Psych Flashcards
1
Q
what are 6 features of ADHD?
A
very short attention span
quick moving from one activity to another
quickly losing interest in a task and not being able to persist with challenging tasks
constant moving or fidgeting
impulsive behaviour
disruptive or rule breaking
must be consistent across various settings and adversely affect person for at least 6 months
2
Q
what is the diagnostic criteria for ADHD?
A
A persistent pattern (e.g., at least 6 months) of inattention symptoms and/or a combination of hyperactivity and impulsivity symptoms that is outside the limits of normal variation expected for age and level of intellectual development
3
Q
what is the management of ADHD?
A
conservative - diet and exercise, food diary (causative links), self management strategies and organisation, parent training program
Medication - central nervous stimulants - methylphenidate (ritalin) [1st line] or lisdexamfetamine, dexamfetamine, atomoxetine
4
Q
what monitoring needs to be done for those on medication for ADHD?
A
height and weight measurements as reduces appetite (especially in children)
cardiovascular effects - BP and HR
5
Q
what are 6 common side effects of methylphenidate?
A
Decreased Appetite + Growth retardation
Headache
mood disturbance - agression, irritability, anxious, tense, depressed
insomnia
dry mouth
6
Q
What are the 5 Ps of formulation?
A
Presenting
Predisposing
Precipitating
Perpetuating
Protective
7
Q
what is psychological formulation?
A
the dynamic framework through which the connection between our individual characteristic, experiences and behaviours can be understood
8
Q
What are the 4 types of risk?
A
risk to self
risk to others
risk from others
risk to property
9
Q
what is a delusion?
A
Fixed false belief that is outside of cultural or religious norms
10
Q
what is an overvalued idea?
A
Delusional idea but held with less conviction when challenged than a delusion - the patient might accept there is a possibility that it is not real.
11
Q
What is the name of the delusional belief and it’s syndrome where you believe that someone important is in love with you?
A
erotomania
de clerambault’s syndrome
12
Q
What is the name of the delusion and its syndrome that there are bugs crawling on you skin all the time?
A
Paracitosis
Ekbom’s syndrome
13
Q
what is the name for a delusion shared by multiple people?
A
Folie à deux (or trois)
14
Q
what is the name for a delusions where you think that someone you know has been replaced by an imposter?
A
Capgras syndrome
15
Q
what is the name for a delusion where you think multiple people are actually a single person in disguise?
A
Fregoli’s syndrome
16
Q
what is the name for a delusion where you think you have special powers, wealth, a mission, intelligence or identity?
A
Grandiose delusions
17
Q
what is the name of delusions where you think there is something wrong with part or all of your body?
A
somatic delusions
18
Q
what is the name of delusions where you think that unrelated occurrences in the external world have special significance to you in particular?
A
delusion of reference
19
Q
what are delusions where you falsely think someone is out to get you?
A
Persecutory delusions
20
Q
what are delusions where you feel guilty for something you haven’t done?
A
delusions of guilt
21
Q
what is a delusional perception?
A
a true perception that a patient attributes false meaning to
22
Q
what is the name and syndrome of a delusion where you believe your partner is cheating on you?
A
Delusion of jealousy
Othello syndrome
23
Q
what is the name of the delusion where you believe you are dead or don’t exist?
A
nihilistic delusions
delires de negation
Cotards syndrome
24
Q
what is the name of the delusions where you believe your thoughts and actions are being controlled by an external force?
A
delusion of passivity/control
25
what is a hallucination?
a sensory perception in the absence of external stimuli
26
what is a somatic hallucination?
when you believe you can feel your internal organs moving or you heart beating out of chest
27
what is an extracampine hallucination?
one that is not possible due to geography
e.g. hearing the kings voice talking to you in sheffield from buckingham palace
28
what is a hallucination as you're falling asleep called?
hypnogogic
NORMAL
29
what is a hallucination as you're waking up called?
hyponopompic hallucinations
NORMAL
30
what are pseudohallucinations?
vivid mental images that though they sound like hallucinations are not EXTERNAL to the patient ie they're coming from within the patient's own head
31
what are illusions?
special perceptual experiences in which information arising from “real” external stimuli leads to an incorrect perception
eg monsters under bed is actually pile of washing
32
what is the old diagnostic criteria for schizophrenia?
schneider's first rank symptoms
33
what are schneider's first rank symptoms of schizophrenia?
A - Auditory hallucinations (3rd person)
B - Broadcasting thoughts
C - Control delusions - thoughts (withdrawal, insertion, interruption) and actions controlled by someone else (passivity phenomenon)
D - Delusional perceptions
34
what are 5 risk factors for schizophrenia?
FHx
Black Caribbean ethnicity
Migration
Urban environment
Cannabis
35
what are the 3 features of psychosis?
hallucinations
delusions
disorganised thinking and speech
36
What are 6 presentations of BPD?
Intense emotions/emotional instability
Impulsive/risky behaviour
Low self esteem
Difficulty maintaining relationships
Anger, violence and aggression
Self harm, suicide attempts
37
what are the 3 main categories of personality disorders?
Type A - Odd and eccentric
Type B - emotional and erratic
Type C - anxious and fearful
38
what is avoidant personality disorder?
severe anxiety about rejection or disapproval and avoidance of social situations due to this
39
what is dependent personality disorder?
heavy reliance on others to make decisions and take responsibility for their lives, taking a very passive approach. Fear being left to care for selves
40
what is obsessive compulsive personality disorder?
unrealistic expectations of how things should be done by themselves and others, and catastrophising about what will happen is these expectations are not met
41
what is paranoid personality disorder?
