psych Flashcards
What is conversion disorder
Functional neurological symptom disorder
What is conversion disorder suggested by
Loss of motor control or sensory function
Not fully explained by physiological mechanisms
Assosiated with psychological conflict
What is hypochondriasis
Preoccupation with body illness
Accompanying anxiety and health seeking behaviour
Mechansim of buspirone
Partial serotonin receptor agonist
Treatment of PTSD
Eye movement desensitisation and reprocessing (EMDR)
Drugs known to increase lithium concentrations
Metronidazole
NSAIDs
ACEIs / ARBs
TTDs
Corticosteriods
Tetracyclines
Where is lithium excreted?
Kidneys
Causes of cortical dementia (damage to cerebral cortex - outer grey matter layer of the brain)
Alzheimers
FTD
CJ Disease
Features of cortical dementia
Severe memory loss
Cannot remember words / understand language
Causes of subcortical dementia (damage to area beneath the cortex and disruption of frontostriatal connections)
PD
VD
MS
NPH
Huntingtons
Wilsons
HIV dementia complex
Features of subcortical dementia
Planning difficulties
Poor verbal fluency
Personality change
Task swtiching
Reduced verbal output, slowed rate of response and reduced altertness
Complex motor tasks preserved in the early syages
What is splitting
Defense mechanism whereby people do not integrate the good and bad qualities of other people - rather they have representatinos of people at one extreme or the other (i.e. all good or all bad)
Inheritanc eof lesch nyhan syndrome
X linked recessive
Almost exclusively affects boys
Pathology of lesch nyhan syndrome
Inborn error of purine metabolism
Results in abnormally high levels of xanthine and uric acid in the blood
Gene mutation short arm of chromosome Xq26-27
Presentation of lesch nyhan syndrome
Severe mental disability
Wheelchair bound
Increased tendon reflexes
Microcephaly common
Epileptic seizures
Verbal and physical aggression
Self injurious behaviour (biting lips, inside of mouth, fingers, hitting head)
Common assosiation with downs syndrome
Accelerated alzheimers disease
Tx for GAD
SSRI e.g. citalopram
1st line Tx depression in the elderly
SSRI
Features of fragile X syndrome
Sometimes not detected until adult life
Short
Large head circumference
Macro-orchidism
Characteristic facial appearance - large forehead with supraorbital fullesness, long face, long nose, prominent jaw, high arched palate and large ears
Pale irises
Cognitive deficit
Epilepsy
Features of prader willi syndrome
Constant hynger/hyperphagia
Restricted growth
Hypogonadism
LDs
4 symptoms of narcolepsy
Chronic daytime sleepiness
Cataplexy
Hypnagogic/hypnopompic hallucinations
Sleep paralysis
Screening questionaire to identify those with postnatal depression
Edinburgh Postnatal depression scale (EPDS)
Features of borderline PD
Instability of mood, self image and interpersonal relationships
Problem with self harm and feelings of emptiness
Features of histrionic PD
Excessive attention seeking emotions
Innapropriately seductive behaviour
Excessive need for approval
Features of narcissistic PD
Inflated sense of their own importance
Deep need for admiration
Lack of empathy
How long do schizophrenia symptoms need to be present for for a diagnosis
1 month
Diagnosis of narcolepsy
Multiple sleep latency EEG (immediate entry into REM at sleep onset on two or more occassions)
Pathology of narcolepsy
Abnormality of REM sleep
Another name for munchausens syndrome
Facticious disorder
Example of an abnormal grief reaction
No obvious grief reaction since the event
Treatment of newly diagnosed schizophrenia
Atypical antipsychotics e.g.
