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Psych Flashcards

1
Q

Long-term lithium use can result in ________________ and resultant ________________

A

hyperparathyroidism and resultant hypercalcaemia

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2
Q

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)

A

Depression vs dementia

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3
Q

What is the most important test to perform when starting a patient on anti-psychotics?

A

FBC - agranulocytosis/neutropenia is a life-threatening side effect of clozapine

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4
Q

Antisocial personality disorder is associated with ______________ disorder

A

Conduct disorder

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5
Q

Schizoaffective vs mania

A

Mania: mood disturbances precede psychotic symptoms (low mood for a year and now presents with a manic episode + psychosis)

Schizoaffective: psychotic symptoms precede mood disturbances

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6
Q

Confusion
Ataxia
Ophthalmoplegia/nystagmus

A

Wernicke’s encephalopathy

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7
Q

Profound anterograde amnesia
Limited retrograde amnesia
Confabulation

A

Korsakoff’s syndrome

Retrograde: no past memories
Anterograde: no new memories

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8
Q

Which medication is used to treat Tardive dyskinesia?

A

Tetrabenazine = both begin with T

Have been TAking antipsychotics for several years -> give Tetrabenezine

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9
Q

Which medication is used to treat acute dystonia?

A

Acute dySTonia common when STarting antipsychotics -> give procyclidine

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10
Q

Which medication is used to calm a patient who is having a psychotic episode (among many other indications)?

A

Lorazepam

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11
Q

Which medication is used to treat akathisia?

A

Propranolol

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12
Q

Which medication is used as anti-depressant in children?

A

Fluoxetine

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13
Q

Give examples of typical antipsychotics

A

Haloperidol
Chlorpromazine

Blocks D2: Haloperidol and the “-zines”

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14
Q

Give examples of atypical antipsychotics

A

Clozapine
Risperidone
Olanzapine

Blocks 5HT2: “-idones”, “-apines” + Aripiprazole

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15
Q

Which drugs are normally avoided with SSRIs?

A

Aspirin
NSAIDs: if given co-prescribe PPI
Warfarin / heparin: consider mirtazapine
Triptans and MOAIs: serotonin syndrome

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16
Q

What are the preferred SSRIs?

A

Fluoxetine and Citalopram (risk of QT interval prolongation, avoid in congenital long QT syndrome, known pre-existing QT interval prolongation, or in combination with other medicines that prolong the QT interval)

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17
Q

For patients who are on SSRIs and under the age of 25 years, there is an increased risk of _______ should be reviewed after _______

A

For patients who are on SSRIs and under the age of 25 years, there is an increased risk of suicide should be reviewed after 1 week

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18
Q

When stopping a SSRI the dose should be gradually reduced over a __ week period (this is not necessary with ___________). ___________ has a higher incidence of discontinuation symptoms

A

When stopping a SSRI the dose should be gradually reduced over a 4 week period (this is not necessary with fluoxetine). Paroxetine has a higher incidence of discontinuation symptoms

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19
Q

Using SSRIs in the first trimester gives a small increased risk of..

A

Congenital heart defects

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20
Q

Using SSRIs in the third trimester can result in..

A

Persistent pulmonary hypertension of the newborn

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21
Q

The SSRI ____________ has an increased risk of congenital malformations, particularly in the first trimester

A

The SSRI Paroxetine has an increased risk of congenital malformations, particularly in the first trimester

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22
Q

Following the initiation of antidepressant therapy patients should normally be reviewed by a doctor after ________. If a patient makes a good response to antidepressant therapy they should continue on treatment for at least ________ after remission as this reduces the risk of relapse

A

Following the initiation of antidepressant therapy patients should normally be reviewed by a doctor after 2 weeks. If a patient makes a good response to antidepressant therapy they should continue on treatment for at least 6 months after remission as this reduces the risk of relapse

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23
Q

Hypersensitivity and an unforgiving attitude when insulted
Unwarranted tendency to questions the loyalty of friends
Reluctance to confide in others
Preoccupation with conspirational beliefs and hidden meaning
Unwarranted tendency to perceive attacks on their character

Which PD is shown here?

A

Paranoid PD - Cluster A (Odd or eccentric)

Conspiracy theorist

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24
Q

Indifference to praise and criticism
Preference for solitary activities
Lack of interest in sexual interactions
Lack of desire for companionship
Emotional coldness
Few interests
Few friends or confidants other than family

Which PD is shown here?

A

Schizoid PD - Cluster A (Odd or eccentric)

Aloof virgin

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25
Q

Ideas of reference (differ from delusions in that some insight is retained)
Odd beliefs and magical thinking
Unusual perceptual disturbances
Paranoid ideation and suspiciousness
Odd, eccentric behaviour
Lack of close friends other than family members
Inappropriate affect
Odd speech without being incoherent

Which PD is shown here?

A

Schizotypal PD - Cluster A (Odd or eccentric)

Rambler

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26
Q

Failure to conform to social norms with respect to lawful behaviours as indicated by repeatedly performing acts that are grounds for arrest
Deception
Impulsivenes
Irritability and aggressiveness - repeated physical fights or assaults;
Disregard for the safety of self or others;
Consistent irresponsibility
Lack of remorse

Which PD is shown here?

A

Antisocial PD - Cluster B (Dramatic, Emotional, or Erratic)

Liar, fighter, lazy

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27
Q

Avoid real or imagined abandonment
Unstable interpersonal relationships which alternate between idealisation and devaluation
Unstable self image
Impulsivity in potentially self damaging area (e.g. Spending, sex, substance abuse)
Recurrent suicidal behaviour
Affective instability
Chronic feelings of emptiness
Difficulty controlling temper
Quasi psychotic thoughts

Which PD is shown here?

A

Borderline PD - Cluster B (Dramatic, Emotional, or Erratic)

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28
Q

Inappropriate sexual seductiveness
Need to be the centre of attention
Rapidly shifting and shallow expression of emotions
Suggestibility
Physical appearance used for attention seeking purposes
Impressionistic speech lacking detail
Self dramatization
Relationships considered to be more intimate than they are

Which PD is shown here?

A

Histrionic PD - Cluster B (Dramatic, Emotional, or Erratic)

Attention seeking hoe

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29
Q

Grandiose sense of self importance
Preoccupation with fantasies of unlimited success, power, or beauty
Sense of entitlement
Taking advantage of others to achieve own needs
Lack of empathy
Excessive need for admiration
Chronic envy
Arrogant and haughty attitude

Which PD is shown here?

A

Narcissistic PD - Cluster B (Dramatic, Emotional, or Erratic)

Delulu and greedy

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30
Q

Details, rules, lists, order, organization, or agenda
Perfectionism that hampers with completing tasks
Elimination of spare time activities
Etiquettes of morality, ethics, or values
Dot capable of disposing worn out or insignificant things even when they have no sentimental meaning
Is unwilling to pass on tasks or work with others except if they surrender to exactly their way of doing things
Takes on a stingy spending style towards self and others; and shows stiffness and stubbornness

Which PD is shown here?

A

Obsessive-compulsive PD - Cluster C (Anxious and Fearful)

Literally just me tbh

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31
Q

Avoidance of occupational activities which involve interpersonal contact due to fears of criticism, or rejection
Unwillingness to be involved unless certain of being liked
Preoccupied with ideas that they are being criticised or rejected in social situations
Restraint in intimate relationships due to the fear of being ridiculed
Reluctance to take personal risks due to fears of embarrassment
Views self as inept and inferior to others
Social isolation accompanied by a craving for social contact

Which PD is shown here?

A

Avoidant PD: Cluster C (Anxious and Fearful)

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32
Q

Difficulty making everyday decisions without excessive reassurance from others
Need for others to assume responsibility for major areas of their life
Difficulty in expressing disagreement with others due to fears of losing support
Lack of initiative
Unrealistic fears of being left to care for themselves
Urgent search for another relationship as a source of care and support when a close relationship ends
Extensive efforts to obtain support from others
Unrealistic feelings that they cannot care for themselves

Which PD is shown here?