Hypersensitivity and an unforgiving attitude when insulted
difficulty in trusting or revealing personal information to others
42
what is schizoid personality disorder?
lack of interest or desire to form relationships with others and feelings that this is of no benefit to them
Few friends and like being alone
43
what is schizotypal personality disorder?
unusual beliefs thoughts and behaviours, as well as social anxiety that makes forming relationships difficult
44
what is borderline personality disorder?
fluctuating strong emotions and difficulties with identity and maintaining healthy relationships
45
what is histrionic personality disorder?
the need to be at the centre of attention and having to perform for others to maintain that attention
Rapidly shifting shallow emotions
46
what is narcissistic personality disorder?
feelings that they are special and need others to recognise this or else they get upset. They put themselves first.
47
what is antisocial personality disorder?
reckless and harmful behaviour with lack of concern for consequences or the impact of their behaviour on others
48
what are the 6 domains of personality disorder traits recognised in the ICD-11?
Negative affectivity
Detachment (from society)
Dissocialisation
Disinhibition
Anankastia - preoccupation with orderliness and control
Borderline pattern
49
What is the management for personality disorders?
Dialectic behavioural therapy (DBT) and CBT
No medical (though there may be other co-existing psychiatric problems that can be dealt with medically)
50
what are 6 risk factors for personality disorders?
Hx of abuse
FHx of schizophrenia
Negative parental interactions
emotional/disruptice disorder in childhood
ethnicity - White
other psychiatric diagnosis
51
what are 2 positive and 5 negative presentations of psychosis?
+ Hallucinations
+ Delusions
- Affect Flattening (lack of spontaneity or reactiveness)
- Avolition (lack of drive)
- Ahedonia
- Attention Deficit
- Impoverished speech or language
52
What is the prodromal period?
a period of subclinical signs and symptoms preceding the onset of psychosis that can last from a few days to around 18 months
53
what are 6 features of the prodromal period?
transient, low intensity psychotic symptoms
Reduced interest in daily activities
Problems with mood, sleep, memory, concentration, affect, motivation
Anxiety, irritability or depressive features
Incoherent or illogical speech
Positive family history
54
what are 8 risk factors for psychosis?
Genetics
Stressful life event
childhood adversity
Ethnicity - increase in south asian and african populations
Urban living
migration
cannabis and other substance use (including high dose corticosteroids)
Early life factors - maternal stress, nutritional deficiency, IUGR
55
what is the treatment for psychosis and schizophrenia?
Refer to early intervention in psychosis team/ crisis resolution team
Bio - Antipsychotics
psycho - CBT
Social - Family intervention, Care plan (crisis plan, advanced statement, key contacts), inform DVLA and don't drive during episodes
Trial of 2x other antipsychotics for 6 weeks
Then Clozapine
56
What are 12 first generation antipsychotics?
Benperidol
Haloperidol
Chlorpromazine
Levomepromazine
Pericyazine
Perphenazine
Prochlorperazine
Promazine
Trifluperazine
Flupentixol
Zuclopenthixol
Pimozide
Sulpiride
57
what is the MOA of typical antipsychotics?
Dopamine D2 receptor antagonists
58
What are 7 2nd generation (atypical) antipsychotics?
Olanzapine
Quetiapine
Clozapine - when 2 other anti-psychotics have failed
Paliperidone
Risperidone
Amisulpride
Aripirazole
59
What are typical antipsychotic side effects?
Extrapyramidal - abnormal movements and pseudoparkinsonisms, restlessness, tardive dyskinesia
Increased risk of VTE and stroke
Antimuscarinic side effects - dry mouth, blurred vision, urinary retention, constipation
Sedation
Raised prolactin - galactorrhoea
Diabetic type effects - Weight Gain, dyslipidaemia, impaired glucose tolerance
Neurological -reduced seizure threshold neuroleptic malignant syndrome
Cardiac - QT prolongation (Haloperidol)
60
what antipsychotic side effect is most associated with atypicals?
Weight gain and metabolic syndrome
61
what typical antipsychotic can cause QT prolongation?
Haloperidol
62
What are the 3 core symptoms of autism ?
social interaction problems
communication problems
behavioural problems
63
what are 6 features of social interaction deficits in autism?
lack of eye contact
delay in smiling
avoids physical contact
unable to read non-verbal cues
difficulty establishing friendships
not displaying a desire to share attention
64
what are 4 features of communication deficits in autism?
Delay, absence or regression in language development
lack of appropriate non-verbal communication such as smiling, eye contact, responding to others and sharing interests
Difficulty with imaginative or imitative behaviour
repetitive use of words or phrases
65
What are 6 behavioural deficit features in autism?
Greater interest in objects, numbers or patterns than people
Stereotypical repetitive movements - self stimulating repetitive movements to comfort self
Intensive and deep interests that are persistent and rigid
repetitive behaviours and fixed routines
Anxiety and distress with experiences that are outside their normal routine
Extremely restricted food preferences
66
What are 5 psychiatric emergencies?
Suicide, harm to self, harm to others
Substance intoxication and withdrawal
Overdose of psychoactive drug
Neuroleptic malignancy syndrome
Serotonin syndrome
67
what is neuroleptic malignant syndrome?
High fever, muscle stiffness, altered mental status and autonomic dysfunction (BP swings, excessive sweating, excessive salavating)
Caused by antipsychotics
68
what is seen on bloods in neuroleptic malignant syndrome?
Raised creatinine kinase
Raised WCC
69
what is serotonin syndrome and symptoms?
