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FINALS > Psych > Flashcards

Psych Flashcards

1
Q

Illusion

A

Perception when a sensory stimulus is present but is incorrectly perceived

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2
Q

Hallucination

A

Sensory perception occurs in absence of stimulus

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3
Q

Pseudo-hallucination

A

Externalised sensory image vivid enough to be a hallucination but recognised as unrea

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4
Q

Overvalued idea

A

Solitary abnormal belief neither delusional nor obsessional in nature but preoccupying to the extent of dominating the sufferers life

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5
Q

Delusion

A

Abnormal belief which is held with absolute subjective certainty which requires no external proof, which may be held in the face of contradictory evidence, and which has personal significance to person involved.
Absolute certainty, cant be rationalised away, held in face of contradictory evidence, not part of cultural or religious background

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6
Q

Delusional perception

A

A true perception to which a patient attributes a false meaning

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7
Q

Loosening of association

A

Disorganised speech due to a lack of connectivity between ideas

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8
Q

Perseveration

A

Continual repetition of thought or behaviour e.g. finger wiggling

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9
Q

Confabulation

A

Memory error in which gaps are unconsciously filled with fabricated information

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10
Q

Somatic passivity

A

Experience of bodily sensations imposed by external agency

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11
Q

Pressure of speech

A

Rapid and frenzied speech

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12
Q

Anhedonia

A

Inability to experience plasure in normally pleasurable acts

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13
Q

Incongruity of affect

A

Mismatch between experienced emotions and its expression

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14
Q

Blunting of affect

A

Diminished facial expressions, expressive gestures and vocal expressions, Difficulty expressing emotions

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15
Q

Belle indifference

A

Absence of psychological distress despite serious illness

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16
Q

Depersonalisation

A

Dissociative disorder = persistant or recurrent feelings o being detatched

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17
Q

Thought alienation

A

Feel own thoughts are no longer own

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18
Q

Thought insertion

A

Experiencing one’s own thoughts as someone elses

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19
Q

Thought withdrawal

A

Believe a person or entity has removed thought from mind

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20
Q

Thought broadcast

A

Believe people can hear thoughts

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21
Q

Thought echo

A

Hearing own thoughts aloud after thinking them

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22
Q

Thought block

A

Unable to think, speak or move

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23
Q

Akathisia

A

Movement disorder = hard to stay still

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24
Q

Clouding of consciousness

A

Inattention and reduced wakefulness

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25
Q

Depression definition

A

Persistent low mood +/- loss of pleasure in activities
Emotional, cognitive, physical and behavioural Sx

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26
Q

Core depression sx

A

Depressed mood
Anhedonia
Weight change
Insomnia
Others
Psychomotor agitation
Low energy
Guilt
Reduced concentration
Mild = 2 typical +2 core
Moderate = 2 typical + 3+ core
Severe = 3 typical and 4+ other core
Severe = all

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27
Q

Depression Ix

A

Bloods
CXR = infections
ECG = metabolic

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28
Q

Mx depression

A

Mild-moderate = CBT or psychotherapy
Moderate-severe = psychotherapy and antidepressant
1st episode = generic SSRI = citalopram, sertraline
Recurrent = antidepressant with previous good response

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29
Q

GAD definition

A

Disproportionate, pervasive, uncontrollable and widespread worry

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30
Q

S+S GAD

A

Restlessness
Fatigue
Irritability
Poor concentration
Sleep disturbance
Muscle tension

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31
Q

Physical features of GAD

A

Dry mouth
Diarrhoea
Chest constriction
Palpitations
Urinary frequency
Libido loss

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32
Q

ICD 10 GAD

A

At least 4 of
- Symptoms of autonomic arousal = palpitations, sweating, shaking, dry mouth
- Physical = breathing difficulty, choking, chest pain, nausea
- Mental state sx = dizzy, derealisation, fear of losing control
- General = hot flushes, chills, numb, tingling
- Sx tension = muscle tension, aches and pains, restlessness
- Other – exaggerated response to minor surprises
At least 6 months present most of the time

