4 weeks duration, what management may be appropriate

A

Period of watchful waiting

48
Q

What are the 4 features of PTSD

A
  1. Flashbacks
  2. Avoidance
  3. Hyperarousal
  4. Emotional numbing
49
Q

Management of PTSD

A
  1. Debriefing is NOT recommended
  2. Watchful waiting if <4 weeks symptoms
  3. Military personnel have access to treatment by armed forces
  4. Trauma focused CBT or EMDR
  5. Venlafaxine or SSRI or risperidone
50
Q

NICE recommend classifying OCD impairment with what scale and into what categories

A

Y-BOCS scale
Mild, moderate or severe

51
Q

Management of OCD - mild, moderate, severe

A
  • Mild - first-line = CBT, exposure and response prevention (ERP). After that, SSRI or more intensive CBT can be offered.
  • Moderate = SSRI (fluxoetine for body dysmorphia) or intensive CBT. Consider clomipramine if cannot have SSRI
  • Severe = refer to mental health team. While awaiting assessment, offer combined SSRI (or clomipramine) + CBT
52
Q

If treatment with SSRI for OCD is effective, then how long should it be continued for at least to prevent relapse and allow time for improvement

A

AT LEAST 12 months

53
Q

Compared to depression, the regime for SSRI for OCD differs how?

A

Requires a higher dose

Longer duration of treatment (at least 12 weeks) for initial response

Patient must continue it for at least 12 months to prevent relapse + allow time for improvement

54
Q

Benzodiazepines mechanism of action

A

Enhance effect of GABA by increasing frequency of chloride channels

55
Q

Committee on Safety of Medicines advises that benzodiazepines are only prescribed for what period of time

A

2-4 weeks

56
Q

How should you withdraw a benzodiazepine

A
  • Withdraw in steps of about 1/8 range of daily dose every 2 weeks
  • Switch patients to equivalent dose of diazepam
  • Reduce dose of diazepam every 2-3 weeks in steps of 2 or 2.5mg
  • Time needed for withdrawal can vary from 4 weeks to a year or more
57
Q

Patients who withdraw too quickly from benzodiazepines can experience withdrawal - similar to alcohol withdrawal. This may occur up to how long after stopping?

A

Up to 3 weeks after stopping

58
Q

side effects of tricyclic anti-depressants

A

Dry mouth
Blurred vision
Urinary retention
Constipation
Postural hypotension
Prolonged QT interval

59
Q

Low dose amitriptyline is commonly used in the management of what 2 things

A

Neuropathic pain
Prophylaxis of headache (migraine + tension)

60
Q

Clozapine monitoring requires what and when

A

FBC every week for 18 weeks
Then every 2 weeks after
Until 1 year of treatment

61
Q

What is required before starting haloperidol

A

ECG

62
Q

Which syndrome is characterised by a person believing they are dead or non-existent?

A

Cotard syndrome

63
Q

Difference between mania vs hypomania

A

Mania - lasts for 7 days. Has psychotic symptoms
Hypomania - less than 7 days. No psychotic symptoms

64
Q

What is the commonest eye condition associated with Charles-Bonnet syndrome

A

Age-related macular degeneration

65
Q

circumstantiality

what is this

A

long-winded answer
seen in hypomania or anxiety

66
Q

Risk of developing schizophrenia when the following has schizophrenia:
(a) monozygotic twin
(b) parent
(c) sibling
(d) no relatives

A

(a) monozygotic twin = 50%
(b) parent = 10-15%
(c) sibling = 10%
(d) no relatives = 1%

67
Q

Switching from citalopram, escitalopram, sertraline, or paroxetine to another SSRI

A

Withdraw first SSRI before the alternative is started

68
Q

Switching from fluoxetine to another SSRI

A

withdraw then leave a gap of 4-7 days (as it has a long half-life) before starting a low-dose of the alternative SSRI

69
Q

Switching from a SSRI to a tricyclic antidepressant (TCA)

A

cross-tapering is recommend (the current drug dose is reduced slowly, whilst the dose of the new drug is increased slowly)

EXCEPT fluoxetine - withdraw prior to starting TCA

70
Q

Switching from fluoxetine to TCA

A

Withdraw fluxetine first
Then start TCA

71
Q

Switching from citalopram, escitalopram, sertraline, or paroxetine to venlafaxine

A

cross-taper cautiously. Start venlafaxine 37.5 mg daily and increase very slowly

72
Q

Switching from fluoxetine to venlafaxine

A

withdraw and then start venlafaxine at 37.5 mg each day and increase very slowly

73
Q

Adverse effects of clozapine

A

Agranulocytosis
Neutropenia
Reduces seizure threshold
Constipation
Myocarditis
Hypersalivation

74
Q

Section 2

A

Up to 28 days
AMHP + 2 doctors

75
Q

Section 3

A

6 months
AMHP + 2 doctors

76
Q

Section 4

A

72 hours
GP + AMHP + NR

77
Q

Section 5(2)

