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3a PTS - PM - ZTF > Psych > Flashcards

Psych Flashcards

1
Q

EUPD description (3)

A

Problems in the functioning of aspects of self i.e. self-worth and direction

Intense interpersonal relationships that alternate between idealisation and devaluation

Associated with a history of recurrent self-harm

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2
Q

Histrionic PD description

A

Need to have attention and acting in a dramatic and narcissistic way to achieve this

Inappropriate sexual seductiveness

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3
Q

Paranoid PD description

A

Hypersensitivity and unforgiving if insulted

Question loyalty of those around them and are reluctant to confide in others

Anti-social

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4
Q

Schizoid PD description

A

Anti-social, aloof, indifferent and not complying to social norms

Lack of interest in sexual interactions

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5
Q

Schizotypal PD description

A

History of ‘magical thinking’ / odd beliefs and ideas of reference

Lack of close friends other than family members

  • The ideas of reference are not firm enough to meet the criteria for delusional disorder or schizophrenia
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6
Q

Narcissistic PD

A

Grandiose sense of self importance

Preoccupation with fantasies of unlimited success and power

Lack of empathy

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7
Q

Obsessive-compulsive / Anakastic PD

A

Unhelpful perfectionism - occupied with details, rules, lists

Rigid with respect to morals, ethics and values that everyone should follow

Unwilling to pass on tasks

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8
Q

Avoidant/anxious PD

A

Preoccupied with ideas that they are being criticised or rejected in social situations and therefore avoid interpersonal contact

Certainty of being liked is needed before becoming involved with people

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9
Q

Dependent PD

A

Difficulty making everyday decisions without excessive reassurance from others

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10
Q

Anti-social PD

A

Failure to conform to social norms
Repeatedly performing acts that are grounds for arrest
More common in men
Lack of remorse
Aggressiveness

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11
Q

Psychological therapy used for EUPD

A

Dialectical behaviour therapy (DBT)

medication should not be used unless comorbidities exist e.g. depression or psychosis

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12
Q

Factors favouring delirium over dementia

A

Acute onset
Impairment of consciousness
Fluctuation of symptoms: worse at nights, periods of normality
Abnormal perception (e.g. illusions and hallucinations)
Agitation, fear
Delusions

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13
Q

Monoamine Oxidase Inhibitor metabolise which neurotransmitters

A

serotonin and noradrenaline

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14
Q

2 examples of MAOIs drugs
- ine

A

Phenelzine
Tranylcypromine
Selegiline
Isocarboxazid
Rasagiline

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15
Q

Adverse effect of non-selective MAOI drugs

A

‘Cheese effect’:
Hypertensive reactions with tyramine-rich foods e.g. cheese, pickled herring, Bovril, OXO, marmite, broad beans

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16
Q

Prophylactic mood stabilisation in bipolar disorder 1st & 2nd line

A

1st line: Lithium (teratogenic)
2nd line: Sodium valproate (teratogenic)
3rd line: Olanzapine
Rapid cycling bipolar: Carbamazepine

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17
Q

Difference between hypomania and mania

A

Mania: severe functional impairment or PSYCHOTIC symptoms (e.g. delusions of grandeur) for 7 days or more
- Type 1

Hypomania: decreased or increased function for 4 days or more
- Type 2

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18
Q

Side effects of Lithium - name 5

A

Nausea/vomiting/diarrhoea
Hypothyroidism / Weight gain
Fine tremor
Polyuria and polydipsia secondary to nephrogenic DI (lithium = nephrotoxic)

Other:
Hyperparathyroidism and resultant hypercalcaemia (stones, bones, moans, groans)
Idiopathic intracranial hypertension
Leucocytosis

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19
Q

Lithium monitoring

A

Lithium levels:
taken 12 hours post-dose
After a dose change or after starting: weekly until levels are stable
Normally checked every 3 months