Neuromuscular excitation - Rigidity, hyperreflexia, myoclonus
Autonomic system excitation - increased HR + BP, hyperthermia, diaphoresis, dilated pupils, headache, diarrhoea and vomiting
Altered mental status and seizures
caused by too much serotonin => can lead to death
70
what is the MOA of alcohol?
stimulates GABA to have relaxing effect on brain.
Allso inhibits glutamate receptors causing further relaxation
Long term - GABA becomes down regulated and glutamate becomes upregulated
71
Units of alcohol =
(Volume (ml) X Percentage (%))/1000
72
what is classed as binge drinking?
>6 units for women
>8 units for men
in a single session
73
what are 9 complications of alcohol excess?
Alcohol related liver disease
Cirrhosis
Alcohol dependence and withdrawal
Wernicke-korsakoff syndrome
Pancreatitis
Alcoholic cardiomyopathy
Alcoholic myopathy - proximal muscle wasting and weakness
Increased risk of CVD
Increased risk of cancer - Breast, mouth, throat
74
What are 6 symptoms of alcohol withdrawal?
Tremors
sweating
tachycardia
GI disturbance
Anxiety and irritability
Headache
75
what may be seen on blood results with alcohol excess?
raised MCV
raised ALT and AST
AST:ALT ratio >1.5
raised GGT
76
what is alcohol detoxification treatment?
water
vitamins - B1 (IM if preventative or IV if symptomatic)
Food - high protein, high calorie
Benzos - chlordiazepoxide 5-20mg QDS
77
what medications are used for relapse prevention in alcoholics?
Disulphram - become unwell if drink
Naltrexone - opiate blocker that helps cravins
Acamprisate - helps with craving
78
what is the advise for an alcoholic if they want to cut down themselves?
safe to cut down 10%every day for 10 days
79
what are the serious side effects of alcohol withdrawal?
24-48 hours
Grandmal seizures
Wernicke's encephalopathy
Delerium tremens
confusional state
80
what is the presentation of delirium tremens?
acute confusion
severe agitation
delusions and hallucinations
tremor
tachycardia
hypertension
hyperthermia
ataxia
arrhythmias
81
what causes Wernicke's encephalopathy?
B1 (thiamine) deficiency
82
what are 4 symptoms of Wernicke's encephalopathy?
Ataxia
Confusional state
Eye signs - palsy of lateral rectus or internuclear opthamloplegia, pupillary changes
83
What are 5 signs of opiate withdrawal?
running - eyes and nose
GI cramping and upset
Deep muscular pain into bones
Goosebumps
84
What are 2 opiate substitution options?
Methadone - green liquid, once a day
Buprenorphine - partial agonist
85
what is the antidote to opiates?
Naloxone
86
what medication can be used for relapse prevention in opiate addiction?
Naltrexone - take every day - if take normal dose of heroine then it's blocked
87
what questionnaire can be used to screen for harmful alcohol use?
Alcohol use disorders identification test - AUDIT
88
What are the questions in the CAGE questionaire?
Ever thought of cutting back?
Annoyed when anyone else tells you to cut back?
Ever felt guilty abut drinking?
Eye opener?
89
what are the 7 different types of anxiety disorders?
Generalised anxiety disorder
Panic disorder
PTSD
OCD
Social anxiety
Phobia
Acute stress disorder
90
what is the diagnostic criteria for Generalised Anxiety Disorder?
Excessive anxiety and worry about a variety of topics, events or activities for >6 months
3 of the following:
- Edginess/restlessness
- Fatigue
- Impaired concentration/mind going black
- Irritability
- Difficulty sleeping
- Increased muscle aches or soreness
91
what is the diagnostic criteria for panic disorder?
presence of reoccurring unforeseen panic attacks followed by at least one month of persistent worry about having another panic attack and it's consequences
Need to have at least 2 unexpected panic attacks
92
What is the management of generalised anxiety disorder?
1 - education and monitoring
2 - Self-help, psychoeducational groups
3 - CBT or SSRIs (1 - sertraline)
4 - refer to psychiatry
93
what are 4 medications that can induce anxiety?
Salbutamol
Theophylline
Beta blockers
St johns wart
94
what questionnaire can assess the severity of anxiety?
GAD-7 - Generalised anxiety disorder questionnaire
5-7 = mild anxiety
10-14 = moderate anxiety
15-21 = severe anxiety
95
what are the withdrawal symptoms from SSRIs?
Dizziness, numbness and tingling, GI disturbance, headache, sweating, anxiety and sleep disturbance
96
what is phobia?
intense fear of specific objects or situations
97
what are 3 risk factors for phobia?
somatisation disorder
anxiety disorders
mood disorders
98
what is the treatment for phobia?
Education, CBT, exposure therapy
99
What are 4 manifestations of PTSD?
Intrusion symptoms (flashbacks, reactivity, dreams)
Avoidance symptoms
Negative alterations in cognition and mood
Alterations in arousal and reactivity (hyper-vigilance, exaggerated startle response, irritability)
>1 month of symptoms
100
what is the management of PTSD?
1 - trauma focused CBT
1 - eye movement desensitisation and reprocessing
2 - other psychological therapy
2 - pharmacological management (SSRIs or venlafaxine)
101
what is a screening tool that can be used for PTSD?
Trauma screening questionnaire
102
what is the presentation of OCD?
Obsessive themes
- contamination fears
- harm related obsessions
- unwanted sexual thoughts
- religious/moral obsessions
- perfectionism/symmetry
Compulsive behaviours
- cleaning/washing
- checking rituals
- counting/repeating rituals
- ordering/arranging behaviours
- mental neutralising strategies
103
what scale can be used to grade OCD severity?