A

Dependent PD: Cluster C (Anxious and Fearful)

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33
Q

Mx of PD

A

Dialectical behaviour therapy
Treatment of any coexisting psychiatric conditions

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34
Q

Timeline difference between Acute Stress Disorder vs PTSD

A

PTSD: 4 weeks
ASD: 2 weeks

PTSD has 4 letters so can only diagnose as PTSD 4 weeks after the event

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35
Q

Tx for acute stress disorder

A

CBT
Benzodiazepines for acute symptoms e.g. agitation, sleep disturbance. Addictive potential

Don’t do trauma-focused CBT in the first 4 weeks of an acute stress reaction as it can cause PTSD to develop

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36
Q

Side effects for Clozapine

A

Agranulocytosis, neutropenia, reduced seizure threshold, and myocarditis

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37
Q

All atypical antipsychotics can cause ________ and _____________

A

All atypical antipsychotics can cause weight gain and hyperprolactinemia

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38
Q

The atypical antipsychotic _________ has a good side effect profile and is less likely to increase prolactin levels or cause other side effects

A

Aripiprazole

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39
Q

Which atypical antipsychotic is used to a patient is underweight and cannot sleep?

A

Olanzapine

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40
Q

Which atypical antipsychotic has a notable side effect of postural hypotension?

A

Quetiapine

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41
Q

The atypical antipsychotic ____________ can increase the likelihood of developing extrapyramidal side effects, as well as cause postural hypotension and sexual dysfunction

A

Risperidone

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42
Q

What are the specific warnings when antipsychotics are used in elderly patients?

A

Increased risk of stroke
Increased risk of venous thromboembolism

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43
Q

What are the protective factors of GAD?

A

Aged 16 - 24
Being married or cohabiting

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44
Q

What are the risk factors of GAD?

A

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

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45
Q

Having a _________ disease or _________ may result in symptoms similar to GAD

A

Having a hyperthyroid disease or atrial fibrillation may result in symptoms similar to GAD

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46
Q

Mx of GAD

A
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47
Q

Mx of panic disorder

A
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48
Q

When checking lithium levels, the sample should be taken ________ post-dose

A

12 hours

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49
Q

After starting lithium, levels should be performed ________ and after each dose change until concentrations are stable. Once established, lithium blood level should ‘normally’ be checked every ________. After a change in dose, lithium levels should be taken a ________ later and ________ until the levels are stable

A

After starting lithium, levels should be performed weekly and after each dose change until concentrations are stable. Once established, lithium blood level should ‘normally’ be checked every 3 months. After a change in dose, lithium levels should be taken a week later and weekly until the levels are stable

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50
Q

After starting lithium, _________ and _________ function should be checked every 6 months

A

After starting lithium, thyroid and renal function should be checked every 6 months

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51
Q

What are the nephrotoxic effects of lithium?

A

Polyuria, secondary to nephrogenic diabetes insipidus

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52
Q

What are the endocrinological effects of lithium?

A

Thyroid enlargement, may lead to hypothyroidism
hyperparathyroidism and resultant hypercalcaemia

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53
Q

What are the cardiological effects of lithium?

A

T wave flattening (red) or inversion (blue)

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54
Q

What are the side effects of tricyclics interacting with histamine receptors?

A

Drowsiness

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55
Q

What are the side effects of tricyclics interacting with muscarinic receptors?

A

Dry mouth
Blurred vision
Constipation
Urinary retention

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56
Q

What are the side effects of tricyclics interacting with adrenergic receptors?

A

Postural hypotension

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57
Q

T or F: Tricyclics cause shortening of QT interval

A

False, lengthening

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58
Q

Give examples of sedative tricyclics

A

Amitriptyline
Clomipramine
Dosulepin
Trazodone*

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59
Q

Give examples of less sedative tricyclics

A

Imipramine
Lofepramine
Nortriptyline

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60
Q

Mx of OCD

A
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61
Q

A patient diagnosed with OCD was prescribed with Setraline but has presented with no improvement after 6 weeks. What is the next course of action?

A

Increase dose, if no response after 12 weeks then:

Combined treatment with CBT (including ERP)
Switch to a different SSRI
Switch to clomipramine

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62
Q

First rank symptoms of SZ

A

TAPD:
- Thought disorder
- Auditory hallucinations
- Passivity phenomena
- Delusional perceptions/delusions

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63
Q

Distinguish between dementia and depression regarding memory loss

A

Depression: global memory loss
Dementia: short-term memory loss

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64
Q

What are the three core depressive symptoms?

A

Anhedonia, anergia or low mood

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65
Q

Atypical depression may include..

A

Increased appetite and hypersomnia

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66
Q

Outline somatic symptoms of depression

A

Loss of emotional reactivity
Diurnal mood variation
Anhedonia
Early morning waking
Psychomotor agitation or retardation
Loss of appetite and weight
Loss of libido

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67
Q

A personality disorder can only be diagnosed after..

A

The age of 18

The only exception is borderline PD which may be diagnosed before then provided there is sufficient evidence the patient has fully undergone the process of puberty

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68
Q

Two causes of unexplained symptoms

A

Somatisation = Symptoms
hypoChondria = Cancer

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69
Q

Differentiate between factitious disorder and malingering

A

Factitious: also known as Munchausen’s syndrome, consciously feign the symptoms
Malingering: seek material gain

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70
Q

Which symptoms of alcohol withdrawal starts at 6-12 hours?

A

Tremor
Sweating
Tachycardia
Anxiety

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71
Q

Which symptoms of alcohol withdrawal starts at 36 hours?

A

Seizures

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72
Q

Which symptoms of alcohol withdrawal starts at 48-72 hours?

A

Coarse tremor
Confusion
Delusions
Auditory and visual hallucinations
Fever
Tachycardia

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73
Q

Tx of alcohol withdrawal

A

Long-acting benzodiazepines e.g. chlordiazepoxide or diazepam

Lorazepam may be preferable in patients with hepatic failure

Carbamazepine also effective in treatment

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74
Q

Which scoring system is used to determine the severity of alcohol withdrawal?

A

Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar) scale

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75
Q

What is Perseveration?

A

Repeating the same words/answers

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76
Q

What is Echolalia?

A

Repeating exactly what someone has said

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77
Q

What is Neologism?

A

Making up new words

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78
Q

What is Word salad?

A

Disorganised speech, sentences that do not make sense

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79
Q

Differentiate between circumstantiality and flight of ideas

A

Circumstantiality: excessive unnecessary details before eventually reaching the answer to the question

Flight of ideas: rapid shift in thoughts with loose connections between them, without ever answering the original question

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80
Q

Tx for PTSD

A

Watch and wait for mild symptoms <4 weeks
CBT or EMDR
If drug treatment is used then venlafaxine or SSRI, such as sertraline should be tried. In severe cases, risperidone may be used

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81
Q

____________ is a common finding associated with lithium

A

Benign leucocytosis is a common finding associated with lithium

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82
Q

When is carbamazepine used in the treatment of alcohol withdrawal?

A

Can help manage seizures associated with alcohol withdrawal as it is an anticonvulsant

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83
Q

Outline poor prognostic factors of SZ

A

Strong family history
Gradual onset
Low IQ
Prodromal phase of social withdrawal
Lack of obvious precipitant

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84
Q

Side effects of TCAs

A

‘TCAs’

Thrombocytopaenia
Cardiac (arrhythmias, MI, stroke, postural hypotension)
Anticholinergic (tachycardia, urinary retention, dry mouth, blurry vision, constipation) - Can’t see, can’t pee, can’t spit, can’t shit
Seizures

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85
Q

When performing a mini mental state examination on a patient with depression they will answer with __________ whereas patients with Alzheimer’s will try their best to answer your questions, but answer __________

A

When performing a mini mental state examination on a patient with depression they will answer with ‘I don’t know’, whereas patients with Alzheimer’s will try their best to answer your questions, but answer incorrectly

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86
Q

Which drug is used in treatment resistant schizophrenia?