Thyroid and renal function (U&Es, eGRF) should be checked every 6 months

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20
Q

3 reasons lithium toxicity may be precipitated

A

Dehydration
Renal failure
Drugs: diuretics, ACE inhibitors, NSAIDs

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21
Q

Features of lithium toxicity - name 4

A

Coarse tremor (fine tremor seen in therapeutic)
Hyperreflexia
Acute confusion
Polyuria
Seizure
Coma

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22
Q

Management of assisted alcohol withdrawal

A

1st line: oral long acting benzo e.g. Lorazepam or Chlordiazepoxide

IV if symptoms persist

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23
Q

Features of alcohol withdrawal (timed stages)

A

6-12 hours: symptoms
36 hours: seizures
48-72 hours: delirium tremens

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24
Q

What is given during alcohol detoxification to replenish low B1 stores in delirium tremens

A

IV Pabrinex (thiamine, riboflavin etc.)

oral thiamine is used to replenish low B1 stores when not in DE

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25
Q

Risk factors for delirium

A

PINCHME
Pain
Infection (think UTI)
Nutrition
Constipation
Hydration
Medication
Environment

Hypoxia (type 1 resp failure i.e. low O2 with normal CO2)

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26
Q

Causes of serotonin syndrome (2)

A
  1. Antidepressants e.g. MAOIs + SSRIs e.g. rasagiline + Citalopram, or SSRI-drug interactions e.g. St John’s wort / Tramadol
  2. Illicit substances e.g. Ecstasy + Amphetamines
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27
Q

3 features of serotonin syndrome (triad)

A

think: excess 5-HT to neuromuscular and central synapses (brain + spinal cord)

Neuromuscular excitation: Hyperreflexia, Myoclonus, Rigidity

Autonomic nervous system excitation:
Hyperthermia, Sweating 😓

Altered mental state:
Confusion

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28
Q

Favouring features for neuroleptic malignant syndrome compared with serotonin syndrome

A

Caused by antipsychotics
Slower onset (days to weeks vs 24h)
Hyporeflexia, normal pupils

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29
Q

Neuroleptic malignant syndrome investigation results

A

Raised creatine kinase (due to muscle rigidity) - rhabdomyolysis
Raised white cell count (leukocytosis)
Acute renal failure = abnormal U&Es
Deranged LFTs
Metabolic acidosis - low pH, low HCO3

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30
Q

Neuroleptic malignant syndrome tetrad

A

think: neurotransmitter overload:
1. Autonomic instability - hypertension, tachycardia, tachypnoea
2. Altered mental status - delirium with confusion
3. Hyperthermia (pyrexia)
think: dopamine overload i.e. Parkinsonism rigidity:
4. Muscle rigidity

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31
Q

Definition of severe depression

A

triad (low mood for at least 2 weeks, anhedonia, anergia)
PLUS most other symptoms e.g. weight change, sleep change, psychomotor, worthlessness, inability to think, suicidal ideation - all of which markedly interfere with functioning

PHQ-9 > 16

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31
Q

3 core symptoms of depression

A

Low mood for at least 2 weeks
Anhedonia
Anergia

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32
Q

ICD-10 criteria for delirium (5)

A
  1. Impairment of consciousness and attention
  2. Global disturbance in cognition
  3. Psychomotor disturbance
  4. Disturbance of sleep-wake cycle
  5. Emotional disturbances
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33
Q

Name 4 medical problems associated with Down’s syndrome

A

Heart defects (ToF, AV/V/A septal defects)
Hearing loss
Visual disturbance (cataracts, strabismus)
GI problems (oesoph/duodenal atresia, Hirschsprung’s)
Hypothyroidism
Haematological malignancies (AML, ALL)
Alzheimer’s risk increase

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34
Q

Describe 4 physical appearance features in Down’s syndrome

A

Face:
Upslanting palpebral fissures
Epicanthic folds
Brushfield spots in iris
Protruding tongue
Small low set ears
Round/flat face
Flat occiput

Single palmar crease

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35
Q

NICE first line for mild depression

A

Watch and wait (review in 2 weeks) and consider referral to IAPT for low intensity psychological interventions

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36
Q

NICE first line for severe depression

A

Combination of individual CBT + an antidepressant

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37
Q

First line antidepressant for less severe depression

A

SSRI

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38
Q

What kind of antidepressant is amitriptyline

A

Tricyclic antidepressant

NICE recommends avoiding TCAs in history or risk of overdose due to toxicity

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39
Q

What kind of antidepressant is duloxetine

A

SNRI

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40
Q

What kind of antidepressant is isocarboxazid

A

MAOI

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41
Q

GAD definition

A

Syndrome of ongoing, uncontrollable, widespread worry about many events that the patient recognises as excessive - must be present on most days for at least 6 months

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42
Q

Agoraphobia definition

A

Fear of public spaces or fear of entering a public space from which immediate escape would be difficult in the event of a panic attack

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43
Q

First and second line drug for GAD

A
  1. SSRI e.g. sertraline
  2. another SSRI or an SNRI e.g. duloxetine and venlafaxine
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44
Q

Examples of stimulant drugs

A

Cocaine
Meth
MDMA
Khat
Nicotine

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45
Q

4 main dopaminergic pathways

A

Mesolimbic
Mesocortical
Nigrostriatal
Tuberohypophyseal

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46
Q

4 common indications for the prescription of a benzodiazepine

A

Alcohol withdrawal
Seizures
Severe anxiety
Severe insomnia

Benzos should not be used for more than 2-4 weeks due to addiction / side effects (drowsiness)

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47
Q

4 extrapyramidal side effects of typical antipsychotics

A

Parkinsonism
Acute dystonia - sustained muscle contraction such as torticollis or oculogyric crisis
Akathisia (severe restlessness)
Tardive dyskinisea (chewing and pouting of jaw or excessive blinking)

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48
Q

How is acute dystonia secondary to antipsychotics managed

A

Procyclidine

anti-cholinergic which corrects cholinergic neurotransmission

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49
Q

what 2 complications can antipsychotics cause in the elderly

A

Stroke
VTE

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50
Q

Non-EPSE side effects of typical antipsychotics

A

Antimuscarinic - dry mouth, blurred vision, urinary retention, constipation
Sedation
Dyslipidaemia/Weight gain
Hyperprolactinaemia - may result in galactorrhoea
Dysglycaemia/diabetes Mellitus
Prolonged QT interval (particularly haloperidol)

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51
Q

Adverse effects of atypical antipsychotics

A

Weight gain
Hyperprolactinaemia
+ Clozapine is associated with agranulocytosis

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52
Q

Examples of atypical antipsychotics

A

Clozapine
Olanzapine
Risperidone
Quetiapine
Amisulpride
Aripiprazole

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53
Q

Atypical antipsychotic that increases risk of dyslipidemia and obesity

A

Olanzapine

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54
Q

Atypical antipsychotic with good side effect profile

A

Aripiprazole

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55
Q

Why is FBC monitoring essential during clozapine treatment

A

Significant risk of agranulocytosis

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56
Q

When is clozapine indicated in schizophrenia

A

Sequential use of two or more antipsychotic drugs (one of which should be a second generation anti-psychotic drug) each for at least 6-8 weeks

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57
Q

What activity can cause a rise in clozapine blood levels

A

Smoking

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58
Q

Adverse effects of clozapine (5)

A

Agranulocytosis, neutropaenia
Reduced seizure threshold
Constipation
Myocarditis
Hypersalivation

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59
Q

Management of depressive episode in bipolar disorder

A

Fluoxetine + atypical antipsychotic e.g. olanzapine

Talking therapies

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60
Q

Management of manic episode in bipolar disorder

A

Consider stopping antidepressant (SSRIs and TCAs especially venlafaxine increase risk of ‘switch’)

Atypical antipsychotic therapy e.g. olanzapine

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61
Q

Midazolam

A

RAPID acting benzo

Indications: status epilepticus

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62
Q

ICD-10 criteria for agoraphobia

A
  • fear and avoidance of 2 of: crowds, public spaces, travelling alone, travelling away from home
  • symptoms of anxiety in feared situation with autonomic arousal
  • significant emotional distress due to avoidance or anxiety symptoms
  • recognised as excessive or unreasonable
  • symptoms restricted to feared situation
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63
Q

Panic disorder definition

A

Recurrent, episodic, severe panic attacks which are unpredictable and not restricted to any particular situation or circumstance

Not associated with marked exertion or with exposure to dangerous or life-threatening situations

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64
Q

ICD-10 criteria of panic disorder (5)

A
  • discrete episodes of intense fear or discomfort
  • starts abruptly
  • reaches a crescendo within a few minutes and lasts at least some minutes
  • at least 1 symptom of autonomic arousal
  • other symptoms of anxiety
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65
Q

Schizophrenia Schneider’s first rank symptoms (4)

A

auditory hallucinations
delusional perceptions
thought disorders
passivity phenomena

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66
Q

Auditory hallucinations in schizophrenia (3)

A

thought echo
two or more voices discussing the patient in the third person
voices commenting on the patient’s behaviour

67
Q

Thought disorders in schizophrenia (3)

A

thought insertion
thought withdrawal
thought broadcasting

68
Q

Passivity phenomena seen in schizophrenia definition

A

bodily sensations being controlled by external influence

69
Q

Delusional perceptions in schizophrenia definition

A

two stage process:
first a normal object is perceived
secondly there is a sudden intense delusional insight into the objects meaning for the patient
e.g. ‘The traffic light is green therefore I am the King’

this can include persecutory delusions

70
Q

Name 4 negative symptoms of schizophrenia

A

incongruity/blunting of affect
anhedonia (inability to derive pleasure)
alogia (poverty of speech)
avolition (poor motivation)
social withdrawal

71
Q

Schizophrenia prognostic indicators

A

strong family history
gradual onset
pre-morbid low IQ
prodromal phase of social withdrawal
lack of obvious precipitant

72
Q

Strongest risk factor for developing a psychotic disorder

A

Family history

73
Q

Risk factors associated with an increased risk of future completed suicide after an attempted suicide (5)

A

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

74
Q

Suicide risk factors

A

static:
male sex
history of deliberate self-harm
history of mental illness
depression
schizophrenia (10%)
history of chronic disease
advancing age

dynamic:
alcohol or drug misuse
unemployment or social isolation/living alone
financial problems
being unmarried, divorced or widowed

75
Q

Flumazenil

A

reverses the sedative effects of benzodiazepines (particularly in benzodiazepine overdose)

76
Q

Indication for the use of EMDR in PTSD

A

recommended in patients who have presented between 1 and 3 months after a non-combat related trauma who specifically prefer EMDR > trauma-focussed CBT

77
Q

Indication for the use of trauma-focused CBT in PTSD

A

1st line for patients

78
Q

1st line medical management of PTSD (2)

A

SSRIs e.g. sertraline or venlafaxine (SNRI)

79
Q

4 types of thought disorganisation seen in psychosis

A

alogia e.g. … (poverty of speech)
tangentiality e.g. ‘How was your week?’ ‘The sky is blue’
clanging e.g. Where are the keys knees freeze breeze?
word salad e.g. soggy blankets and red tomatoes

80
Q

5 conditions where psychosis is a symptom

A

Schizophrenia (most common)
Depression (psychotic depression seen in elderly patients)
Bipolar disorder
Parkinson’s disease
Corticosteroid induced
Illicit drugs e.g. cannabis

81
Q

Knight’s move thinking

A

phenomenon where a patient’s thoughts move from one topic to another

differential from flight of ideas: knight’s move has no logical connection between them

82
Q

Flight of ideas

A

increased rate of thought with at least some logical links between the frequent changes of topics that a patient is talking about

commonly a feature of mania/hypomania

83
Q

Circumstantiality

A

patient gives an excessive amount of detail that is irrelevant to the question but there is a logical progression of thought + normal rate

84
Q

Perseveration

A

repetition of a certain word/phrase/thought

85
Q

Features of opioid misuse

A

rhinorrhoea
needle track marks
pinpoint pupils
drowsiness
watering eyes
yawning

86
Q

emergency management of opioid overdose

A

IV or IM naloxone

87
Q

1st line treatment for opioid detoxification

A

methadone or buprenorphine

88
Q

lithium in pregnancy

A

teratogenic

risk of Ebstein’s anomaly (congenital heart defect characterised by enlarged right atrium, shrunken right ventricle, pansystolic murmur by defective tricuspid valve)

89
Q

Clomipramine

A

tricyclic antidepressant used 2nd line in OCD

90
Q

4 features of a capacity assessment

A

WURC

The ability to…
weigh-up
understand
retain
communicate
…the decision made

91
Q

How does a person need to communicate their decision for a capacity assessment

A

A person can communicate their decision verbally or by other means such as in writing or via sign language, the assessor must take into account the patients’ primary communication method

92
Q

Egodystonic vs egosyntonic in OCD thoughts

A

Obsessive thoughts are usually egodystonic (very different to the patient’s normal beliefs and values) rather than egosyntonic (in keeping with ones beliefs and values)

93
Q

Cognitive function test used in primary care settings

A

Six Item Cognitive Impairment Test (6-CIT)

94
Q

Medications associated with delirium

A

PROF

Propranolol
Ranitidine (H2 blocker)
Chlorphenamine (H1 blocker)
Oxybutynin - causes constipation (PINCH ME)
Furosemide (diuretic)

95
Q

Blood test monitoring clozapine

A

first 18 weeks: minimum of 1 blood test per week
until 1 year: fortnightly
after 1 year: monthly (as long as there are no abnormalities)

96
Q

Confusion screen (4)

A

Infection screen

Chest X-ray
C-Reactive Protein
Full Blood Count, B12/folate, TFTs, glucose, calcium
Urinalysis

97
Q

Depression over Dementia features

A

short history, rapid onset
biological symptoms 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)

98
Q

GAD risk factors (4)

A

Aged 35-54
Being divorced or seperated
Being a lone parent
Living alone

99
Q

How long should a patient continue with treatment once they have reached remission with antidepressant therapy

A

6 months (to reduce the risk of relapse)

100
Q

Over what period of time should SSRIs be reduced when stopping them

A

4 weeks

101
Q

Section 5 (4)

A

Holding power for nurses for up to 6 hours

102
Q

Section 5 (2)

A

Holding power for doctors for up to 72 hours

103
Q

key differential when elderly patient experiences drowsiness, confusion, or convulsions while taking an SSRI

A

Hyponatraemia

104
Q

Disulfiram

A

Deterrent drug which increases serum acetaldehyde if alcohol is consumed which causes diaphoresis, palpitations, facial flushing, nausea etc.

not an anti-craving drug - used for alcohol abstinence

105
Q

Naltrexone use in alcohol abuse recovery

A

Naltrexone blocks opioids from releasing endorphins (associations of alcohol with endorphin rush are diminished) = undermines the reinforcement/reward system with drinking alcohol

106
Q

3 drugs used for alcohol addiction rehabilitation

A

Naltrexone
Disulfiram
Acamprosate

107
Q

Normal pressure hydrocephalus

A

Reversible cause of dementia thought to be secondary to reduced CSF absorption at the arachnoid villi

these changes may be secondary to head injury, sub arachnoid, meningitis

108
Q

Normal hydrocephalus features triad

A

Urinary incontinence
Dementia and bradyphrenia
Gait abnormality

109
Q

Neuroimaging of normal pressure hydrocephalus

A

Ventriculomegaly in the absence of sulcal enlargement

110
Q

Management normal pressure hydrocephalus

A

Ventriculoperitoneal shunting

111
Q

Medications that can trigger anxiety (5)

A

Salbutamol
Theophylline
Corticosteroids
Antidepressants
Caffeine

112
Q

Alternative causes of anxiety disorders

A

Hypothyroidism - TFTs
Cardiac disease - ECG
Medication induced anxiety
Anaemia (palpitations + fatigue) - FBC
Phaeochromocytoma - 24 hour urinary metanephrines

113
Q

Management of serotonin syndrome

A

IV fluids + Benzodiazepines

More severe cases: serotonin antagonists i.e. cyproheptadine and chlorpromazine

114
Q

1st line management step after someone presents with depression in a primary care setting for the first time

A

PHQ-9 questionnaire

115
Q

Acamprosate mechanism of action

A

Reduces alcohol cravings by increasing GABA transmission

116
Q

Indication for the use of mertazapine as an antidepressant

A

the 2 side effects of mirtazapine, sedation and an increased appetite, can be beneficial in older people that are suffering from insomnia and poor appetite

117
Q

what is the 1 absolute contradiction for ECT

A

Raised intracranial pressure

118
Q

Causes of drug induced psychosis

A

Illicit substances
Alcohol
Anti-malarial
Bromocriptine
Levodopa
Steroids

119
Q

Edwards and Gross criteria for alcohol dependence

A
  • Narrowing of repertoire
  • Salience of drink-seeking behaviour
  • Increased tolerance to alcohol
  • Repeated withdrawal symptoms
  • Relief or avoidance of withdrawal symptoms by further drinking
  • Subjective awareness of compulsion to drink
  • Reinstatement after abstinence
120
Q

Schizoaffective disorder

A

Schizophrenia along with another disorder e.g. depression or bipolar

121
Q

What age does autism normally present by

A

3 years old

122
Q

Features of autism

A
  1. Impaired social communication and interaction
  2. Repetitive behaviours, interests, and activities

Often associated with intellectual impairment or language impairment
ASD has a co-occurrence of 35%

123
Q

3 management options in autism

A

Early educational and behavioural interventions e.g. applied behavioural analysis
SSRIs for anxiety symptoms
Family support and counselling

124
Q

Risk factors for OCD

A

Family history
Age: peak onset 10-20 years
Pregnancy/post natal period
History of abuse, bullying, neglect

125
Q

Severe OCD features

A

> 3 hours a day on their obsessions/compulsions
Severe interference/distress
Very little control/resistance

126
Q

Mild functional impairment OCD management

A

1st: low-intensity CBT including exposure response prevention
2nd: SSRI or more intensive CBT with ERP

127
Q

Moderate functional impairment OCD management

A

1st: Intensive CBT with ERP +/- SSRI for at least 12 weeks
2nd: Different SSRI or Clomipramine (1st if the person prefers it, has had a good previous response, or if SSRI is C/I)

128
Q

Severe functional impairment OCD management

A

Refer to the secondary care mental health team for assessment and whilst waiting offer SSRI and CBT with ERP (or clomipramine as alternative)

129
Q

SSRI for body dysmorphia

A

Fluoxetine

130
Q

OCD SSRI dose vs depression

A

Higher dose and longer duration of treatment before an initial response (at least 12 weeks)

131
Q

Somatatisation disorder definition

A

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

132
Q

Illness anxiety disorder (hypochondriasis)

A

Persistence belief in the presence of an underlying serious disease e.g. cancer
Patient refuses to accept reassurance of negative test results

133
Q

Conversion disorder

A

Psychological stress converted to loss of motor or sensory function

Doesn’t consciously feign the symptoms (factitious) or seek material gain (malingering)

La belle indifference = indifferent to their apparent disorder

134
Q

Factitious disorder

A

Also known as Münchausen’s syndrome
Intentional production of physical or psychological symptoms

135
Q

Malingering disorder definition

A

Fraudulent simulation or exaggeration of symptoms with the intention of financial or other gain

136
Q

Concordance rate for schizophrenia in monozygotic twins

A

50%

137
Q

Mental Health Act: Section 2

A

Admission for assessment for up to 28 days
Not renewable
2 doctors (usually 1 consultant psychiatrist) + AMHP
Treatment can be given against a patient’s wishes

138
Q

Mental Health Act: Section 3

A

Admission for treatment for up to 6 months
Renewable
2 doctors + AMHP (all must have seen patient within past 24 hours)
Treatment can be given against a patient’s wishes

139
Q

How long can a section 136 be used for

A

24 hours (whilst a MHA assessment is arranged)

140
Q

What should be offered to all schizophrenia patients after medication

A

Cognitive behavioural therapy

141
Q

Differential diagnoses in depression

A

Bipolar disorder
psychotic disorders
premenstrual syndrome
substance misuse
Anaemia
Hypothyroidism

142
Q

3 screening tools for depression

A

PHQ-9
HADS
BDI-II

143
Q

What should be co-prescribed with an SSRI if they are already taking an NSAID

A

PPI

144
Q

Patient under 25 time until review after initiating SSRIs

A

1 week

145
Q

Acute stress disorder definition

A

Acute stress reaction that occurs in the first 4 weeks after a person has been exposed to a traumatic event

(PTSD is diagnosed after 4 weeks)

146
Q

1st line for acute stress reaction

A

1st line: Trauma focused CBT

Benzodiazepines can sometimes be used for acute symptoms e.g. sleep disturbance - but should be used with caution due to addictive potential

147
Q

4 antipsychotics used in a manic episode

A

Haloperidol
Olanzapine
Quetiapine
Risperidone

148
Q

2 typical antipsychotics

A

Chlorpromazine
Haloperidol

149
Q

3 features of PTSD

A

Re-experiencing e.g. flashbacks, nightmares
Avoidance e.g. avoiding people or situations
Hyperarousal e.g. hyper vigilance, sleep problems

150
Q

Most effective antipsychotic for dealing with negative symptoms

A

Clozapine

151
Q

Catatonia definition

A

Stopping of voluntary movement or staying in an unusual position arising from disturbed mental state

152
Q

Most likely SSRI to cause QT prolongation and torsades de points

A

Citalopram

153
Q

Most useful SSRI post-myocardial infarction

A

Sertraline

154
Q

SSRI discontinuation symptoms

A

Increased mood change
restlessness
Difficulty sleeping
Sweating
GI symptoms: pain, cramping, diarrhoea
Dizziness
electric shock sensations
Anxiety

155
Q

Use of SSRIs in pregnancy (3)

A

1st trimester: small risk congenital heart defects
3rd trimester: small risk pulmonary hypertension of new born
Paroxetine increases risk of congenital malformations (particularly in 1st)

156
Q

SSRI drug-drug interactions

A

NSAIDs (co-prescribe PPI)
Warfarin/Heparin (prescribe mirtazapine instead)
Aspirin
Triptans (increased risk of SS)
MAOIs (increased risk of SS)

157
Q

Recommended monitoring before initiating treatment of SNRI

A

Blood pressure

158
Q

Signs of cocaine use

A

Dilated pupils
Hyperreflexia

159
Q

Chronic insomnia definition

A

Difficulty with falling or staying asleep at least 3 nights per week for at least 3 months

160
Q

TCA side effect profile

A

Histamine receptors: drowsiness
Muscarinic receptors: dry mouth, blurred vision, constipation, urinary retention/overflow incontinence

161
Q

Flight of ideas vs knights move thinking

A

Flight of ideas = discernible links, seen in bipolar
Knight’s move = no discernible links, seen in schizophrenia

162
Q

Where would a patient with hypomania be referred to from primary care

A

Community mental health team

163
Q

When might dose adjustment of clozapine be necessary

A

If smoking is started (increase) or stopped (reduce)

164
Q

Charles-Bonnet syndrome

A

Persistent complex hallucinations occurring in clear consciousness with a background of visual impairment (age related macular degeneration is the most common)

Patients usually have insight that the hallucinations are not real

165
Q

anorexia bloods

A

most things low
G’s and C’s raised: growth hormone, glucose, salivary glands, cortisol, cholesterol, carotinaemia

3a PTS - PM - ZTF (8 decks)

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