Yale-Brown obsessive compulsive scale
104
what is the management of OCD?
1 - CBT, exposure and response prevention
2 - Pharmacotherapy - 1 - SSRIs or 2 - clomipramine
combine if severe
105
what is somatisation disorder?
multiple physical SYMPTOMS present for at least 2 years
patient refuses to accept reassurance or negative test results
106
what conditions can ECT treat?
severe depression - if:
Preferred by patients
Need rapid response
Refractory to medication
Severe/long lasting mania
Catatonia
107
what is ECT?
electroconvulsive therapy
108
what is an abosolute contraindication to ECT?
Raised ICP
109
what are 5 short term side effects of ECT?
Headache
Nausea
Short term memory impairment
Cardiac arrhythmia
110
what is 1 long term side effect of ECT?
Reports of impaired memory
111
what are hypnotics?
medications used to treat insomnia
112
what medications are hypnotics?
benzodiazepines
zolpidem and zopiclone - non-benzo hypnotics
Clomethiazole
antihistamines
113
which hypnotic benzos have a hangover effect that can cause drowsiness the next day?
nitrazepam
flurazepam
114
which 3 hypnotic benzos are shorter acting so cause no hangover?
Loprazolam
lormetazepam
temazepam
115
what is bipolar I?
manic episode of abnormal persistent, elevated, expansive or irritable mood with abnormally and persistently increased energy or activity lasting for at least one week.
Also depression
116
what is bipolar II?
current or past hypomanic episode and current or past major depressive episode.
Hypomania presents similarly to mania but causes less impairment and lasts at least 4 days
117
what is the management of acute mania in bipolar?
Antipsychotics - olanzapine, quetiapine, risperidone, haloperidol
Lithium, sodium valproate
118
what is the management of an acute depressive episode in bipolar?
Olanzapine PLUS fluoxetine
antipsychotics - olanzapine or quetiapine
lamotrigine
119
What is the chronic treatment of Bipolar?
1 - mood stabiliser (lithium) or antipsychotic (halporidol, olanzapine, quetiapine, risperidone, valporate***)
*not women of childbearing age
120
what are the monitoring requirements for lithium and range?
has narrow therapeutic index so levels must be monitored regularly (3-6 monthly) - should be between 0.4-1mmol/L
121
what are 2 screening questions for depression?
during the last month have you often been bothered by feeling down, depressed or hopeless?
Do you have little interest or pleasure in doing things?
122
what are 2 core symptoms of depression?
Persistent Low mood
Anergia (low energy)
Anhedonia (loss of enjoyment)
for 2 weeks+
123
what are 7 cognitive symptoms of depression?
Processing
- reduced concentration
- reduced memory
- reduced processing speed
Thought
- self confidence reduced
- ideas of guilt and worthlessness
- thinking it will never get better
- Suicidal ideation
124
what are 5 biological symptoms of depression?
sleep disturbance
changes in appetite and weight
loss of libido
Slow/fast movements - psychomotor agitation/retardation
loss of energy
125
what is the criteria for a diagnosis of depression?
1 core symptom + 4 other symptoms
>2 weeks
+ clinically significant distress and not attributable to substances or other conditions
126
what are 4 medical conditions that are differentials for depression?
Hypothyroidism
Neurological disorders - parkinsons, MS
Nutritional deficiencies - B12, folate, vitamin D
Endocrine disorders - Cushings, Addisons
127
what are 4 psychiatric differentials for depression?
Bipolar
Dysthymia - persistent depressive disorder
Adjustment disorder with depressed mood
Anxiety
128
what are 3 medications that can cause depression?
Beta blockers
Corticosteroids
isotretinoin
129
what are 6 symptoms of antidepressant withdrawal?
Unsteadiness, vertigo, dizziness
Altered sensations
Restlessness/agitation
Problems sleeping
Abdo symptoms
Palpitations, tiredness, Headaches, muscle and joint aches, sweating
130
what is the management of less severe depression? 11
PHQ-9 <16
Guided self help
Group CBT
Group behavioural activation
Individual CBT/BA
group exercise
group mindfulness and meditation
Interpersonal psychotherapy
SSRIs
counseling
short term psychodynamic psychotherapy (STPP)
131
what is the management of severe depression?
PHQ-9 >16 inclusive
1 - CBT + SSRIs/SNRIs
individual behavioural activation
individual problem solving
counseling
Short term psychodynamic therapy
guided self help
group exercise
132
what is the last line medication for depression?
vortioxetine - used if 2 prev antidepressants have not been responded to
133
what is the 1st line SSRI in children?
Fluoxetine 10-20g OD
134
what antidepressants should be avoided in warfarin use and what is the alternative?
SSRIs
Mirtazapine is alternative
135
what is the max dose of citalopram in adults?
40mg
136
what monitoring is needed with SSRIs?
Review after 2 weeks or 1 week if <30 years
continue treatment for at least 6 months post remission
137
what are 2 beneficial associated features of mirtazapine?
Drowsiness
Increased appetite
138
what antidepressant is 1st line post MI?
Sertraline - 50mg OD
139
what are the 2 2nd line antidepressants in children?
Sertraline
Citalopram
140
what is the 1st line management of moderate-severe depression in childre?
CBT, non-directive supportive therapy, interpersonal therapy and family therapy
141
what is cyclothymia?
A persistent instability of mood involving numerous periods of depression and mild elation, none of which is sufficiently severe or prolonged to justify other diagnosis
142
what are 5 medications that interact with SSRIs?
NSAIDs - gastroprotection needed
Warfarin/heparin
Aspirin
Triptans
Monoamine oxidase inhibitors - risk of serotonin syndrome
143
what antidepressant has highest risk of antidepressant discontinuation syndrome?
paroxetine
144
what are 2 SSRIs that causes long Q-T?
Citalopram and escitalopram
145
what are 2 of the most common causes of general cognitive impairement?
Down's syndrome
Foetal Alcohol syndrome
146
what are 6 specific learning difficulties without generalised cognitive impairement?
Dyslexia
Dyscalculia
ADHD
Specific language impairment
Central auditory processing disorder
Dyspraxia
147
What are 11 genetic disorders that can cause cognitive impairment?
Down's syndrome
Fragile X
Prader-willi syndrome
Angelman's syndrome
15q11 duplication syndromes
William's syndrome
Rett's syndrome
Turner's syndrome
Tuberous sclerosis
DiGeorge syndrome
16p11.2 deletion syndrome
148
what are 5 intra-uterine infections or drugs that can cause cognitive impairement?
Cytomegalovirus
Toxoplasmosis
Rubella
Foetal alcohol syndrome
Teratogenic drugs
149
What are 2 perinatal events that can cause cognitive impairmenent?
Extreme prematurity
Perinatal hypoxia
150
What are 6 CNS disorders that can cause cognitive impairment?
Bacteria meningitis
encephalitis
tumour
trauma
hypoxia
Seizures
151
what is the definition of a cognitive impairment?
IQ <70
152
what is schizoaffective disorder?
a combination of mood and psychotic symptoms lasting at least one month. Bipolar type has manic symptoms and can also have depressive ones. Depressive type has psychosis and depressive symptoms only.
153
what section of the mental health act allows police to enter private property and take someone to a place of safety for assessment?
section 135
154
what section of the mental health act allows police to pick someone up of the street and take them to a place of safety for assessment?
section 136
only for 24 hours before mental health act assessment is needed
155
How long can you detain someone under section 135/6 of the MHA?
25 hours (up to 36 if still waiting for assessment)
156
what sections of the MHA allow doctors or nurses to detain a patient?
section 5 (2) - doctors for 72 hours
Section 5 (4) - nurses for 6 hours
157
How long can you detain someone for under section 2 of the MHA?
28 days
158
How long can you detain someone for under section 3 of the MHA?
6 months with further renewals
AMHP with 2 doctors
159
what section of the mental health act allows patients to go on leave?
section 17
160
what are the 5 core principles of the mental capacity act?
1 - assume capacity until proven otherwise
2 - Use all means necessary to allow people to make their own decisions
3 - people are allowed to make unwise decisions
4 - all actions must be in the patients best interest
5 - treat in the least restrictive way possible
161
What is CBT?
focuses on what you believe and how you think and tests you on these behaviours in order to develop the ability to self test thoughts and change behaviours
162
what are 7 risk factors for suicide?
Prev Hx of suicide/mental illness
Chronic illness
criminal/legal/financial problems
Substance use
impulsive/aggressive tendencies
Fhx
isolation
163
what is anorexia nervosa?
an eating disorder characterised by restriction of calorific intake leading to low body weight, an intense fear of gaining weight and body image disturbances
164
what are 6 features of anorexia nervosa?
Weight loss
Amenorrhoea
Lanugo hair
Hypotension
Hypothermia
Mood changes - anxiety and depression
165
what are 3 cardiac complications of anorexia nervosa?
Arrythmia
Cardiac atrophy
sudden cardiac death
166
what electrolyte deficiencies does prolonged starvation cause?
hypokalaemia - especially intracellular
Hypophosphatemia
Hypomagnesaemia
167
what is the management of anorexia nervosa?
CBT-ED
Anorexia focused family therapy in children
Slow refeeding
magnesium, potassium, phosphate and glucose monitoring
Fluid balance monitoring
ECG monitoring
supplementation - B vitamins, thiamine
168
what is the pathophysiology of refeeding syndrome?
Glucose after prolonged starvation causes insulin release which shifts glucose into intracellular space leading to higher demand for phosphate, magnesium and potassium leading to low levels of these electrolytes intravascularly
169
what are 4 risk factors for refeeding syndrome?
BMI <16
not eaten for 5+ day
Compensatory behaviours
rapid weight loss
170
what is classed as mild, moderate, severe and extreme anorexia nervosa by BMI?
mild >17
moderate 16-17
severe 15-16
extreme <15
171
what are the 2 types of schizoaffective disorder?
depressive type - more common in older patients
bipolar type - more common in younger people
172
what are the 2 types of schizoaffective disorder?
depressive type - more common in older patients
bipolar type - more common in younger people
173
what questionnaire can be used to screen for eating disorders?
SCOFF
Sick - every make self sick because feel uncomfortably full
Control - wory lost control over how much eaten
One stone - more than 1 stone loss in a month
Fat - do you think you are fat
Food - would you say food dominates your life
174
what are the 7 most common physical signs of bulimia nervosa?
Alkalosis on blood gas
Hypokalaemia
Parotid hypertrophy
dental erosion
Russell's sign - scaring on dorsum of hands from teeth scraping when inserted into mouth
Mouth ulcers
GORD
175
What is the management of bulimia nervosa?
1st line - Bulimia focused self help (4 weeks)
2nd - Individual CBT-ED
Children - Bulimia focused family therapy
3 - SSRIs (fluoxetine 20mg OD)
176
What are the 3 things necessary for capacity?
ability to understand relevant information
ability to retain information
ability to weigh up information and communicate a decision
177
What is the therapeutic range of lithium?
0.4-1.0 mmol/L
178
what is dysthymia?
A chronic depression of mood, lasting at least several years, which is not sufficiently severe, or in which individual episodes are not sufficiently prolonged, to justify a diagnosis of severe, moderate, or mild recurrent depressive disorder
179
what is hypomania?
persistent mild elevation of mood, increased energy and activity but does not affect function and no psychotic symptoms
4-7 days
180
what is mania?
elevated mood with increased energy, overactivity, pressure of speech and decreased need to sleep. Attention cannot be sustained, grandiosity, loss of normal social inhibitions and alteration of function
lasting 1 week+
may have psychotic symptoms
181
what is delirium?
disturbance of attention, orientation and awareness that develops within a short period of time typically presenting as significant confusion or global neurocognitive impairment with transient symptoms that may fluctuate
182
what are the causes of delerium? (mneumonic)
PINCH ME
Pain
Infection
Nutrition
Constipation
Hydration
Medication
Environment
183
what is classed as a mild learning disability?
IQ 50-69
Some learning difficulties at school but can generally work and function independently
184
what is classed as a moderate learning disability?
IQ 35-49
marked developmental delays in childhood but can learn some level of independence will probably need support in the community
185
what is classed as a severe learning disability?
IQ 20-34
likely to need continuous support in all things
186
What is classed as a profound learning disability?
IQ <20
severe limitation in self-care, continence, communication and mobility
187
what is the 4 essential diagnostic criteria for schizophrenia?
At least one of :
- persistent delusions
- persistent hallucinations
- disorganised thinking or speech
- Experiences of influence, passivity or control
must be experienced for at least a month
188
what is the 3 none essential diagnostic criteria of schizophrenia?
Negative symptoms
Grossly disorganised behaviour
Psychomotor disturbances
189
what are 5 negative symptoms of schizophrenia?
affect flattening
alogia (poverty of speech)
avolition (lack of motivation)
anhedonia
social withdrawal
190
what are 5 poor prognostic factors for schizophrenia?
strong FHx
Gradual onset
low IQ
prodromal phase
lack of obvious precipitant
191
what scale can be used for depression questionnaire in elderly?
Geriatric depression scale questionnaire
192
where in the body are the most serotonin receptors?
GI tract
193
what depression scale can be used in patients with dementia?
cornell depression scale
194
what electrolyte disturbance can SSRIs cause?
hyponatraemia
195
what is the second line management of panic disorder?
if SSRIs/SNRIs ineffective after 12 weeks try imipramine or clomipramine
196
what questionnaire can be used in depression?
PHQ-9
197
what is a less severe depression score on PHQ-9?
<16
198
what is a more severe depression score on PHQ-9?
>16 inclusive
199
what are 6 biological features of anorexia nervosa?
Most things low but
Gs and Cs raised
Growth hormone
Glucose
Salivary Glands
Cortisol
Cholesterol
Carotinaemia (oranging of skin)
200
when do alcohol withdraw symptoms start?
6-12 hours after last drink
201
when can hallucinations start in alcohol withdrawal?
12-24 hours
202
when is the peak incidence of seizure in alcohol withdrawal?
36 hours
203
when is the peak incidence of delirium tremens?
48-72 hours
204
What are the symptoms of delirium tremens?
coarse tremor, confusion, delusions, auditory and visual hallucinations, fever, tachycardia
205
what medication is given first line in management of alcohol withdrawal?
1- Chlordiazepoxide
2 - lorazepam in liver cirrhosis as chlordiazepoxide in oxidised in liver
206
what medication is given to prevent wernikes in people with alcohol withdrawl?
Thiamine - Vitamin B1 => Pabrinex
207
what are 5 side effects of ECT?
headache
nausea
short term memory impairment
memory loss of events prior to ECT
cardiac arrhythmia
208
what is a contraindication to ECT?
raised ICP
209
what is an obsession?
an unwanted intrusive thought, image or urge that repeatedly enters the person's mind
210
what is a compulsion?
repetitive behaviours or mental acts that the person feels driven to perform
211
which SSRI has a long half life?
fluoxetine
fully withdraw fluoxetine and wait a few days when switching antidepressants
212
when is gastroprotection needed with SSRI?
if use NSAIDs - add PPI
213
what medications when taken with SSRIs increase risk of serotonin syndrome?
Triptans
St john's wart
Monoamine oxidase inhibitors
amphetamines and ecstasy
214
what is the management of serotonin syndrome?
Supportive
Benzodiazepines
If severe - Serotonin antagonists – cyproheptadine, chlorpromazine
215
what is the management of neuroleptic malignant syndrome?
supportive
Dantrolene in severe cases
216
what are 9 side effects of lithium?
Nausea, vomiting, diarrhoea
Fine tremor
Nephrotoxicity secondary to diabetes insipidus
Thyroid enlargement => hypothyroidism
ECG - T wave flattening/inversion
weight gain and idiopathic intracranial hypertension
leucocytosis
hyperparathyroidism => raised calcium - bones, stones, groans, moans
217
when should lithium levels be taken?
12 hours post dose
218
how often should lithium levels be monitored?
weekly until at stable dose
then 3 monthly once stable
219
what 2 bloods should be done every 6 months in patients on lithium?
TFTs
U+E
220
what are 2 monoamine oxidase-B inhibitors?
Rasagiline
Selegiline
221
what can't monoamine oxidase inhibitors be taken with?
tyramine containing foods
cheese, pickled herring, Bovril, Oxo, Marmite, broad beans
can cause hypertensive reaction
222
what is the management of acute mania?
antipsychotics - olanzapine, haloperidol
223
what are 5 side effects of clozapine?
Agranulocytosis
Reduced seizure threshold
Constipation
Myocarditis
Hypersalivation
224
which antipsychotic is most likely to cause dyslipidaemia and obesity?
olanzapine
225
what antipsychotics are most likely to cause extra pyramidal side effects?
1st generation antipsychtics - haloperidol, chlorpromazine etc
226
what are extrapyramidal side effects of antipsychotics?
Parkinsonism
Acute dystonia
Sustained muscle contraction
Akathisia – severe restlessness
Tardive dyskinesia - Choreoathetoid abnormal, involuntary movements
227
what is the management of sustained muscle contraction due to antipsychotics (acute dystonia)?
procyclidine
228
what is acute dystonia?
involuntary contractions of muscles of the extremities, face, neck, abdomen, pelvis, or larynx in either sustained or intermittent patterns that lead to abnormal movements or postures due to medications usually antipsychotics
229
which non-antipsychotic can cause acute dystonia?
metoclopramide - antiemetic
230
what is the management for acute dystonia?
IV anticholinergics - benzotropine
IV Benzodiazepines
231
at what level does lithium toxicity usually occur?
>1.5 mmol/L
232
what are 3 things that may precipitate lithium toxicity?
dehydration
renal failure
drugs - diuretics (thiazides), ACEI/ARBS, NSAIDS, metronidazole
233
what are 5 side effects of lithium toxicity?
COARSE tremor (fine is side effect of normal lithium level)
hyperreflexia
acute confusion
seizure
polyuria
coma
234
what is the management of lithium toxicity?
IV fluids until euvolaemic
Monitor serum sodium closely
haemodialysis if severe
235
what is the diagnostic criteria for delirium? (5)
1.) Impairment of consciousness and attention
2.) Global disturbance in cognition
3.) Psychomotor disturbance
4.) Disturbance of sleep-wake cycle
5.) Emotional disturbances
236
what is the MOA of benzodiazepines?
They facilitate and enhance the binding of GABA to the GABAA receptors
237
what is the MOA of antipsychotics?
block the postsynaptic dopamine D2 receptors
238
what are 4 blood results for neuroleptic malignant syndrome?
Raised CK (creatine kinase) --> due to muscle rigidity
Raised white cell count
Deranged LFT’s
Acute renal failure --> abnormal U&E’s
Metabolic acidosis --> low pH, low HCO3
239
what are the hallucinations like in schizophrenia?
3rd person auditory
external to patient
thought echo
running commentary
multiple voices talking about the patients amongst themselves
240
what is Illness anxiety disorder (hypochondriasis)?
persistent belief in the presence of an underlying serious DISEASE, e.g. cancer
patient again refuses to accept reassurance or negative test results
241
what is conversion disorder?
typically involves loss of motor or sensory function
the patient doesn't consciously feign the symptoms (factitious disorder) or seek material gain (malingering)
patients may be indifferent to their apparent disorder - la belle indifference - although this has not been backed up by some studies
242
what is factitious disorder?
aka Muchausen's syndrome - intentional production of physical or psychological symptoms
243
what is malingering?
fraudulent simulation or exaggeration of symptoms with the intention of financial or other gain
244
How often is monitoring for clozapine?
weekly for 18 weeks then fortnightly till one year then every month
245
what is the name for severe restlessness in antipsychotic use?
akathisia
246
what is acute stress reaction?
Phycological condition following exposure to severe stress or traumatic events lasting up to a month
247
what are 5 risk factors for acute stress reaction?
Genetics + neurobiological factors
Prior psych Hx
Trauma/precipitating event
Lower socioeconomic status
Lack of coping mechanisms and social support
248
what are 3 cognitive symptoms of acute stress reaction?
Confusion and disorientation
Intrusive thoughts - memories, dreams, flashbacks
Derealisation and depersonalisation
249
what are 2 behavioural symptoms of acute stress reaction?
Avoidance behaviour - avoid thoughts, conversations, activities, places or people
Hyper-vigilance
250
what are 2 physiological symptoms of acute stress reaction?
tachycardia and hypertension
Sweating and trembling
251
what is the management of acute stress reaction?
1 - Trauma focused CBT
Mindfulness
can consider short term use of benzodiazepines
252
what is self harm?
intentional self injury without suicidal intent
Cutting is most common
253
what are the 6 steps in the cycle of self harm?
Emotional suffering
Emotional overload
Panic
Self-harm
Temporary relief
Shame and guilt
254
what are 7 presenting features that increase risk of suicide?
Previous attempts
Escalating self harm
impulsiveness
hopelessness
feelings of being a burden
making plans
Writing a note
255
what are 9 background factors that increase risk of suicide?
Mental health conditions
physical health conditions
Hx of abuse/trauma
FHx
Financial difficulties/unemployment
Criminal problems
Lack of social support
Alcohol and drugs
Access to means
256
what are 4 protective factors for suicide?
Social support and community
sense of responsibility over others
resilience, coping and problem solving skills
access to mental health support
257
what are 4 examples of self harm?
Cutting
hitting self
burning own skin
applying tight ligatures to skin
258
What are the baby blues?
transient mood disturbance in the 1st week post partum
crying, fatigue, sensitivity, anxiety, irritability, helplessness, low mood and mood swings
Managed with reassurance and support
259
What is postnatal depression?
low mood, anhedonia and low energy typically affecting mothers around 3 months post natally
260
what is the management of postnatal depression?
Mild - reassurance, support, self help, follow up
Moderate - SSRIs - sertraline, paroxetine, CBT
Severe - referral to psychiatry, impatient care on mother and baby unit
261
what scoring system is used for post natal depression?
Edinburgh postnatal depression scale
262
What is pueperal psychosis?
typically onset 2-3 weeks postnatal with mother experiencing psychotic symptoms (delusions, hallucinations, depression, mania, confusion, thought disorder)
263
what is the treatment for puerperal psychosis?
admission to mother and baby unit
CBT
medications - antidepressants, antipsychotics, mood stabilisers
electroconvulsive therapy
25-50% recurrence rate in future pregnancies
264
what is charles-bonnet syndrome?
persistent or recurrent complex hallucinations - usually visual - predominantly against a background of visual impairment. Insight is preserved and there is absence of other neuropsychiatric disturbance
265
what are 5 risk factors for charles bonnet syndrome?
Older age
peripheral visual impairment
Social isolation
sensory deprivation
early cognitive impairment
266
what are 3 types of dissociative disorders?
Depersonalisation-derealisation disorder
Dissociative amnesia
Dissociative identity disorder
267
what is Depersonalisation-derealisation disorder ?
feeling of being separated/outside body and feeling that the world is not real
268
what is Dissociative amnesia?
forgetting autobiographical information typically following trauma
269
what is Dissociative identity disorder?
AKA multiple personality disorder - lack of clear individual identity, with multiple separate identities
270
what is catatonia?
abnormal movement, communication and behaviour presenting in a variety of ways
271
what is reactive attachment disorder?
from severe neglect and trauma in childhood
emotional withdrawal and inhibition, sadness, fearfulness, irritability, impaired cognition
272
what is alien hand syndrome?
patient loses control of one of their hands which then acts independently
can occur after brain tumour, injury surgery
273
what is alice in wonderland syndrome?
AKA todd syndrome
incorrectly perceiving size of objects or body parts
May be caused by migraine, epilepsy, brain tumour
274
what is Koro syndrome?
delusion that sex organs are retracting or shrinking and will one day disappear
275
what is body integrity dysphoria?
delusion the part of body does not belong to them and they want to remove it
276
what is binge eating disorder?
characterised by episodes where a person excessively overeats and feels as though they have lost control - likely to be overweight
binges may involve eating very quickly, unrelated to feelings of hunger, being uncomfortably full, eating in dazed state, feelings of guilt/disgust
marked distress regarding binges
at least once a week for 3 months
277
what is tolerance?
loss of effect when taking the same dose - person may have to increase dose to get same effect
278
what is dependence?
psychological and psychosocial need to keep using a drug
may occur due to physiological changes and psychological factors
279
what are benzos withdrawal symptoms?
Anxiety, irritability, tremmors, insomnia, seizures
due to reduced natural production of GABA (inhibitory neurotransmitter)
280
what pathway of the brain is involved in psychological addiction?
mesolimbic pathway
involves ventral tegmental area, nucleus accumbens, amygdala and prefrontal cortex
281
what is the mechanism of psychological addiction?
substances lead to dopamine release within mesolimbic pathway leading to pleasurable reward. Repeat dopamine exposure reduces number and sensitivity of dopamine receptors leading to a need for increasingly stronger stimuli to produce same reward
282
what is the MOA of cocaine?
Blocks reuptake of dopamine by presynaptic membrane
283
what is the MOA of MDMA?
stimulates release of serotonin and blocks reuptake
284
what is the MOA of methamphatamines?
Stimulates release of dopamine and blocks reuptake
285
what is the MOA of alcohol and benzos?
stimulate GABA receptors
286
what is the MOA of hallucinogens?
stimulate serotonin receptors, particularly 5-HT2A receptors
287
what are the rules surrounding driving and alcoholsim?
must inform DVLA - licence revoked until extended period of abstinence
288
what is the management of alcoholic ketoacidosis?
infusion of saline and thiamine
289
what is the diagnostic criteria for alcoholism?
3+ of
Compulsion to drink
difficulties controlling alcohol consumption
physiological withdrawal
tolerance
neglect of alternative activities to drinking
persistent use of alcohol despite evidence of harm
290
what is phenomenology is psychiatry?
the scientific study of subjective experiences
291
what is insomnia?
difficulty initiating or maintaining sleep or early morning waking that leads to dissatisfaction with sleep quantity or quality
292
what is classed as chronic insomnia?
difficulty sleeping at least 3 nights per week for >3 months
293
what are 6 risk factors for insomnia?
female
increased age
lower educational attainment
unemployment
economic inactivity
widowed, divorced, separated status
alcohol and substance abuse, corticosteroids, poor sleep hygiene, chronic pain or illness
294
what is the MOA of benzodiazepines?
enhace effect of inhibitory neurotransmitter GABA by increasing frequency of chloride channels
295
how long should benzos be given for?
no more than 2-4 weeks
296
what are 3 examples of z-drugs?
zopiclone
zolpidem
zaleplon
297
what are 3 concerning side effects of hypnotics?
daytime sedation
poor motor coordination
cognitive impairment
298
what monitoring is needed for antipsychotics?
FBC, U+E, LFT - initiation, annually - clozapine FBC initially weekly
Lipids, weight - initiation, 3 months, annually
Fasting blood glucose, prolactin - initiation, 6 mon, anual
BP - Initiation, dose titration
ECG - baseline
CVD risk - annually
299