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33
Q

GAD Mx

A

active monitoring
Psychological interventions = CBT
= with marked functional impairenent = high intensity psychological intervention and drug treatment

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34
Q

GAD drugs

A

SSRI 1st line
SNRI
Pregabalin

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35
Q

OCD definition

A

Recurrent obsessional thoughts or compulsive acts
Obsessions = unwanted intrusive thoughts
Compulsions = behaviours that result from obsessive thoughts

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36
Q

S+S OCD

A

Often sudden onset
ICD10
Obsessional thoughts = enter mind repeatedly, invariably distressing, own thoughts
Compulsive = stereotyped behaviours that are repeated, not enjoyable, performed to prevent an unlikely event and recognised as pointless

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37
Q

MX OCD

A

CBT
Supportive psychotherapy
SSRI
Clomipramine
Specialist referral

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38
Q

Bipolar 1

A

Underlying depression, interspersed with mania

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39
Q

Bipolar 2

A

Depression more dominant

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40
Q

Bipolar Manic Sx

A

Elevated mood
Increased energy –> over activity, reduced sleep
Pressured speech
! week
Flight of ideas
Grandiosity
Reduced attention span
Reckless
Psychotic Sx = aud 2nd person

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41
Q

Bipolar hypomanic sx

A

4 days
Mildly elevated mood
Increased energy
Sociability
No psychotic

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42
Q

Mx bipolar

A

Acute manic
- 1st line = atypical antipsychotic = olanzapine, risperidone
- 2nd line = valproate, lamotrigine, lithium
Depressive= avoid ADs, atypical AP instead
General maintenance = lithium, mood diary, education

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43
Q

Positive psychosis sx

A

Delusions Held Firmly Think Psycho
Delusions
Hallucinations (3rd, auditory)
Formal Thought disorder = form, possession, content
Thought interference
Passivity
Lack of insight

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44
Q

Negative Sx psychosis

A

A6C
Asocial
Avolition
Alogia
Affect blunted
Anhedonia
Attention deficit
Catatonia

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45
Q

Psychosis

A

Schizophrenia = most common form

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46
Q

Schizophrenia prodrome

A

Deterioration in social functioning + transient/attenuated psychotic Sx

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47
Q

1st rank schizophrenia S+S

A

Auditory hallucinations 3rd person
Thought withdrawal, insertion and broadcast
Delusional perception
Somatic passivity (external agents imposed)

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48
Q

Specifics of the voices heard in 1st rank sx

A
  • Own thoughts spoken aloud
  • auditory 3rd person hallucinations
  • running commentary
  • not commanding
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49
Q

ICD10 schizophrenia

A

At least 1 of
- thought echo, broadcasting, insertion, alienation
- delusions
- Delusions of control
- 3rd aud hall
Or at least 2 of
- persistant hall in any modality
- Irrevalent speech or neologism
- Catotonic
- neg sx
- significant and consistent change in personal behaviou

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50
Q

Schizophrenia Mx

A

Early intervention = CBT or family intervention
No 1st line AP= choice depends on personal choice, medication hx, degree of sedation required, risk of adverse effects and negative sx
Clozapine usually offered to those who don’t respond to 2 other Aps due to SEs
Atypical usually 1st line (risperidone, olanzapine, quietpaine, aripiprazole

51
Q

PTSD

A

Following traumatic event characterised by involuntary re-experiencing of elements with Sx of hyperarousal, avoidance and emotional numbing

52
Q

S+S PTSD

A

2 or more persistent Sx of increased psychological sensitivity and arousal = sleep, irritable, reckless
Persistent remembering of stressor
avoidance
inability to recall aspects

