Psych Flashcards
What should be considered in elderly patients with new onset psychosis?
Organic cause -> CT head
Patients ≤ 25 years who have been started on an SSRI should be reviewed when?
after 1 week
What is flight of ideas?
Jumping from idea to idea with links between these
What is Knights move?
Jumping from idea to idea with no links between these
What is the risk of SSRI in third trimester?
Persistent pulmonary HTN
What is a C/I to triptans for migraines?
Patients taking SSRI
Patients under 25 starting an SSRI should be reviewed when?
After 1 week
When do you get alcohol withdrawal symptoms, seizures and delirium?
symptoms: 6-12 hours
seizures: 36 hours
delirium tremens: 72 hours
Management of OCD?
- SSRI
- Clomipramine
OCD vs OCPD?
OCD must have functional component/impact of daily life
Management of SSRIs before ECT?
Dose should be reduced but not stopped
When should lithium levels be checked after a change in dose?
One week after change and then weekly until levels are stable
Signs of alcohol addiction
Attempted and failure of abstinence, compulsion to drink, narrowing of drinking repertoire, increased tolerance to alcohol, alcohol is priority over oth e r aspects of life, physical withdrawal when alcohol is stopped
Why can antipsychotics cause elevated prolactin?
Prolactin release from lactotrophs is inhibited by dopamine released from the hypothalamus. Therefore, when this inhibition is lifted, prolactin release is increased
How can patients appeal against being sectioned?
Appeal must be applied for in writing to a mental health tribunal within 14 days o f detention
How does activated charcoal work?
Activated charcoal works by providing a large surface area to absorb a potential poison and stop it from being absorbed by the GI tract;
Lithium toxicity may be precipitated by what?
NSAIDs
Management of PTSD?
- Trauma focused CBT
- EMDR
- Venlafaxine/SSRI
Triggers for lithium toxicity
Dehydration
Infection
Renal failure
ACE/ARB
NSAID
Diuretic
How long should symptoms be present for with PTSD?
4 weeks
What is the management of lithium toxicity?
Mild/Moderate: IV Fluid resus
Severe: Haemodialysis
Bipolar I vs Bipolar II
Bipolar I - mania and depression
Bipolar II - hypomania and depression
Purposefully causing symptoms such as hypoglycaemia?
Munchausen syndrome
Hypomania in the community?
Routine referral to community mental health
How do you define chronic insomnia?
Trouble falling asleep/staying asleep for 3 months or longer
What are risk factors for insomnia?
- Increasing age
- Female gender
- Lower educational attainment
Which medications can cause insomnia?
Corticosteroids
OCD vs psychosis?
OCD will have a level of insight of their actions
What can be protective factors against completed suicide ideation?
- Social support
- Religious beliefs
- Having children at home
- Regretting an attempt
What are common PTSD symptoms?
- Flashbacks/nightmares
- Avoiding people or situations
- Hypervigilance/Sleep problems
Schizoid vs schizotypal PD?
Schizotypical will also have unusual beliefs/magical thinking
How should SSRI dose be stopped?
Over a 4 week period
What ophthalmic feature is associated with Charles Bonnet?
Age related MD
Flight of idea vs tangentiality?
In flight of ideas, they would answer the question then jump to another idea whereas in tangentiality, they would not answer the question
Sweating, tremor, confusion and hyperreflexia?
Serotonin syndrome
Which medications can cause serotonin syndrome?
- MAO
- SSRIs + Tramadol/St Johns Wort
- Ecstasy
- Amphetamines
Which medications can be used as mood stabilizers?
- Lithium
- Sodium valproate
- Carbamazepine
5 stages of grief
- Denial
- Anger
- Bargaining
- Depression
- Acceptance
What is an hallucination?
Abnormal perception in the absence of external stimulus
Which deaths should be referred to coroner?
- Unknown cause of death
- Death was violent or suspicious
- Accidental death
- Death due to self neglect
- Death related to employment/industrial disease
- Death during operation
What are risk factors for NMS?
- Use of neuroleptic medication
- High dose medication
- Depot
- Previous NMS
Which receptor is blocked in NMS?
Dopamine
What are principles of the mental capacity act?
- Assume capacity
- Decisions made in best interests
- Help can be provided to make decision for themselves
- People with capacity can make unwise decisions
- Decisions made should be with the least restrictive option
Who can be a representative party for patients when no relatives during mental capacity discussions?