A

72 hours on inpatient
Doctor

78
Q

Section 5(4)

A

6 hours
Nurse

79
Q

Section 17a

A

Community treatment order
Supervised community treatment

80
Q

Section 135

A

Police take patient from home to place of safety

81
Q

Section 136

A

Police take patient from public place to place of safety
24 hours

82
Q

Schneider’s first rank symptoms may be divided into what 4 components

A
  1. auditory hallucinations
  2. thought disorders
  3. passivity phenomena
  4. delusional perceptions
83
Q

Anorexia features
including Gs and Cs

A

Most things are low - hypokalaemia, LH, FSH, testosterone, BP, HR

Gs and Cs are raised: growth hormone, glucose, salivary Glands, cortisol, cholesterol, carotinaemia

84
Q

delusion that a famous is in love with them, with the absence of other psychotic symptoms

A

Erotomania a.k.a De Clerambault’s syndrome

85
Q

alogia is included in thought disorganisation - what is this?

A

little information conveyed by speech, speaking less

86
Q

factors that increase risk of suicide

A
  1. male sex (HR 2.0)
  2. history of self-harm (1.7)
  3. alcohol or drug misuse (1.6)
  4. age
  5. history of mental illness
  6. chronic disease
  7. unemployment or social isolation
  8. unmarried or widowed or divorced
87
Q

3 factors which reduce the risk of a patient committing suicide

A
  1. family support
  2. children at home
  3. religion
88
Q

management of sleep paralysis if troublesome

A

clonazepam

89
Q

Mirtazapine may be prescribed due to useful side effects which include what?

A

Sedation - good for patients with insomnia
Increased appetite

n.b. also reduces alcohol intake

90
Q

What is the SSRI of choice post myocardial infarction

A

Sertraline

91
Q

What is the SSRI of choice in children and adolescents

A

fluoxetine

92
Q

Management of schizophrenia

A

Oral atypical antipsychotics
CBT!

93
Q

Once a stable dose of lithium has been achieved after weekly monitoring, how often should levels be checked?

A

Every 3 months

94
Q

Depression in older people are less likely to attend with depressed mood. They tend to present with physical complaints e.g. hypochondriasis, agitation and insomnia. What is first-line treatment?

A

SSRIs

95
Q

If a patient makes a good response to antidepressant therapy they should continue on treatment for at least how long after remission?

A

6 months to reduce the risk of relapse.

96
Q

Schizophrenia: management

A
  1. Oral atypical antipsychotics
  2. CBT
  3. Review cardiovascular risk factors
96
Q

Depression (variable appetite, poor sleep) with excess alcohol use may benefit from which antidepressant

A

Mirtazapine

97
Q

Differencer between type 1 and type 2 bipolar disorder

A

Type 1 - mania (>7 days) and depression
Type 2 - hypomania (4-7 days) and depression

98
Q

patients with bipolar disease - DVLA rules

A

bipolar disease patients must inform DVLA of their diagnosis. manic episodes - must stop driving for at least 6 months.

99
Q

What things other than blood tests are monitored for anti-psychotics and how often?

A
  1. Weight - start of therapy, 3 months, annually
  2. Fasting blood glucose - at the start of therapy, 6 months, annually
  3. Blood pressure - baseline, frequently during dose titration
  4. ECG - baseline
  5. CVS risk - annually
100
Q

What blood tests are monitored with antipsychotics?

A

FBC
U+Es
LFTs
These three are at the start, then annually. Clozapine is more frequent (weekly for first 18 weeks)

Prolactin - at the start, at 6 months, annually

101
Q

How often is ECG done with antipsychotics

A

At baseline

102
Q

When is cardiovascular risk assessment done with antipsychotics

A

Annually

103
Q

When is BP monitored in antipsychotics

A

At baseline
Frequently during dose titration

104
Q

When is fasting blood glucose and prolactin monitored with antipsychotics?

A

At the start of therapy
6 months
Annually

105
Q

When are lipids and weight monitored in antipsychotics?

A

Start of therapy
3 months
Annually

106
Q

When are FBC, U+Es. LFTs monitored in antipsychotics?

A

Start of therapy
Annually

Clozapine needs weekly FBCs for first 18 weeks

107
Q

What tricyclic antidepressant is most dangerous in overdose

A

dosulepin

108
Q

seasonal affective disorder treatment is the same as what other disorder

A

depression

  • psych therapy and SSRI if needed
109
Q

alcohol withdrawal timeframe for:
- symptoms
- seizures
- delirium tremens

A
  • symptoms: 6-12 hours
  • seizures: 36 hours
  • delirium tremens: 72 hours
110
Q

management of alcohol withdrawal

A
  1. long-acting benzodiazepines e.g. chlordiazepoxide or diazepam
  2. carbamazepine

AKT (25 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions