Psych Flashcards
Crazy lady thinks neighbours are shining lights in her window tryna buy up her property to build a tennis court. Badly-done make-up, eccentric dress. Feels happy but thinks memory, hearing and vision are all worse. On time for appt without reminder.
Lewy body dementia
Schizophrenia
Late-onset schizophrenia
Paranoid personality disorder
MCD with Alzheimers
Paranoid personality disorder…. but by definition personality disorders start in adulthood around 18 years of age.
?prodomal schizophrenia
Suicide risk, bruising on arms. What do you need to do after assessing suicide risk?
- Explore relationship with husband
- Social networks
- Refer to social worker
- Give antidepressant
Explore relationship with husband
Screen for domestic abuse
35 year old office manager with bilateral wrist injuries (self-harm). Says his mood is low but doesn’t reflect his affect. His responses about safety are varying suggesting he should be admitted. Bullied at school, says he never had a circle of friends. Childhood sexual abuse from his uncle. Agrees to call his family - mum and dad are very glad to know where he is and say they have always been supportive. Which feature distinguishes this presentation (personality disorder) from an affective or psychotic condition?
A) Onset after drugs
B) Family onset
C) Onset after adulthood
D) Pattern of pervasive and inflexible behaviour
Pattern of pervasive and inflexible behaviour = personality disorder
Lady who has had 1 month of episodes with shortness of breath, palpitations, sweating, she is no longer going to the gym. She lives at home with her dad and 2 siblings. Her mother died 6 months ago of breast cancer.
a) GAD
b) Panic Disorder
c) PTSD
d) Substance abuse
e) Grief reaction
Panic Disorder
Anorexia Nervosa - what is the most important question when establishing a diagnosis?
· Body image
· Menstrual cycle
· Purging
· Bingeing
Body image
Patient w hx of amphetamine use prescribed SSRI, not working. Given additional mirtazapine + quetiapine. Suddenly feeling energetic, hyperthermic, stomach gurgling. Some examination findings - high temp, jerking and hyperreflexia?….Cause?
Neuroleptic malignant syndrome
Serotonin syndrome
Drug abuse
HYPERREFLEXIA/CLONUS IS ALWAYS SEROTONIN SYNDROME.
Old guy was found by Police in his hallway after neighbours complained of a bad smell coming from his house. Had a fever and was confused? Was also dehydrated. Bad ulcer on back (thats what smelled). When asked how he got it, he was surprised when asked about this and replied “It must have developed within the last few days!”…
· Delirium
· Dementia
· Drugs
Delirium
Man worried about HIV, although results are negative and 4 doctors have checked them. He settles down after hearing results, but soon starts worrying again and this is causing functional impairment. Likely diagnosis?
· Health anxiety
· Somatisation
· Generalised anxiety disorder
· Factitious disorder
- Panic disorder
- Paranoid personality
Health anxiety/hypochondriasis/somatic delusions
Teen girl believes people are taking thoughts out of her head, what do you give
· Risperidone
· Fluoxetine
· Haloperidol
· Zuclopenthixol decanoate
· Clozapine
Quite a specific symptom of schizophrenia
Risperidone.
Patient brought in with partner. Very agitated in the consult. When you ask him about how he is feeling he replies: “I love you, i love you, i love you girl… in a whirl, world to Timbuktu… I do, I do, I do love you”
a. Mania
b. Schizophrenia
c. Histrionic disorder
Mania
Patient with schizophrenia started on antipsychotics. Shortly after he becomes restless, agitated and has insomnia. What has he likely to have developed?
1. Acute Akathisia
2. Tardive dyskinesia
3. QTc prolongation
4. Metabolic syndrome
6. Anticholinergic symptoms
Acute Akathisia
Patient on antipsychotics develops acute muscle dystonias with oculogyric crisis. Treatment?
1. Benztropine
2. Metoclopramide
3. Haloperidol
4. Risperidone
Benztropine
Used for drug-induced extrapyramidal ADRs. Note it won’t help in tardive where it is an upregulation issue.
Homeless patient with poorly treated/untreated schizophrenia for years and years, what part of their cognition is likely to be impacted?
- Verbal fluency and proverbs
- Orientation and concentration
- Short-term memory and recall
- Language and writing
Orientation and concentration
Person with schizophrenia. Death of a parent 2 years ago. What is a negative prognostic
Factor?
1. Long prodrome
2. Living rurally
3. Sentinel event
4. Depression
5. Married
6. Late age of onset
7. Female
Long prodrome
Old depressed man who sounded catatonic. Wouldn’t eat or drink and wouldn’t respond verbally. Management?
1. ECT
2. SSRI
3. Counseling
4. CBT
5. Nothing
ECT
Guy who was mad his meta-analysis about Autism Treatments didn’t get published in The
Lancet and wrote angry letters to everyone who wouldn’t publish him - believing they were trying
to ruin his academic reputation. Has done it before with other editors. Also believed they should
just publish his stuff cos he was an “expert” etc etc
1. Narcissistic personality disorder
2. Normal academic behavior
3. Hypomania
4. Paranoid ideation
Likely narc
36 year old with what sounded like BPD whose parents were concerned about him - what is the
difference between this and affective disorder / schizophrenia?
1. Inflexible and pervasive thinking
2. Personality disorder is only diagnosed in adulthood
3. Can occur secondary to alcohol use
4. Causes distress for family
Inflexible and pervasive thinking
Can diagnose antisocial personality before 18.