Independent Mental Capacity Advocates
What is an advanced decision?
Legally bound document allowing someone to state treatment they would not want in the future if they lack capacity to make the decision
What is panic disorder?
Regular, sudden or unexpected attacks of panic or fear
What questionnaires can be used for anxiety?
- Beck Anxiety Inventory
- Hamilton Anxiety scale
- General health questionnaire
Signs of anorexia on examination
- Bradycardia
- Lanugo hair
- Dry skin
- Evidence of self harm
- Acid erosion
- Hypotension
What is a community treatment order?
Service user has to meet certain supervised conditions in the community, if they fail to do this, they may be recalled to hospital
Risk of using antipsychotics in elderly?
- Stroke
- VTE
Recurrent vomiting can cause what?
- Russell sign
- Erosion of teeth
Clozapine S/E
- Agranulocytosis
- Reduced seizure threshold
- Constipation
- Dose must be adjusted if smoking if started/stopped
What assessment tools can be used for depression?
- HAD scale
- PHQ-9 scale
Section 2
- Admission for upto 28 days
- AMHP
Section 3
Treatment for 6 months
- 2 doctors and AMHP
Section 4
- 72 hours order
- GP and AMHP
Section 5(2)
Detained for 72 hours by doctor
Section 5(4)
Detained for 6 hours by nurse
Section 17(A)
Community treatment order
Section 135
Police order to retrieve someone from home to place of safety
Section 136
Police order to bring someone from public place to a place of safety
What is the most important prognostic indicator in paracetamol overdose?
Arterial PH
What is indication for liver transplant in paracetamol overdose?
pH < 7.3 more than 24 hours after transplant
What kind of reaction does N-acetylcysteine cause?
Anaphylactoid - non-IgE mediated mast cell release
What is high in anorexia?
- Growth hormone
- Glucose
- Salivary glands -> parotidomegaly
- Cortisol
- Cholesterol
- Carotenaemia
When can paracetamol overdose become high risk to develop liver failure?
- Chronic alcoholic
- HIV
- Anorexia
- Taking P450 inducers
Lead pipe rigidity is a sign of what?
Neuroleptic malignant syndrome
What is a Fregoli delusion?
Belief that everyone is the same person/strangers are familiar
What is a capgras delusion?
Relative/Friend has been replaced by an imposter
What are C/I to using anti-cholinesterase inhibitors?
- prolonged QT
- 2nd/3rd degree heart block
- Sinus bradycardia
Use Cognitive stimulation therapy instead
What is logoclonia?
Where the patient gets stuck on a particular word and repeats it
What is Ekbom syndrome?
Believe they are infested with parasites
What test is used to assess muscle wasting in patients with anorexia?
Sit-up-squad-stand test
Postpartum depression has to be within when?
12 months after birth
Stopping of voluntary movement or staying still in an unusual position
Catatonia
Serotonin syndrome vs NMS
Serotonin: faster onset, increased reflexes, dilated pupils
NMS: slower onset, decreased reflexes, normal pupils
Social phobia vs agoraphobia
Agoraphobia - fear of open spaces + crowds / difficulty of immediate easy escape to a safe place
Social Phobia - feat of scrutiny in small groups e.g. public speaking
Lithium can cause a benign what?
Leucocytosis - raised WCC
Antipsychotics can increase the risk of what?
Stroke
Symptoms of aspirin overdose?
- Hyperventilation
- Tinnitus
- Sweating
- N+V
- Seizures
- Causes respiratory alkalosis then metabolic acidosis
Conversion disorder?
Neuro symptoms without any underlying cause
Tahycardia, HTN, CNS stimulate, GI upset?
Think opioid withdrawal
What is agnosia?
Inability to recognise people, objects or places which were once known
Confusion screen bloods
FBC, U&E, LFTs, CRP/ESR, Ca2+, TFTs, B12, folate, syphilis, HIV
ophthalmoplegia, ataxia, and confusion
Wernickes
Personality disorders
Cluster A - Paranoid, schizoid, schizotypal
Cluster B - Antisocial, EUPD, Histrionic, Narcissistic
Cluster C - OCPD, Avoidant, Dependent
Fregoli delusion
Different people are the same person
How long should treatment for SSRI be continued before thinking about switching?
4 weeks - younger
6 weeks - elderly
What is schizoaffective disorder?
Schizophrenia with mood disturbance e.g. depression/mania