53
Q

PTSD Mx

A

CBT
EMDR
SSRIs

54
Q

Borderline personality disorder

A

Act impulsively
Intense short lived emotional attachments
Chromic internal emptiness
Frequent SH
Transient pseudo psychotic featires
FHx

55
Q

Paranoid PD

A

Extreme sensitivity
Suspicious
Self important
Preoccupation with conspiracy theories

56
Q

Schizoid PD

A

Emotionally cold and detatched
Limited capacity to express emotions
Indifference to praise or criticism
Preference for solitary activities

57
Q

Antisocial PD

A

Callous inconcern for feelings of others
Incapacity to maintain enduring relationships
Low tolerance of frustration
Incapacity to experience guilt
Blame others

58
Q

Histrionic PD

A

Self dramatisation, theatricality
Shallow and liable emotions
Continual seeking for excitement and appreciation
Inappropriately sedutive appearance an behaviour

59
Q

Suicide risk assessment in adolescents

A

Home and environment
Education
Activities
Drugs and alcohol
Sexuality
Suicide and depression

60
Q

The dependence syndrome

A

Primacy of drug seeking behaviour
Narrowing of repertoire = preference
Increased tolerance
Loss of control of consumption
Sx withdrawal on attempted abstinence
Drug taking to avoid withdrawal Sx
Continued use despite consequences
Rapid reinstatement of previous pattern after abstinence

61
Q

Screening for alcohol dependency

A

CAGE
AUDIT
Increased MCV and GGT

62
Q

FRAMES principles

A

Feedback
Responsibility
Advice
Menu
Empathy
Self efficacy

63
Q

Opiates sx

A

Pinpoint pupils
Low BP
Venepuncture marks

64
Q

Stimulants Sx

A

Rapid speech
Large pupils
Agitation
Restlessness
High BP

65
Q

Opiate withdrawal Sx

A

Dialte pupils
High BP
Sweaty
Rhinorrhoea
Cramps
Goose bumps

66
Q

Mx phobias

A

Behavioural therapy
Flooding
Cognitice
BDZ if severe

67
Q

Serotonin syndrome

A

Iatrogenic syndrome resulting from excess serotonin levels in central and peripheral nervous system

68
Q

Medications that cause serotonin syndrome

A

SSRIs
SNRIs
MAOIs
TCA
Tramadol
Stimulants

69
Q

S+S serotonin syndrome

A

Agitation and confusion
Hypomania
Seizures
Tone increased
Tremor
Hyperreflexia and clonus
HTN
Diarrhoea
hyperthermia

70
Q

Mx serotonin syndrome

A

Cease offending drugs
Cyproheptadine

71
Q

S+S OCPD

A

Perfectionism
Rigid mannersisms
Extreme attention to detail
Excessive devotion
Doubt, indecisiveness, caution
called anankastic

72
Q

Sx alcohol withdrawal

A

Mild = HTN, tachy, anorexia, anxiety
Moderate = worsening mild plus agitation and coarse tremor
Severe = delerium tremens = confusion, TC seizures, hallucinations, hyperthermia

73
Q

Sx wernickes encephalopathy

A

Confusion
Ataxia
Eye paralysis
Nystagmus
Memory disturbance
Hypothermia and hypotension
Caused by thiamine deficiency therefore prescribe thiamine

74
Q

Delerium tremens

A

Acute confusional state secondary to alcohol withdrawal
Clouding consciousness
Disorientation
Amnesia for recent events
Psychomotor agitation
Hallucinations (liliputian)

75
Q

Opiate detoxification

A

Methadone
Moderate = aches, dialted pupils, yawning = 10-20mg methadone
Severe = vomiting, HTN = 20-30mg methadone

76
Q

Conversion disorder

A

Loss of motor or sensory function
Doesn’t consciously feign symtpoms or seek material gain
Belle indifference

77
Q

Somatisation

A

Multiple physical symptoms present for at least 2 years
Refuses to accept reassurance or negative test results

78
Q

benzodiazapine used for alcohol withdrawal

A

chlordiazepoxide

79
Q

ICD 10 anorexia

A

Low body weight - 15% below expected BMI 17.5 or less
Self-induced weight loss
Body image distortion
Endocrine
Delayed/arrested puberty

80
Q

Anorexia Ix

A

FBC
ESR
U+E, phosphate, magnesium, bicarbonate, LFTs
Glucose = hypo
TFTs = low T3/4
ECG = sinus brady, raised QTc
Hypokalaemia, hyponatraemia, hypoglycaemias, hypothermia, increased cortisol

81
Q

Anorexia Mx

A

Treat psychological disorder
Encourage weight gain
Family therapy

82
Q

Anorexia complication

A

Cardioac = brady, hypotn, ECG changes
CNS = impaired concentration
Derm = brittle skin, nails and hair loss
Haem = anaemia
Met = hypok, hypona, hypogly
Amenorrhoea

83
Q

Refeeding syndrome

A

Potentially fatal shift in fluids and electrolytes
High risk = give thiamine, vit B, daily bloods

84
Q

Metabolic consequences of refeeding syndrome

A

Hypophosphataemia
Hypokalaemia
Hypomagnesium = torsades de points
Abnormal fluid balance

85
Q

NICE recommendation for refeeding

A

If not eaten >5 days, refeed at no more than 50% of requirements for 2 days

86
Q

High risk refeeding

A

1 or more of the following:
- BMI < 16 kg/m2
- unintentional weight loss >15% over 3-6 months
- little nutritional intake > 10 days
- hypokalaemia, hypophosphataemia or hypomagnesaemia prior to feeding (unless high)
2 or more of the following:
- BMI < 18.5 kg/m2
- unintentional weight loss > 10% over 3-6 months
- little nutritional intake > 5 days
- history of: alcohol abuse, drug therapy including insulin, chemotherapy, diuretics and antacids

87
Q

Bulimia ICD10

A

Persitent preoccupation with eating
Irresistable craving for food
Binges
Attempts to counter food effects
Morbid dread of fatness

88
Q

Complications of purging

A

Arrhythmia
Cardiac failure
Electrolyte disturbance
Oesophageal erosions or gastric perforation
Ulcers
Pancreatitis

89
Q

Acute dystonic reaction

A

After new ATAP or and increased dose recently
Torticollis, trismus, jaw opening
Procyclidine given

90
Q

Neuroleptic malignant syndrome

A

Reaction to APs
Fever, rigidity, autonomic dysfunction, confusion, tachy, tremor
Raised CK and leukocytosis
Stop AP
BZD
Supportive

91
Q

Lithium toxicity

A

> 1.5mmol/l = toxic
- therapeutic range 0.5-1
- Tremor (coarse), Renal failure, Hyperreflexia, convulsions, N+V, vision
- Stop lithium, fluids and NaCl, dialysis if severe

92
Q

features opioid overdose

A
  • pinpoint
  • decreased RR
  • altered status
  • response to naloxone
93
Q

Opiod detox

A

Methadone/buprenorphine/dihydrocoedine
Lofexidine to relieve withdrawals
Naltrexone to prevent relaps
Overdose = naloxone

94
Q

Pathophysiology alcohol abuse

A

Up regulation NMDA receptors
Downregulation GABA receptors
Cessation causes CNS hyperexcitability

95
Q

Alcohol wdrawal

A

6hrs = malaise, tremor, nausea
36hrs = seizures
72hrs = delirium tremens

96
Q

Withdrawal alcohol treatment

A

Chlordiazepoxide
IV thiamine (B1) pabrinex
Disulfiram = bad se when drink = build-up of acetaldehyde
acamprosate = reduce cravings = enhances GABA transmission
naltrexone = reduced pleasure = opioid antagonist