Patient who insists Jacinda Ardern is a terminator from the future who has come to kill us all and specifically him as well. Speaking very fast but interruptible.
1. Pressure of speech
2. Persecutory delusion
3. Flight of ideas
4. Formal thought disorder
5. Grandiose delusions
Persecutory delusion
30 y old brought in by the landlord, has been neglecting self care, talking to non-visible phenomena and laughing.
FIrst line treatment
1. Olanzapine
2. Clozapine
3. Sertraline
Olanzapine
Girl going to a conference in 4 months who is scared of flying, best management?
1. CBT
2. Benzos for flight
3. Antipsychotics
4. Lithium
5. Family therapy
CBT
Girl depressed, lives rurally and gives away her stuff. What displays the greatest risk to her commiting suicide?
1. Giving away her stuff
2. Living rurally
3. Recommencing smoking
Giving away her stuff
19yo brought in by parents with weird thinking that he knew something awful was going to
happen
1. Nihilistic delusions
2. Alexithymia
3. Delusional mood
4. Knight’s move thinking
5. Circumstantiality
Nihilistic delusions
Woman with depressive sx and 2 young kids, what is most important thing to ask?
Any thoughts about harming your children
Woman 6 weeks post partum. Says baby cries a lot then starts to cry herself. Says she has been struggling, not eating, lost 5kg since birth, can’t sleep even when baby is asleep. Vehemently denies depression because she didn’t have it with her first baby. What is the diagnosis?
Post natal depression
Baby blues
Post partum psychosis
Adjustment disorder
Post natal depression
Someones stealing theatre scalpel blades with features of borderline personality disorder. Mentioned low mood and suicidal ideation. What is the most important [initial] thing to do
· Assess suicidal risk
· Seek specialist opinion
· Refer straight to ED
Assess suicidal risk
Someone started on haloperidol presents w/ fevers, sweating and muscle rigidity
- Neuroleptic malignant syndrome
- Akinesia
- Acute dystonia
Neuroleptic malignant syndrome
Young man goes to GP because he doesn’t like his nose, GP thinks his nose is normal, but the young man wants to be referred to a plastic surgeon because he feels girls don’t like him because of his nose
Body dysmorphia
Obsessive compulsive
Illness anxiety
Schizophrenia
Weird nose disorder
Body dysmorphia
Overdose with pinpoint pupils and RR 3
a. Naloxone
b. Atropine
c. Flumazenil
d. NAC
Naloxone
pinpoint pupils = OP poisoning or opioid, treat opioid overdose with naloxone and OP poisoning with atropine
Guy is brought in by daughter who says he is on paroxetine and some other medications that aren’t known. Had definite fever 39ish, myoclonus, hyperreflexia.
What will help most with determining the diagnosis?
a. Full medication list
b. Ask medication compliance
c. Ask more about presentation
Full medication list
Woman with previous diagnosis of MDD and then a manic episode presents after
discontinuing meds, what do?
Lithium
Older lady wants referral to hospital because only they can fix her problems. She
comments on how young the doctor is. Is enjoying the interview. Is immaculately
dressed by apologises for behaviour saying she is too depressed to do herself up.
Dx?
Histrionic personality disorder
Young woman with known borderline personality disorder. Comes in for the 3rd time
this week with superficial cuts on wrists. Tells doctor he is the best doctor and that
she doesn’t want to see any of the other doctors because are not as good as him.
This is an example of:
Splitting (black + white thinking)
Doctor who sends lots of letters to government and newspapers saying our whole
food chain is rife with mad cow disease and we should stop eating beef. He has sent
100 letters in a week. He is a nuisance but otherwise is functioning well. Diagnosis?
Delusional disorder (>1 month symptoms, NO OTHER PSYCHOTIC SYMPTOMS).
Woman alcoholic who is 8 weeks pregnant. Binges on weekends with 12-14
drinks. Next step in management?
Brief intervention
Old man with recent MI feeling sad, which is most likely diagnostic of depression
Pervasive negative thinking
- low, depressed mood
- loss of interest/pleasure
Why is using ECT justified when some people claim it is punishment
Recover from depression faster than antidepressants or fewer dangerous
side effects or because you don’t need to take anti-depressants
Extra pyramidal symptoms after metoclopramide
Give benzatropine
Girl lives with grandparents, comes to ED with horizontal nystagmus and other
symptoms
//
Girl OD on drug when visiting grandparents. OE, temp 37.8, increased RR, normal pulse
TCA overdose
Citalopram
???? NO clue
man brought in by police. appeared unkempt. has been sleeping on bench. talks
slowly and replies slowly.
schizophrenia
Which of the following parkinsons drugs don’t act on dopamine
Benserazide(levodopa),
benztropine(anti-cholinergic) ,
entacapon (carbidopa)
carbidopa - this just helps levodopa not be broken down
Diarrhea, patient looks emaciated
laxative abuse
patient diagnosed with breast cancer, a week later is weepy with low mood
normal adjustment
Man gets leg amputation gets phantom pain, TX
non-pharmacological –> CBT
Dude not sleeping since coming back from overseas trip 3 weeks ago
Hypomania
Child with abdo pain. Not at night. Relieved with warm. Good in school and captain of netball?
Abdominal migraine
