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Psych Flashcards

1
Q

Serotonin syndrome presentation

A

Hyperthermia
Autonomic instability
Confusion
Twitching
Tachycardia
High BP

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2
Q

poor prognostic indicators in schizophrenia

A

gradual onset
male
low IQ
predominant negative symptoms

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3
Q

sneiders first ranks

A

passivity phenomenon
3rd person auditory hallucinations
thought interference
delusional perception eg traffic light is green therefore I am King

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4
Q

negative vs postive symptoms in schizo

A

negatives - anhedonia, low mood, apathy, algae, asocial
positives - delusions, hallucinations, passivity, thought interference

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5
Q

RX of schizo - bio, psycho, social

A

1st line - atypical anti-psychotic
2nd line - change to another anti-psychotic
3rd line - ie resistant schizo, give clozapine

CBT, family intervention, social skills training, support groups, supported employment programmes

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6
Q

rf for schizo

A

fhx, age 15-35, childhood trauma, cannabis, low socioeconomic status

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7
Q

types of delusions

A

grandiose, persecutory, nihilistic, reference

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8
Q

lithium monitoring timings

A

every week 12 hrs after dose until stable
then every 3 months

if change dose go back to step1

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9
Q

lithium side effects - short term and long term

A

short - fine tremor, GI upset, weight gain
long - hypothyroidism, hyperparathyroidism and hypercalcaemia, diabetes insipidus

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10
Q

what drugs co prescribed may trigger lithium toxicity

A

NSAIDs, ACEi, ARBs, loops and thiazides

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11
Q

how long should anti depressants be continued after the resolution of sx

A

6 months

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12
Q

what can untreated wernickes encephalopathy lead to and what is the triad

A

Korsakoffs
anterograde amnesia - can’t form new memories
confabulation - false memories
retrograde amnesia - can’t remember old memories

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13
Q

icd10 for ptsd

A

exposure to traumatic event
sx occurs within 6 months
persistent remembering
avoidance
either - inability to recall or persistent sx of increased psychological sensitivity and arousal

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14
Q

questionnaires for ptsd

A

trauma screening questionnaire
post traumatic diagnostic scale

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15
Q

rx of GAD - Bio psycho social

A

1st line - SSRI
2nd line - other SSRI or SNRI
3rd line - pregabalin

psychoeducation
CBT
Support groups
Charities eg mind

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16
Q

atypical vs typical antipsychotic side effects

A

Typical - EPS and hyperprolactinaemia, lower seizure threshold (clozapine also does this)
Atypical - Diabetes, weight gain, metabolic syndrome

Both - long Qt,

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17
Q

4 EPS and what are they

A

acute dystonia - oliguric crisis, torticolis
tardive dyskinesia - involuntary movements
parkinsonism
akathisia - restlessness

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18
Q

what pathway do antipsychotics work through?
which pathway causes hyperprolactinaemia?
which pathway causes EPS

A

meso limbic and meso cortical

tubuloinfundibular - prolactin

nigrostriatal causes EPS

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19
Q

obsession vs compulsion

A

o - repetitive unwanted intrusive thoughts images or urges that person recognises as absurd
c -repetitive behaviours that a person feels driven into performing, may be overt or covert. no enjoyment in this action

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20
Q

ocd questionnaire

A

Y-BOCS

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21
Q

Rx of OCD - bio, psycho, social

A

1st line: SSRI
2nd line: clomipramine

psychoeducation
CBT - exposure and response prevention (ERP)
distraction techniques

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22
Q

at what hours do the flowing most likely occur in alcohol withdrawal:
- symptoms
- seizures
- delirium tremens

A

6-12 hrs
36 hrs
72 hrs

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23
Q

what med to use as alternative to risperidone if causing hyperprolactinaemia

A

aripiprazole

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24
Q

which antidepressant is useful for sleep and for weight gain

A

mirtazipine

25
Q

side effects of SSRIs

A

hyponatraemia
GI upset
increased suicidal thoughts
erectile dysfunction

26
Q

symptoms of ssri discontinuation syndrome

A

profuse diarrhoea
electric shocks everywhere
dizziness
abdo pain
restless
sweating
difficulty sleeping

27
Q

side effect of citalopram to be aware of

A

long QT - tornadoes de pointes

28
Q

what drug class can trigger mania or hypomania

A

Anti depressants - particularly venlafaxine (SNRI), SSRIs and TCAs

29
Q

hypomania vs mania

A

hypo - 3-4 days, no delusions of grandeur, does not impair functionality
mania - >7 days, delusions of grandeur, severely impaired functionality

30
Q

rx of acute dystonia

A

procyclidine

31
Q

somatisation disorder vs hypochondriac

A

somatisation is for symptoms but no investigations are positive
hypochondriac is convinced they have cancer

32
Q

how long should SSRIs be tapered down for once 6 months of sx resolution has passed

A

4 weeks

33
Q

how long do you need symptoms for depression

A

2 weeks

34
Q

indications for ECT

A

Euphoria - prolonged mania
Catatonia
Treatment resistant depression or severe life threatening

35
Q

contraindications of ECT

A

Recent MI <3months or stroke <1mo
increased ICP - ABSOLUTE CI
Aneurysm

36
Q

Side effects of ECT

A

amnesia
status epilepticus
headache
arrythmias
anaesthetic risks

37
Q

common side effects of clozapine and 3 life threatening

A

1 - constipation
2 - agranulocytosis
3 - myocarditis

hyper salivation
weight gain
sedation

38
Q

when to use the mental health act

A

has a mental health condition and
- refuses treatment
- is a risk to others or self
- community rx options are not appropriate

39
Q

5 principles of capacity

A
  • assume everyone has capacity until proven otherwise
  • give all the information in an accessible way
  • allow unwise decisions
  • always act in best interests
  • make decision with least restrictive option
40
Q

2 stages of capacity assessment

A

identify that pt has a condition that will cause impairement
then do the understand, weigh, retain and communicate

41
Q

what are the following sections
- section 2
- section 3
- section 5(2)
- section 5(4)
- 117
- 135
- 136
- CTO

A

2 - 28 days for assessment
3 6 months for treatment
5(2) Inpatient dr for 72hrs
5(4) Inpatient nurse for 6hrs
117 Care at home eg been released but need someone to help with meds
135 - Police can enter and remove from home 24 hrs
136 - Police can remove form streets 24hrs
CTO - can be treated at home instead of a hospital but can be taken to hospital for treatment if required

42
Q

physiological abnormalities in anorexia

A

hypokalaemia
low FSH, LH, oestrogens and testosterone
raised cortisol and growth hormone
impaired glucose tolerance
hypercholesterolaemia
hypercarotinaemia
low T3

43
Q

features of anorexia

A

reduced body mass index
bradycardia
hypotension
enlarged salivary glands
lanugo hair

44
Q

ICD10 for anorexia

A

FEEDD

Fear of weight gain
Endocrine disturbance eg amenorrhoea, low libido
Emaciated - BMI <17.5
Deliberate weigh loss
Distorted body image

45
Q

Complications of anorexia

A

anaemia
osteoporosis
bradycardias
pancreatitis
hypokalaemia
renal failure
seizures
hypothermia

Refeeding syndrome!

46
Q

Electrolyte imbalances in referring syndrome and how to monitor for

A

hypokalaemia, magnasemia and phosphataemia

monitor bloods daily, start slow and look for signs of tachycardia and oedema (can cause cardiac failure)

47
Q

ICD10 for bulimia nervosa

A

Behaviour to prevent weight gain
Preoccupation with eating
Fear of fatness
Overeating - 2 ep per week for >3months

48
Q

Signs seen in bulimia nervosa

A

Russelss sign (marks on hands from teeth)
B/L parotid swelling
dental erosion

49
Q

rx of anorexia bio psycho social

A

treat complications
SSRI
psyched
CBT
MANTRA
IPT
anorexia focused family therapy first line in children

self help groups
charities

50
Q

rx of bulimia bio psycho social

A

treat complications
fluoxetine
psychoed
CBT - BN
IPT
eat in company, small reg meals
self help programmes
food diary
charities

51
Q

what is diabulimia

A

insulin ommitance to prevent weight gain leading to DKA

52
Q

complications of repeated vomiting

A

mallory weiss
hypokalaemia (tall p waves, flattened t waves)
metabolic alkalosis
parotid enlargement
dehydration
renal failure
aspiration pneumonitis

53
Q

ICD 10 for specific phobias

A

at least 2 sx of anxiety in feared situation that is restricted to feared situation,. Marked fear or avoidance

54
Q

PRESENTATION OF NMS

A

Fever
Muscle rigidity
Tachycardia, HTN, tachypnoea
Agitated delirium

55
Q

Ix of NMS

A

CK - elevated
AKI - due to rhabdo
FBC - Leukocytosis

56
Q

Rx of NMS

A

stop the meds!!
IV fluids
bromocriptine or dantrolene

57
Q

SS vs NMS

A

NMS - hyporeflexia, lead pipe rigidity, normal pupils

SS - hyperreflexia, clonus, dilated pupils

58
Q

charities/support groups for
- eating disorders
- depression
- schizo
- alcohol, smoking, drugs
- diabetes
- parkinsons
- dementia
- weight loss

A
  • mind, samaritans helplines, eating disorder hope,
  • mind, schizo research fund
  • mind, turning point, quit ready
  • DESMOND (T2) and DAFNE (T1) courses
  • Parkinsons UK, age UK
  • Age UK
  • nhs weight loss plan app, couch to 5k

Look on ohs website for lifestyle stuff

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