97
Q

Delirium tremens

A

72hrs after
Cog impairement, liliputian, paranoid delusion, sweating, dehydration
Mx = pabrinex and lorazepam

98
Q

Wernicke

A

Delirium, nystagmus, hypothermia, ataxia
Mx = pabrinex

99
Q

mechanism of paracetamol overdose

A

More paracetamol shunted to CP450 system so more NAPQO produced

100
Q

Mx paracetamol OD

A

within 1hr = activated charcoal
> 8hrs IV N acetylcysteine = 3 consecutive IV infusions
1st infusion is 1hr

101
Q

Give NAC if

A
  • past line 4hrs post
  • Staggered overdose
  • 8-24hrs after >150mg/kg
  • > 24hrs jaundiced, tender, ALT
102
Q

Kings college hospital criteria

A

For liver transplant post paracetamol OD if
- Arterial PH <7.3 24hrs post
Or all 3 of
- PT >100
- Creatinine >300
- Grade 3 or 4 encephalopathy

103
Q

absolute contraindication for ECT

A

raised intracranial pressure

104
Q

relatice contraindications for ect

A

cerebral tumour/aneurysm
phaeochromocytoma
pregnancy
recent MI

105
Q

Indications for ECT

A

catatonia
no medication has worked
psychotic

106
Q

Drug induced psychosis

A

cannabis
corticosteroids
opioids
cocaine
amphetamines
levodopa
anti-malaria

107
Q

mech of action of trypical antipsychotics

A

dopamine receptor blockade = D2 antagonists

108
Q

Acute dystonia

A
  • AP adverse reaction
  • abnormal msucle contraction
  • IV procyclidine
109
Q

SE of typical APs

A
  • hyperprolactinaemia
  • extrapyradimal = pd, akathasia, dystonia
  • Metabolic = weight gain, T2
  • Anticholinergic = tachy, vision, constipation
  • Neuro = NMS, seizures
110
Q

MoA atypical APs

A
  • Blocl 5HT2 serotonin receptors
  • More selective
111
Q

Clozapine SE

A
  • agranulocytosis
  • Lowers seizure threshold
  • FBC weekly then 2 monthly
112
Q

the 4 dopamine pathways

A
  • mesolimbic (+ve sx)
  • Mesocortical (-ve Sx)
  • Nigrostriatal (EPS and TD)
  • Tuberinfundibular (prolactin)
113
Q

which pathway causes hyperprolactinaemia

A

tuberoinfindibular

114
Q

which pathway causes EPS and TD

A
  • nigrostriatal
115
Q

SE SSRI

A
  • N+V
  • Headache
  • Anxiety
  • Sexual dysfunction
  • Insomnia
  • Hypona
116
Q

SNRI SE

A
  • nausea
  • dry mouth
  • dizzy
  • sweat
  • htn
117
Q

lithium monitoring

A
  • 0.6-1
  • 1 after start, 1s after dose change and weekly until stable then 3m
  • 12 hrs post dose
  • 6m thyroid, parathyroid, renal
  • weekly plasma
118
Q

Lithium SE

A
  • Nausea
  • diarrhoea
  • muscle weajness
  • hypo/hyperthyroid
  • tremor fine
  • weight gain
  • polyuria and dipsia
  • hyper PTH
  • nephro
119
Q

lithium toxicity

A
  • drowsy
  • N+V
  • blurred vision
  • coarse tremor
  • delirium
  • dysarthria
120
Q

what tool to screen for depression post partum

A
  • Edinburgh postnatal depression scale
121
Q

Baby blues

A
  • 3-7 days following birth
  • anxious, tearful, irritable
  • reassurance, support, health visitor
122
Q

postnatal depression

A
  • 1-3m after
  • support, SSRI, CBT
123
Q

puerperal psychosis

A
  • 2-3w
  • severe mood swings
  • auditory hallucinations, delusions
  • specialist mother and baby unit

FINALS (31 decks)

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