A

Clozapine

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87
Q

Differentiate between borderline PD and bipolar disorder

A

EUPD - intense emotions, impulsivity, self-harm and unstable relationships
Bipolar - episodes of mania (elevated mood, increased activity, decreased need for sleep) interspersed with episodes of depression

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88
Q

The SSRI of choice in people with unstable angina or recent myocardial infarction is _________

A

Sertraline

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89
Q

Differentiate between mania and hypomania

A

Mania: severe functional impairment, psychotic symptoms, >7 days
Hypomania: high functioning and does not impair functional capacity, <7 days and no psychotic symptoms

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90
Q

Mx of bipolar disorder

A

Lithium is the mood stabiliser of choice (alt. valproate)

For mania/hypomania:
Consider stopping antidepressant if the patient takes one (antipsychotic therapy e.g. olanzapine or haloperidol

For depression:
Talking therapies and fluoxetine

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91
Q

Which co-morbidities exist with Lithium?

A

Diabetes, cardiovascular disease and COPD

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92
Q

What is ECT used for?

A

ECT
Euphoric - prolonged or severe mania
Catatonia
Tearful - severe depression

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93
Q

What is a C.I to ECT?

A

Raised intracranial pressure

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94
Q

What are the short-term side-effects to ECT?

A

Headache
Nausea
Short term memory impairment
Memory loss of events prior to ECT
Cardiac arrhythmia

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95
Q

What are the long-term side-effects to ECT?

A

Impaired memory

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96
Q

Hypertrophied dental gums is seen in which eating disorder?

A

Bulimia

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97
Q

What are the features of PTSD

A

HEART:

Hyperarousal
Emotional numbing
Avoidance of triggers
Re-experiencing
Time

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98
Q

Differentiate between OCD and psychosis

A

In OCD the patients normally have a good level of insight into their condition and understand that if they did not perform the acts their obsessive though would not come true. However, they still get the urge to perform them anyway, just to put their mind at ease

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99
Q

Which parameters are raised in anorexia nervosa?

A

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

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100
Q

What is Hoover’s sign?

A

Clinical tool to differentiate organic from non-organic leg paresis. In non-organic paresis, pressure is felt under the paretic leg when lifting the non-paretic leg against pressure, this is due to involuntary contralateral hip extension - conversion disorder

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101
Q

Hypercalcaemia sx

A

Stones, bones, abdominal moans, and psychic groans

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102
Q

Which foods are avoided with MOAi?

A

Tyramine containing foods e.g. cheese, pickled herring, Bovril, Oxo, Marmite, broad beans

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103
Q

Psychotic episodes that last for less than a month are called..

A

Brief psychotic disorders

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104
Q

Which neurological conditions can cause psychotic symptoms?

A

Parkinson’s disease, Huntington’s disease

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105
Q

Which prescribed drugs can cause psychotic symptoms?

A

Corticosteroids

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106
Q

Which illicit drugs can cause psychotic symptoms?

A

Cannabis, phencyclidine

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107
Q

Outline thought disorganisation features seen in psychosis

A

Alogia: little information conveyed by speech
Tangentiality
Clanging
Word salad

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108
Q

Symptoms you get when you FINISH taking SSRIs

A

Flu like symptoms
Insomnia
Nausea (& other GI side effects)
Imbalance
Sensory disturbances (paraesthesia)
Hyperarousal (restlessness, agitation)

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109
Q

Symptoms of anxiety and __________ often overlap

A

Hyperthyroidism

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110
Q

Clozapine is reserved for two cases. These are..

A

Treatment resistant schizophrenia - two antipsychotics have been trialled at their highest tolerated doses for adequate durations
Negative symptoms

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111
Q

What can improve concordance with SZ medication?

A

Switch to depot

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112
Q

Clozapine is contraindicated in those with a..

A

Chaotic lifestyle and/or poor adherence

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113
Q

When to stop SSRIs?

A

666 rule:

  • Wait at least 6 weeks for it to take effect (before switching medication)
  • Continue for 6 months to stabilise and avoid relapse
  • Take at least 6 weeks for the washout period in order to avoid adverse effects
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114
Q

Differentiate between Knight’s move and flight of ideas

A

Knight’s move - illogical leaps from one idea to another
Flight of ideas - discernible links between ideas

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115
Q

________________ is the most common endocrine disorder developing as a result of chronic lithium toxicity

A

Hypothyroidism

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116
Q

Outline blood tests that are used as screening tests to look for other identifiable causes of confusion

A

TFTs, FBC, ESR, CRP, U&E, Ca, HbA1c, LFTs, serum B12 and folate

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117
Q

Mx for encephalitis

A

1st line: steroids and intravenous immunoglobulin +/- plasma exchange if not responding to meds
2nd line, if no response within two weeks: rituximab and cyclophosphamide + 1st line therapy

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118
Q

Anyone under the influence of _________ and ________ is specifically excluded from detainment under the Mental Health Act

A

Anyone under the influence of drugs and/or alcohol is specifically excluded from detainment under the Mental Health Act

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119
Q

What is the four criteria a patient needs to meet to demonstrate capacity to make a decision?

A

Understand the decision
Retain the information long enough to make the decision
Weigh up the pros and cons
Communicate their decision

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120
Q

What is Lasting power of attorney (LPA)? When does it come into effect?

A

When a person legally nominates a person of their choice to make decisions on their behalf if they lack mental capacity. LPA only comes into effect if the patient lacks the capacity to decide for themselves

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121
Q

Baby blues vs Post-partum depression vs Depression regarding time

A

Firs two weeks + resolves spontaneously - baby blues
First 12 months - postpartum depression
More than 2 weeks + not within first 12 months of birth - depression
2 weeks after - postpartum psychosis

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122
Q

Ix for CJD

A

Tissue biopsy, with tonsil or olfactory mucosal biopsy

EEG, MRI, and lumbar puncture

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123
Q

Change in personality. Often recognised by the patient’s friends and family, this can include changes in food preference or picking up new, often problematic hobbies like gambling. Memory remains intact until the later stages of the disease

A

Fronto-temporal lobe dementia

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124
Q

Triad of REM sleep disorder, a history of falls (secondary to motor problems), and hallucinations

A

Lewy body dementia

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125
Q

Which subtype of dementia has a stepwise decline in function?

A

Vascular

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126
Q

Tx for acute mania with agitation

A

IM therapy (neuroleptic or benzodiazepine) and potential secure unit admission

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127
Q

Tx for acute mania without agitation

A

Oral antipsychotic monotherapy, potential addition of sedatives or mood stabilisers

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128
Q

Tx for acute depression

A

Mood stabiliser, atypical antipsychotic, or antidepressant with psychosocial support

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129
Q

Alternative treatment for lithium

A

Valproate

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130
Q

Tx for treatment-resistant BPD

A

Atypical antipsychotics and anticonvulsants

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131
Q

Korsakoff’s syndrome is characterised by profound ____________ amnesia, limited ____________ amnesia, and confabulation

A

Korsakoff’s syndrome is characterised by profound anterograde amnesia, limited retrograde amnesia, and confabulation

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132
Q

What is Capgras delusion?

A

In which the patient believes that someone close to them has been replaced by a clone

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133
Q

What is Fregoli delusion?

A

Where a patient believes that everyone they meet is the same person but with different disguises

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134
Q

Which blood test should be performed when starting lithium?

A

Thyroid function tests
Urea and electrolytes (calcium and eGFR)

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135
Q

Mx for opiate relapse/craving reduction

A

Neltrexone

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136
Q

Mx for opiate overdose

A

Naloxone

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137
Q

Mx for opiate detox

A

Methadone and buprenorphine (the latter is a partial agonist of the opiate receptor, so can trigger withdrawal)

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138
Q

Mx for opiate withdrawal symptoms

A

Methadone
Lofexidine
Loperamide (for diarrhea)
Anti-emetics (for nausea)

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139
Q

Mx of lithium toxicity

A

Supportive + stopping lithium:

Maintaining electrolyte balance
Monitoring renal function (haemodialysis if poor)
Seizure control
IV fluid therapy and urine alkalisation, which enhance the excretion of the drug
Benzodiazepines may be used to treat agitation and seizures

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140
Q

Atrophy of the frontal lobes

A

Fronto-temporal dementia

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141
Q

Widespread cerebral atrophy

A

Alzheimer’s

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142
Q

Alpha-synuclein cytoplasmic inclusions

A

Lewy-Body dementia

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143
Q

Widespread infarcts

A

Vascular dementia

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144
Q

Prions causing encephalopathy

A

Creutzfeldt-Jakob disease

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145
Q

Always check a patient’s ______ before starting anti-cholinesterase inhibitors

A

ECG

Contra-indications include prolonged QT, second or third degree heart block in an unpaced patient and sinus bradycardia <50 bpm

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146
Q

In ________ syndrome, the patient believes they have been infested with parasites. The patient will complain of crawling sensations on the skin and can be due to a psychological or organic reason such as ____ deficiency

A

In Ekbom syndrome, the patient believes they have been infested with parasites. The patient will complain of crawling sensations on the skin and can be due to a psychological or organic reason such as B12 deficiency

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147
Q

___________ pupils are associated with opioid intoxication rather than withdrawal. In withdrawal, ___________ pupils are more commonly seen

A

Constricted pupils are associated with opioid intoxication rather than withdrawal. In withdrawal, dilated pupils are more commonly seen

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148
Q

Progressive cognitive decline, visual hallucinations, parkinsonism, fluctuating alertness, and falls

A

Dementia with Lewy bodies (DLB)

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149
Q

False belief that a close relative or partner has been replaced by an impostor

A

Clone = Capgras

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150
Q

Individual believes their partner is unfaithful, despite the absence of proof

A

Othello syndrome

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151
Q

False belief that the person themselves is dying or dead

A

Cotard’s syndrome

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152
Q

Belief that strangers are familiar to the individual and may even all be the same person

A

Fregoli = Familiars look the same

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153
Q

Differentiate between CAGE and AUDIT

A

CAGE - quickly screen for alcohol abuse/assess whether the patient needs further screening

AUDIT - assess whether there is a need for a specialist evaluation concerning alcohol consumption

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154
Q

Differentiate between malingering and munchausen’s syndrome

A

Malingering: patients fake or induce illness for secondary gain; e.g. drug seeking, disability benefits, avoiding work or prison time

Munchausen’s syndrome: intentionally faking signs and symptoms (i.e. adding blood to urine and complaining of pain) in order to gain attention and play “the patient role”

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155
Q

Low levels of which neurotransmitter are associated with the development of anxiety?

A

Gamma-aminobutyric acid (GABA)

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156
Q

___________ and ___________ are common side effects of lithium

A

Hypothyrodism and nephrogenic diabetes insipidus

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157
Q

“I took the bus and the train, the problem is it rained yesterday so I was never very good at scrabble and I suppose my favourite food is lasagne because the neighbour’s dog kept me up all night”

A

Knight’s move thinking

Normal thought: a - b - c - d - e - f - g
Knights move: a - c - g - l

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158
Q

“Running lately people purpose purple”

A

Word salad

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159
Q

“I tied the rope soap the slope nope”

A

Clanging

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160
Q

“I like to play games because the river is flowing down a mountain.” (fast paced speech)

A

Flight of ideas

Normal thought: a - b - c - d - e - f - g
Flight of ideas: abcdefghijklmnop

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161
Q

T or F: Visual hallucinations is a first-rank symptom of schizophrenia

A

Visual hallucinations more associated with drug related problems

First rank symptoms:
A - Auditory hallucinations –> 2nd and 3rd person
B - Broadcasting of thoughts, withdrawal, insertion
C - Controlled emotions and actions, passive impulsivity phenomena
D - Delusional perceptions

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162
Q

Clozapine side effects

A

CLOZAPINE
C- Consitipation
Lo- Lowered Seizure Threshold
Z- Zzzzzz- sedation
A- Agranulocytosis
P- Phat- weight gain, dyslipidaemia, diabetogenic
I- Increased salivation
N- Neutropaenia
E- ECG- you need one when you start because it can cause cardiomyopathy

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163
Q

Which type of amnesia is seen as a side effect of ECT?

A

RECT

(R)etrograde amnesia in (ECT)

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164
Q

The tyramine cheese reaction is a classic side effect of…

A

MAOI (monoamine oxidase inhibitor)

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165
Q

_________ and _________ should never be combined as there is a risk of serotonin syndrome

A

SSRIs and MAOIs should never be combined as there is a risk of serotonin syndrome

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166
Q

Lithium blood level should ‘normally’ be checked every…

A

Lithium blood level should ‘normally’ be checked every 3 months

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167
Q

after a change in dose, lithium levels should be taken…

A

A week later and weekly until the levels are stable.

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168
Q

When on lithium, thyroid and renal function should be checked…

A

Every 6 months

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169
Q

Outline the 5 stages of grief

A

Denial
Anger
Bargaining
Depression
Acceptance

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170
Q

When does delayed grief occur?

A

Said to occur when more than 2 weeks passes before grieving begins

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171
Q

When does prolonged grief occur?

A

Difficult to define. Normal grief reactions may take up to and beyond 12 months

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172
Q

What does the following image show?

A

Acute dystonia - torticollis

173
Q

What does the following image show?

A

Oculogyric crisis - involuntary upward deviation of both eyes due to spasms and increased tone in the extraocular muscles.

174
Q

Define akathisia

A

Inability to remain still

175
Q

Define tardive dyskinesia

A

Involuntary movements of the face and jaw

176
Q

Tx for acute dystonia due to antipsychotics

A

Procyclidine

177
Q

There are specific warnings when antipsychotics are used in elderly patients due to..

A

Increased risk of VTE and stroke

178
Q

Which drug causes antimuscarinic side effects?

A

Typical antipsychotics

179
Q

Why do typical antipsychotics cause raised prolactin?

A

Due to inhibition of the dopaminergic tuberoinfundibular pathway

180
Q

Typical/atypical antipsychotic cause impaired glucose tolerance

A

Typical

181
Q

Typical/atypical antipsychotic cause neuroleptic malignant syndrome

A

Typical

182
Q

Typical/atypical antipsychotic cause reduced seizure threshold

A

Both (greater with atypicals)

183
Q

Typical/atypical antipsychotic cause reduced seizure threshold

A

Prolonged QT interval (particularly haloperidol)

184
Q
A
185
Q
A
186
Q
A
186
Q
A
187
Q
A
188
Q
A
189
Q
A
190
Q
A
191
Q
A
192
Q
A
193
Q
A
194
Q
A
195
Q

What is the function of the mesolimbic pathway?

A

Reward - transmits dopamine from the ventral tegmental area (VTA) to the ventral striatum

196
Q

The ventral tegmental area is located in the _________ and the ventral striatum is located in the _________ and includes both the _________ _________ and _________ _________

A

The ventral tegmental area is located in the midbrain and the ventral striatum is located in the forebrain and includes both the nucleus accumbens and olfactory tubercle

197
Q

What is the function of the mesocortical pathway?

A

Involved in cognition and emotion - transmits dopamine from the ventral tegmental area to the prefrontal cortex

198
Q

What is the function of the nigrostriatal pathway?

A

Regulation of movement - transmits dopamine from the substantia nigra pars compacta to the caudate nucleus and putamen

199
Q

The substantia nigra pars compacta (SNc) is located in the ________. The caudate nucleus and putamen are located in the ________ ________

A

The substantia nigra pars compacta (SNc) is located in the midbrain. The caudate nucleus and putamen are located in the dorsal striatum

200
Q

What is the function of the tuberoinfundibular pathway?

A

Regulates secretion of pituitary gland hormones - transmits dopamine from the infundibular nucleus of the hypothalamus to the pituitary gland

201
Q

Which dopamine pathway is involved in regulating prolactin?

A

Tuberoinfundibular pathway

202
Q

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

A

De Clerambault’s syndrome

203
Q

Delusion that a person closely related to the patient has been replaced by an impostor

A

Capgras syndrome

204
Q

Delusion of identifying a familiar person in various people they encounter

A

De Frégoli syndrome

205
Q

Delusion of sexual infidelity on the part of a sexual partner

A

Othello syndrome

206
Q

Delusional parasitosis and describes the delusion of infestation

A

Ekbom syndrome

207
Q

Which metabolic side effects are seen in antipsychotics?

A

Hyperlipidemia
Hypercholesterolemia
Hyperglycemia
Weight gain

208
Q

Which SSRI is given with warfarin / heparin?

A

Avoidi SSRIs - consider mirtazapine aspirin

209
Q

Which two drug classes can increase the risk of serotonin syndrome if combined with an SSRI?

A

Triptans
MOAIs

210
Q

Give three protective factors against suicide

A

Family support
Having children at home
Religious belief

211
Q

Tx for tardive dyskinesia

A

Tetrabenazine

212
Q

Tx for akathisia

A

Propranolol

213
Q

Mild symptoms of hypomania and depression for at least two years

A

Cyclothymia

214
Q

Mood reactivity (mood brightens in response to positive events), increased appetite or weight gain, hypersomnia, leaden paralysis (heavy feeling in arms or legs), and a long-standing pattern of sensitivity to interpersonal rejection

A

Atypical depression

215
Q

Disorganised speech in the form of ‘word salad’ is associated with…

A

Psychosis and mania

216
Q

In OCD the patients normally have a good level of insight into their condition and understand that if they did not perform the acts their obsessive though would not come true. However, they still get the urge to perform them anyway, just to put their mind at ease.

This lack of insight into the condition she has may indicate that there is a delusional element to her symptoms and this may not be an obsessive-compulsive disorder and may have some form of psychosis.

A
217
Q

What are the three core symptoms of depression?

A

anhedonia, anergia or low mood

218
Q

An atypical symptom is one that is unusual in depressive patients and may include..

A

Increased appetite and hypersomnia

219
Q

Which two questions screen for depression?

A

‘During the last month, have you often been bothered by feeling down, depressed or hopeless?’
‘During the last month, have you often been bothered by having little interest or pleasure in doing things?’

220
Q

Which assessments tools are used to assess the degree of depression?

A

Hospital Anxiety and Depression (HAD) scale:
0-7 normal, 8-10 borderline, 11+ case

Patient Health Questionnaire (PHQ-9):
< 16:: less severe depression
≥ 16: severe depression

221
Q

Major Depressive Disorder (MDD) DSM-5 Criteria

A

Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure.

222
Q

Which scoring system is used to assess the severity of withdrawal?

A

Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar) scale

223
Q

Which medication causes nephrolithiasis?

A

Long-term lithium use

224
Q

It is extremely important in patients who take clozapine to exclude __________ if they develop infections

A

Neutropaenia

225
Q

Schizophrenia vs schizotypal personality disorder

A

Schizotypal = better connection with reality

Patients are more open to the idea that their perceptions are distorted. Their abnormal thoughts are generally less frequent, and less intense. Sperstitions or magical thinking, rather than fixed delusions

226
Q

Another name for Hypochondriasis

A

Illness anxiety disorder

227
Q

Factitious vs malingering

A

Factitious/Munchausen’s = Feign symptoms (to play patient)
Malingering = Material gain

228
Q

OCD vs OCPD

A

OCD: Distressing to act
OCPD: Pleasurable to act

229
Q

The only exception to diagnose a PD before the age of 18 is..

A

Borderline personality disorder IF there is evidence the patient has fully undergone puberty

230
Q

List atypical antipsychotics

A

“Cats Often Roam Quietly, Awaiting Ameow”

Clozapine
Olanzapine
Risperidone
Quetiapine
Amisulpride
Aripiprazole

231
Q

In OCD, if treatment with SSRI is effective then continue for at least ____________ to prevent relapse and allow time for improvemet

A

12 months

232
Q

Tangentiality vs Derailment

A

Tangentiality: A tangent goes off forever in another direction
Derailment: A derailed train goes off the track after a little while and needs to be nudged back on

233
Q

What does the following ECG show?

A

Hypokalaemia

234
Q

What ABG finding would you expect in bulimia?

A

Metabolic alkalosis - may see low chloride due to loss of HCL from vomiting

235
Q

A 17-year-old patient presents to A&E complaining of a tight feeling in their chest, shortness of breath and some tingling in their fingers and around their mouth. They have no significant past medical history and are not on any regular medication. An ABG is performed on the patient (who is not currently receiving any oxygen therapy)

An ABG is performed and reveals the following:

PaO2: 14 (11 – 13 kPa) || 105 mmHg (82.5 – 97.5 mmHg)
pH: 7.49 (7.35 – 7.45)
PaCO2: 3.6 (4.7 – 6.0 kPa) || 27 mmHg (35.2 – 45 mmHg)
HCO3–: 24 (22 – 26 mEq/L)

What is the diagnosis?

A

Respiratory alkalosis (no compensation cause HCO3 is not low) - due to panic attack/anxiety

236
Q

What should be monitored when initiating an SNRI?

A

BP

237
Q

If clozapine doses are missed for more than 48 hours, you will need to restart it..

A

Slowly

238
Q

If clozapine doses are missed for more than 72 hours, you will need to restart it..

A

Slowly +may also require more frequent blood tests for a short period

239
Q

If clozapine doses are missed for less than 48 hours, you will need to restart it..

A

Start again as soon as you remember

Unless it is almost time for your next dose, then go on as
before. Do not try to catch up by taking two or more doses at
once as you may get more side-effects

240
Q

Benzodiazipines vs Barbiturates

A

Barbidurates increase duration of chloride channels & Frendodiazepines increase frequency of chloride channels

241
Q

How to withdraw benzodiazepine?

A

Switch patients to the equivalent dose of diazepam
Reduce dose of diazepam every 2-3 weeks in steps of 2 or 2.5 mg
Time needed for withdrawal can vary from 4 weeks to a year or more

242
Q

Which drug can cause anterograde amnesia?

A

Benzodiazepine

243
Q

What is a contraindication for ECT?

A

Raised intracranial pressure

244
Q

Antidepressants should be reduced/stopped/switched to another drug when a patient is about to commence ECT treatment

A

Reduced

Switching drugs or increasing dose makes it hard to know if the ECT is working or if a decrease in symptoms is due to the change in in medications

245
Q

When is Clozapine initiated?

A

Two other antipsychotics must have been trialled before due to its large side effect profile

246
Q

Mirtazapine belongs to the class of drugs known as ..

A

Noradrenergic and specific serotonergic antidepressants (NaSSAs)

247
Q

Dizziness, electric shock sensations and anxiety are symptoms of..

A

SSRI discontinuation syndrome

248
Q

Short term side-effects for ECT

A

“He Should Never Miss Cardio”

Headache
Short-term memory impairment
Nausea
Memory loss of events prior to ECT
Cardiac arrhythmia

249
Q

Capgras vs Fregoli

A

“Capgras Creates Clones; Fregoli Fashions Familiar Faces”

Capgras - Delusional belief that a person or people have been replaced by identical impostors or duplicates

Fregoli - Delusional belief that different people are actually the same person in disguise

250
Q

Schizoaffective VS Schizophrenia/Schizotypal disorders

A

Schizophrenia + bipolar characteristics (psychotic episodes, mania, or depression)

251
Q

Factors associated with poor prognosis of SZ

A

“Fragile Grains Leave Pebbly Paths”
Family history
Gradual onset
Low IQ
Prodromal phase of social withdrawal
Lack of obvious precipitant)

252
Q

When checking lithium levels, the sample should be taken _________ post-dose

A

12 hours

253
Q

After starting lithium, levels should be performed..

A

Weekly and after each dose change until concentrations are stable

254
Q

After starting lithium, levels should be performed weekly and after each dose change until concentrations are stable. Once established, lithium blood level should ‘normally’ be checked every…

A

3 months

255
Q

After a change in dose, lithium levels should be taken..

A

A week later and weekly until the levels are stable

256
Q

When starting lithium, thyroid and renal function should be checked every..

A

6 months

257
Q

_________ is the persistent belief in the presence of an underlying serious disease, e.g. cancer

A

Illness anxiety disorder (hypochondriasis)

258
Q

Primary care referral if symptoms suggest hypomania

A

Routine referral to the community mental health team (CMHT)

259
Q

Primary care referral if there are features of mania or severe depression

A

Urgent referral to the CMHT should be made

260
Q

How often are lipids and weight monitored when starting antipsychotics?

A

At the start of therapy
At 3 months
Annually

261
Q

How often are fasting blood glucose and prolactin monitored when starting antipsychotics?

A

At the start of therapy
At 6 months
Annually

262
Q

Which class of drugs are Mirtazapine?

A

Noradrenergic and specific serotonergic antidepressants (NaSSAs)

263
Q

666 rule for anti-depressants

A

Wait at least 6 weeks for it to take effect (before switching medication)
Continue for 6 months to stabilise and avoid relapse
Take at least 6 weeks for the washout period in order to avoid adverse effects

264
Q

Antagonism of histamine receptors causes..

A

Drowsiness

265
Q

Antagonism of adrenergic receptors causes..

A

Postural hypotension

266
Q

Antagonism of muscarinic receptors causes..

A

Dry mouth
Blurred vision
Constipation
Urinary retention

267
Q

Which tricyclic has a lower incidence of toxicity in overdose?

A

Lofepramine

268
Q

Which tricyclics considered the most dangerous in overdose?

A

Amitriptyline and dosulepin (dothiepin)

269
Q

Consider ________________- with initial onset of psychosis in the elderly to rule out organic causes (e.g. ________________)

A

Consider brain imaging (CT or even an MRI) with initial onset of psychosis in the elderly to rule out organic causes (e.g. a brain tumour, stroke or CNS infection)

270
Q

Persistent or recurrent complex hallucinations (usually visual or auditory), occurring in clear consciousness. This is generally against a background of visual impairment (although visual impairment is not mandatory for a diagnosis). Insight is usually preserved

A

Charles-Bonnet syndrome

271
Q

Sudden changes in his behaviour. Agitated, restless, confused, sweaty and not orientated to time, person or place
Widespread muscle rigidity, hyperreflexia, dilated pupils and flushed skin

A

Serotonin syndrome

272
Q

Which prescribed medications can cause psychotic symptoms?

A

Corticosteroids

273
Q

Which illicit drugs can cause psychotic symptoms?

A

Cannabis, phencyclidine

274
Q

Factors associated with poor prognosis of SZ

A

Strong family history
Gradual onset
Low IQ
Prodromal phase of social withdrawal
Lack of obvious precipitant

275
Q

A 45-year-old female complains of lower back pain, constipation, headaches, low mood, and difficulty concentrating.

Her presentation is likely due to which of the following medications?

A

Lithium = hyperparathyroidism and resultant hypercalcaemia

“Stones, bones, abdominal moans, and psychic groans”

276
Q

When is clozapine started?

A

After trying two antipsychotics

277
Q

Which anti-psychotic is most effective for dealing with negative symptoms of SZ?

A

Clozapine

278
Q

Negative symptoms of SZ

A

Incongruity/blunting of affect
Anhedonia (inability to derive pleasure)
Alogia (poverty of speech)
Avolition (poor motivation)
Social withdrawal

279
Q

Clozapine can present with symptoms of..

A

Infection: check FBC

280
Q

First line investigation for patients who present of a new onset of palpitations with no clear cause?

A

24 or 48 hour holter monitor ECG

281
Q

Memory for recent events is worsening. Struggling to manage her finances, remember words, and recognise objects

A

Amyloid plaques

282
Q

Prevention and treatment of alcohol withdrawal is with..

A

Short acting benzodiazepines such as chlordiazepoxide (Librium) and oxazepam (latter if there is evidence of liver injury)

283
Q

SSRI of choice in GAD

A

Setraline

284
Q

GAD

A

Salbutamol
Theophylline
Corticosteroids
Antidepressants
Caffeine

285
Q

Naloxone vs Neltrexone use

A

Naloxone =NoOverdone
Neltrexone = relapse

286
Q

Lesions in mamillary bodies

A

Wernicke’s encephalopathy

287
Q

Interactions between lithium, and __________ can cause renal impairment

A

Ibuprofen

288
Q

Lithium should be stopped in the first/second/third trimester

A

First - due to risk of Ebstein’s abnormality

289
Q

Give examples of TCAs

A

Amitriptyline, clomipramine and imipramine

290
Q

A 50-year-old patient with a history of bipolar disorder presents with confusion, ataxia, and tremors. They have been on lithium therapy for the last 10 years.

What is the most appropriate initial management of this patient?

A

Discontinuation of lithium and supportive care

291
Q

Enlarged ventricles and absent sulci seen on CT brain scan

A

Normal pressure hydrocephalus

292
Q

Prominent U waves

A

Hypokalaemia - refeeding syndrome

293
Q

Hyperintense temporal lobe lesions + increased lymphocytes in LP

A

Viral encephalitis

294
Q

Symptoms of encephalitis but normal MRI

A

Autoimmune encephalitis

295
Q

Tx for autoimmune encephalitis

A

Steroids and intravenous immunoglobulin
+/- Plasma exchange if not fully responding to above treatment

If no response within two weeks, immunosuppressant therapy with agents such as Rituximab and Cyclophosphamide

Agitation: second-generation antipsychotics eg Risperidone

296
Q

Recurrent episodes of sudden onset anxiety. Shortness of breath, palpitations, and intense feelings of something bad about to happen (e.g. fear of dying). Patient feels well between episodes

A

Panic disorder

297
Q

SSRIs licensed to treat panic disorder include..

A

Escitalopram, sertraline, citalopram, paroxetine and venlafaxine

298
Q

Sudden onset anterograde amnesia, with repetitive questioning and a preserved level of consciousness

A

Transient global amnesia

299
Q

Ix for TGA

A

CT or MRI to exclude stroke/brain abnormalities
EEG
Neuropsychological tests
Blood tests to exclude metabolic causes such as hypoglycemia or electrolyte imbalance

300
Q

Ix for encephalitis

A

Full neurological examination
Bloods (low sodium)
CT and/or MRI
LP

301
Q

Side effects of carbamazepine

A

CARBA MEAN
Confusion
Ataxia
Rashes
Blurred vision
Aplastic anaemia
Marrow (bone marrow) suppression
Eosinophilia
ADH release
Neutropenia

302
Q

Grief reaction >6 months with impact on important areas of functioning, for example, taking care for oneself

A

Prolonged grief disorder

303
Q

Positive symptoms of SZ

A

ABCD

Auditory Hallucinations
Broadcasting of Thoughts
Control Issues
Delusional Perception

304
Q

Negative symptoms of SZ

A

Overlap with features of depressive disorders

Alogia
Anhedonia
Affective incongruity or blunting
Avolition

305
Q

Acute tx for mania with agitation

A

Intramuscular neuroleptic or benzodiazepine, potential psychiatric admission

306
Q

Acute tx for mania without agitation

A

Oral antipsychotic monotherapy (haloperidol, olanzapine, quetiapine, or risperidone). If one is unsuccessful an alternative should be tried

Lithium

ECT

307
Q

Maintenance Tx for chronic BPD

A

Lithium (first line) or Valproate (second line), and psychotherapy

308
Q

Side effect of memantine

A

Constipation

309
Q

What are the most appropriate SSRI in breastfeeding?

A

Sertraline and paroxetine

310
Q

Which medication is most likely to cause sexual dysfunction and constipation?

A

SSRI

311
Q

The antipsychotics most commonly used in the treatment of manic episodes or mixed episodes in bipolar affective disorder..

A

Quetiapine, olanzapine, risperidone and haloperidol

312
Q

Which electrolyte abnormality is associated with panic disorders?

A

Hypocalcaemia

313
Q

Which electrolyte abnormality is associated with refeeding syndrome?

A

Low serum, magnesium and potassium

314
Q

Tangentiality, loose associations, and neologisms

A

Formal thought disorder

315
Q

Which parameter should be checked when started on Venlafaxine?

A

BP

316
Q

Confusion, polyuria, polydipsia, coarse tremor, hyperreflexia

A

Lithium toxicity

317
Q

Fatigue, constipation, weight gain, menorrhagia, bradycardia and hyporeflexia

A

Hypothyroidism

318
Q

Drugs that cause lithium toxicity

A

NSAIDs, furosemide, thiazide diuretics, ACE inhibitors and some antidepressants

319
Q

Metabolic alkalosis/acidosis is seen in anorexia

A

Acidosis

320
Q

Who can take consent?

A

Every clinician - but they must be able to fully explain the
procedure and ideally should be able to carry it out
themselves (e.g. the FY1 on neurosurgery is NOT best
placed to take consent for endovascular aneurysm
repair)

321
Q

Criteria for assessing capacity

A
  • Understand information given
  • Weigh risks and benefits of the specific decision
  • Communicate their decision
  • Retain the decision that they have made and communicated
  • Apply that decision or be aware of how this may be applied
322
Q

Which legal frameworks are used when assessing capacity?

A

Adults with Incapacity
MHS
Advanced statements

323
Q

Guardianship requires assessment carried out by..

A

Two Medical professionals (usually GP and a senior psychiatrist) and a Mental Health Officer

324
Q

T or F: Guardianship can be used to place an adult in a hospital or treatment facility against their will

A

False - if an adult does not comply with the decisions of their appointed Guardian, a Sheriff can issue a compliance order to enforce welfare decisions

325
Q

Who can approve an emergency detention certificate? How long does it last?

A

Any doctor more senior than FY1. Where possible, a mental health officer should also agree to it. BUT can only be removed by a senior psychiatrist

Lasts for 72 hours

326
Q

Who can approve a short term detention certificate? How long does it last?

A

Senior psychiatrist AND Mental Health Officer

Lasts up to 28 days

327
Q

Who can approve a compulsory treatment order? How long does it last?

A

Senior psychiatrist and an MHO with the approval of a
special tribunal hearing

Reports from 2 independent doctors (2 AMPs or AMP+GP), a care plan and MHO report

Lasts for 6 months initially but can be applied for a year at a time if needed longer term

328
Q

What is an advanced statement?

A

Written up by individuals while well and able to make capacitous decisions - outlines wishes and beliefs about treatment they may need

329
Q

Who should sign off on an advanced statement?

A

By the individual and a health or social care worker if possible.
Recommended to be reviewed every 6-12 months

330
Q

T or F: In British law, the patient’s biological mother can always provide consent. If parents are not married and the father is not named on the birth certificate then the father cannot consent

A

True

331
Q

In order to have capacity, the person being examined must be able to demonstrate the following four abilities. What are they?

A

Understand, retain, use, and communicate the information/decision

332
Q

With regards to the provision of contraceptives to patients under 16 years of age the Fraser Guidelines state that all the requirements should be fulfilled. What are they?

A
333
Q

Some doctors use the term ___________ competency when referring to contraception and ___________ competency when referring to general issues of consent in children

A

Some doctors use the term Fraser competency when referring to contraception and Gillick competency when referring to general issues of consent in children

334
Q

Nurse holding power is only held up for…

A

Up to 3 hours

335
Q

Policing powers is only held up for…

A

Up to 24 hours

336
Q

T or F: An Emergency Detention does not authorise treatment

A

True

337
Q

Gender incongruence of adolescence or adulthood cannot be assigned prior to…

A

Onset of puberty

338
Q

Gender incongruence of adolescence or adulthood can be assigned after…

A

2 years

339
Q

Masculinising hormone options

A

Injectables (weekly or bi-weekly)
Patches
Topical gels
Pellet
Undecanoate

340
Q

Masculinising option for atrophy?

A

Estrogen vaginal cream

341
Q

Masculinising option for clitoral enlargement?

A

Test. cream/DHT cream

342
Q

Masculinising option for cessation of menses?

A

Progesterone - IUD, Nexplanaon, Depo

343
Q

Risks of testosterone therapy

A
344
Q

Feminising hormonal options

A

Oral
Injectables
Patches
Anti-androgens: Spironolactone

345
Q

Risks of oestrogen therapy

A
346
Q

Risks of spironolactone therapy

A

Increased urinary frequency
Hyperkalamia
Hypotension
Dehydration + renal insufficiency

347
Q

Gendered health calculator/ equation

A

eGFR (15% reduction applied to ‘female’)
QT interval (longer if assigned female at birth or taking oestrogen)
CHA2DS2VASc (extra point applied to ‘female’)

348
Q

Initia management in suspected ADHD

A

Watch and wait for ten weeks then refer

349
Q

Drug treatment of ADHD in children

A

Only aged 5 years and above:

1st line: Methylphenidate (weight and height should be monitored every 6 months)
2nd line: Lisdexamfetamine
3rd line: Dexamfetamine if can’t tolerate side effects for Lisdexamfetamine

350
Q

Drug treatment of ADHD in adults

A

1st line: Methylphenidate or lisdexamfetamine

Switch between these drugs if no benefit is seen after a trial of the other

351
Q

All ADHD drugs are _________ and require __________

A

Cardiotoxic

Perform a baseline ECG before starting treatment, and refer to a cardiologist if there is any significant past medical history or family history, or any doubt or ambiguity

352
Q

Which medications reduce the risk of refeeding?

A

Thiamine and Forceval

353
Q

Which medications correct electrolyte abnormalities during refeeding syndrome?

A

Oral supplementation using sandok, phosphate sandox and magnesium glycerophosphate

354
Q

Which pharmacologic interventions are used in ASD?

A

SSRIs: repetitive stereotyped behaviour, anxiety, and aggression

Antipsychotics: reduce aggression and self-injury

Methylphenidate: ADHD

355
Q

_________ (35%) and _________ (18%) are also commonly seen in children with ASD

A

ADHD and epilepsy

356
Q

ASD is also associated with..

A

A higher head circumference to the brain volume ratio

357
Q

Long, narrow face
Large ears
Large testicles after puberty
Hypermobile joints (particularly in the hands)

A

Fragile X syndrome

358
Q

Fragile X syndrome is caused by a mutation in the..

A

FMR1

359
Q

Mode of inheritance in fragile X

A

X-linked (unclear whether dominant or recessive)

Males are always affected
In females, if the mother is phenotypically normal, the affected child may have inherited the X chromosome from their mother, or it may result from a de novo (random) mutation

360
Q

Elevated mood, hypertension, tachycardia and hyperthermia

A

Cocaine/ Methamphetamine/ Ecstasy

361
Q

Elevated mood, hypertension, tachycardia and hyperthermia + hallucinations

A

LSD

362
Q

Descreased HR and RR
Constricted pupil

A

Opioids - heroine

363
Q

Drowsiness
Impaired memory
Slowed reflexes
Slowed motor skills
Conjunctival injection
Increased appetite
Paranoia and psychotic symptoms
Tachycardia
Dry mouth

A

Cannabis

364
Q

Ix for BN

A

Urea & electrolytes - hypokalaemia

365
Q

What is considered as severe AZ?

A

Less than 10 is scored on MMSE

366
Q

Which medication can cause insomnia?

A

Corticosteroids

367
Q

Ix for insomnia

A

Patient interview
Sleep diaries + actigraphy

368
Q

When is Polysomnography indicated in insomnia?

A

OSA
Periodic limb movement disorder
When insomnia is poorly responsive to conventional treatment

369
Q

Tx for insomnia

A

Sleep hygiene: no screens before bed, limited caffeine intake, fixed bed times etc

Hypnotics if daytime impairment is severe (zopiclone, zolpidem and zaleplon): daytime sedation, poor motor coordination, cognitive impairment and related concerns about accidents and injuries

Diazepam is not recommended but can be useful if the insomnia is linked to daytime anxiety

370
Q

Guidance on Tx for insomnia

A

Use the lowest effective dose for the shortest period possible

If there has been no response to the first hypnotic, do not prescribe another. You should make the patient aware that repeat prescriptions are not usually given

It is important to review after 2 weeks and consider referral for CBT

371
Q

Electric shock sensation + restlessness

A

Discontinuation syndrome - SSRI

372
Q

Circadian rhythm disturbance is a feature of ____________

A

Schizophrenia

373
Q

Fluctuating cognitive decline

A

Dementia with Lewy bodies

374
Q

Tangentiality, loose associations, and neologisms

A

Formal thought disorder

375
Q

In lithium toxicity, regardless of whether they are symptomatic or not, levels of >4 would indicate..

A

Haemodialysis

376
Q

Precipitated by dehydration or illness. The acute phase often presents with predominantly gastrointestinal symptoms and then neurological features of ataxia, tremor, confusion and nystagmus

A

Lithium toxicity

377
Q

The reason for delayed presentation in a subdural haematoma is because it is lower/higher in pressure than the system that an extradural haematoma occurs in

A

The reason for delayed presentation in a subdural haematoma is because it is lower in pressure than the system that an extradural haematoma occurs in (low-pressure veins bleed more slowly than high-pressure arteries!)

Low-pressure veins bleed more slowly than high-pressure arteries!

378
Q

Lesions in mamillary bodies

A

Wernicke’s encephalopathy

379
Q

Which is the best investigation to confirm the diagnosis of bulimia nervosa?

A

Urea and electrolytes (U&Es)

380
Q

Prolonged PR interval, widespread ST depression and T-wave flattening or inversion and prominent U waves

A

Hypokalaemia - bulimia nervosa

381
Q

An overdose of which medication can cause prolonged QRS duration and QTc interval) and metabolic acidosis?

A

Tricyclic antidepressant (TCA)

382
Q

Confusion, agitation, sweating, hypertension, tachycardia, myoclonus, hyperreflexia and clonus

A

Selective serotonin reuptake inhibitor (SSRI)

383
Q

Nausea and vomiting, abdominal pain and fulminant hepatic failure

A

Paracetamol

384
Q

pH: 7.48 (7.35-7.45)
PaO2: 15.4KPa (>10)
PaCO2: 2.9KPa (4.7-6.0)
HCO3: 22mmol/L (22-26)

A

Acute respiratory alkalosis secondary to hyperventilation

Panic attack

385
Q

In patients with subdural haematoma, surgery is needed if there is..

A

Any focal neurology
If the patient is deteriorating
if there is a large haematoma
Raised intracranial pressure
Midline shift

386
Q

What can be used to treat the somatic symptoms of generalised anxiety disorder?

A

Propranolol

387
Q

Feelings of anxiety are short-lived and unrelated to long-standing worries

A

Panic disorder

388
Q

Feelings of anxiety are constant, usually about multiple things

A

Generalised anxiety disorder (GAD)

389
Q

Which type of delusion is seen in mania?

A

Grandiose delusions

390
Q

Which type of delusion is seen in psychosis?

A

Persecutory/somatic delusions

391
Q

Which type of delusion is seen in depression?

A

Nihilistic delusions

392
Q

Which medication is most commonly associated with reducing the seizure threshold?

A

Ciprofloxacin and other quinolones (levofloxacin, ofloxacin, moxifloxacin, gatifloxacin and nalidixic acid)

393
Q

Meds that lower seizure threshold

A

Antibiotics: Imipenem, penicillins, cephalosporins, metronidazole, isoniazid
Antipsychotics
Antidepressents: Bupropion, Tricyclics, Venlafaxine
Tramadol
Fentanyl
Ketamine
Lidocaine
Lithium
Antihistamines

394
Q

What is Naltrexone used for?

A

Opiod antagonist for relapse prevention

395
Q

What is Diazepam used for in alcohol detox?

A

Anxiolytic but can also be used in reducing regime in drug detox

396
Q

Side effects of clozapine

A

Weight gain
Excessive salivation
Agranulocytosis
Neutropenia
Myocarditis
Arrhythmias

397
Q

Lithium toxicity may be precipitated by..

A

Dehydration
Renal failure
Drugs: diuretics (especially thiazides), ACEi/ARBs, NSAIDs and metronidazole

398
Q

Non-selective monoamine oxidase inhibitors

A

Tranylcypromine, phenelzine

399
Q

When are non-selective monoamine oxidase inhibitors used?

A

Atypical depression (e.g. hyperphagia) and other psychiatric disorder

400
Q

Adverse effects of non-selective monoamine oxidase inhibitors

A

Hypertensive reactions with tyramine containing foods e.g. cheese, pickled herring, Bovril, Oxo, Marmite, broad beans

Anticholinergic effects

401
Q

Cotard syndrome is associated with…

A

Severe depression

402
Q

Muscular rigidity, fever, altered mental status, and autonomic dysfunction (such as tachycardia and hypertension)

A

NMS

403
Q

Seizures, arrhythmias, muscle twitching, and shivering

A

Serotonin syndrome

404
Q

Tx Bulimia nervosa

A

Bulimia-nervosa-focused guided self-help for adults
Unacceptable, contraindicated, or ineffective after 4 weeks: CBT-ED
Children: FT-BN

405
Q

Schizophrenic psychotic features are…

A

Persecutory delusions and auditory hallucinations

406
Q

Carbamazepine is known to exhibit ___________, hence when patients start carbamazepine they may see a return of seizures after 3-4 weeks of treatment

A

Autoinduction

407
Q

Adverse effects of Carbamazepine

A

P450 enzyme inducer
Dizziness and ataxia
Drowsiness
Headache
Visual disturbances (especially diplopia)
Steven-Johnson syndrome
Leucopenia and agranulocytosis
Hyponatraemia secondary to syndrome of inappropriate ADH secretion

408
Q

Petechial rash overlying chest

A

Fat embolism

409
Q

Coarse tremor
Central nervous system disturbance, which may include seizures, impaired coordination, and dysarthria
Cardiac arrhythmias
Visual disturbance

A

Lithium toxicity

410
Q

Long-term atypical antipsychotics can lead to the development of…

A

Glucose dysregulation and diabetes

411
Q

Not a first-rank symptom of schizophrenia

A

Visual hallucinations

412
Q

Sodium valproate associated with…

A

Neural tube defects

413
Q

_____________ often considered the least teratogenic of the older antiepileptics

A

Carbamazepine

414
Q

___________ associated with cleft palate

A

Phenytoin

415
Q

___________ dose may need to be increased in pregnancy

A

Lamotrigine

416
Q

______ requires urea and electrolyte monitoring

A

SSRI

417
Q

Patients will reach conclusions that do not logically follow on from the previous statement or argument; they are also known as non-sequiturs or faulty inferences

A

Illogicality

418
Q

Words are inappropriately substituted; e.g. ‘I baked the cake in the dustbin, then I put the butter back in the dog’

A

Semantic paraphasia

419
Q

Medical management of ADHD

A

Methylphenidate or amphetamine

These medicines have some activity in the frontal lobe, thus increasing executive function, attention, and reducing impulsivity

420
Q

__________ is a common withdrawal symptom of mirtazapine

A

Headache

421
Q

Drugs that cause SJS

A

Phenytoin
Carbamazepine
Salicylates
Sertraline
Imidazole antifungal agents
Nevirapine

422
Q

Side effects of sodium valproate

A

V - VALPROATE:
A - Appetite increase –> weight gain
L - Liver failure
P - Pancreatitis
R - Reversible hair loss (alopecia)
O - Oedema
A - Ataxia
T - Teratogenic, tremor, thrombocytopaenia
E - Enzyme inhibitor (p450), encephalopathy (due to high ammonia)

423
Q

Rigidity, hyperthermia, autonomic instability (hypotension, tachycardia) and altered mental status (confusion)

A

Neuroleptic malignant syndrome

424
Q

Starting smoking, or smoking more, can reduce/increase clozapine levels

Stopping drinking can increase/reduce levels

A

Starting smoking, or smoking more, can reduce clozapine levels

Stopping drinking can also reduce levels

425
Q

If a patient has had a previous overdose on methadone, then _______________ should be given. However, if both drugs are equally suitable, then _______________ should be prescribed first line

A

If a patient has had a previous overdose on methadone, then buprenorphine should be given. However, if both drugs are equally suitable, then methadone should be prescribed first line

426
Q

Overdose + apnoeic = naloxone full dose/titrated
Overdose + NOT apnoeic = naloxone full dose/titrated

A

Overdose + apnoeic - naloxone full dose
Overdose + NOT apnoeic - naloxone titrated

427
Q

Refeeding syndrome

A

Potassium
Magnesium
Phosphate

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