- amisulpride
- olanzapine
- quetiapine
- risperidone
- zotepine
Which antidepressants should be avoided when on warfarin or heparin, and what should be used instead
SSRIs
Consider mirtazepine instead
What is used to reduce alcohol cravings in a patient with alcohol dependence
Naltrexone
Treatment of choice in treatment resistant schizophrenia
Clozapine
Treatment of ADHD
Methylphenidate
Post mortem findings of alzheimers dementia
Neurofibrillary tangles (NFTs)
Senile plaques
Protein tau
Extracellular depostis of amyloid beta peptides
What is anterograde amnesia
Inability to create new memories after an event
Conversion vs somatosation disorder
Somatosation - multiple physical illnesses affecting different body systems, spanning a period of 2 years or more
Conversion disorder - symptoms resemble neurological disorder, blindness, deadness, loss of feeling and muscle power
Which stage of sleep do dreams and nightmares occur
REM sleep
Cardinal features of LBD to distinguish from alzheimers dementia
LBD
- fluctating cognitive function
- varying levels of alertness
- significant daytime somnolence
- visual hallucinations
What type of drug is venlafaxine
SNRI
Genetic change of behavioural variant FTDD and MND overlap
C9orf72 gene
2nd line tx of bipolar disorder if lithium is contraindicated
Sodium valproate
What occurs in 20% of patients on long term treatment with lithium
Hypothyroidism
How does disulfiram work
Inhibits acetadelyhyde dehydrogenase
S/Es of buspirone (tx for anxiety)
Nasal congestion
What is somatic passivity
The belief that sensations are being imposed upon the body by an outside force
Features of schizoid PD
Lack of interest in social relationships
Tendency towards a solitary or sheltered lifestyle
Secretiveness
Emotional coldness
Apathy
NO DELUSIONS / HALLUCINATIONS
MRI and SPECT scanning of FTD / picks disease
MRI - increased T2 signal in the frontal lobe white matter
SPECT - decreased metabolism in the frontal region
Poor prognostic factors of schiozphrenia
FH
Insidious onset
Poor pre morbid personality, especially “schizoid”
Low intellegence
Abscence of precipitating stress
Lack of affective components in the episode
Underlying organic disorder
How many repeats of the abnormal triplet sequence would typically be found in a patient with huntingtons disease
> 37
Treatment of ADHD
Methylphenidate
Treatment of seasonal affective disorder
CBT
What stage of sleep does sleepwalking occur
Stage 3 NREM
S/Es of clozapine
Neutropenia
Agranulocytosis
Hypersalivation
Sedation
Weight gain
Reduced seizure threshold
What drug class is clozapine
Atypical antipsychotic
What is akathisia
Common and distressing drug induced movement disorder
Inability to sit still
Commonly seen in patients on antipsychotics, particularly those at high doses or following rapid dose uptitration
What vitamin deficencies are common in anorexia nervosa
Zinc deficency
Presentation of zinc deficiency
Poor wound healing
Hair loss
Glossitis
3 core criteria for diagnosis of Learning disability
Significant impairment of intellectual functioning
Significant impairment of adaptive/social functioning
Age of onset before adulthood
Normal IQ range
70 - 130
Mild LD IQ
50-69
Moderate LD IQ
35-49
Severe LD IQ
20-34
Profound LD IQ
< 20
What is regression
Return to less mature levels of functioning
A defense mechanism which only appears when anxiety levels are high and not alleviated by more mature defecnes such as intellectuisation and humour
Common features of schizoaffective disorder
Auditory hallucinations
Commentary on a patietnts actions
Major depression
Treatment of OCD
CBT and exposure response prevention (ERP)
What is a haptic hallucination
Experienced as sensations of being touched, strangled or the feeling that insects are crawling beneath the skin
Who is haptic hallucinations common in
Cocaine users
Presentation of tardive dyskinesia and what does this occur secondary to
Lip smacking, lateral jaw movements and tongue protrusion
Stererotyped movements
Caused by dopamine receptor blocking agents e.g. chlorpromazine
What is cyclothymia
Individual has mood swings cycling from mild depression to hypomania (without psychotic features or significant functional impairment)
Dementia vs depressive pseudo-dementia
Dementia - cognitive deficit insidious, unaware of difficulties and confabulate
Depressive pseudo-dementia - Acute and recent cognitive deficit, communicate a sense of distress or agitation and will complain of their cognitive difficulties
Definition of illusion
Misperception of a real external stimulus
Definition of hallucination
False sensory perception in the abscence of real external stimuli
What is ganser syndrome
Patients mimic the symptoms of a psychosis
Features of ganser syndrome
Pseudohallucinations
Poor eye contact
Prolonged periods of staring
Giving approximate answers (vorbierden)
Somatic conversion
Amnesia
What is oculogyric crisis and when does it occur
A type of dystonia seen in patients on antipsychotics
Painful upwards deviation of the eyes
Treatment of oculogyric crisis
Anticholingergics e.g. procyclidine
What can risperidone be significantly assosiated with
Significant hyperprolactinaemia
What is seen on an EEG in narcolepsy
Rapid onset of REM sleep
Drug treatment to prevent relapse of opiod dependency
Naltrexone
The CAGE questionare screens for which disorder
Alcohol dependence
Pathological changes of wernicke korsakoffs syndrome
Neuronal loss in the mammilary bodies
What side effect is seen in 50% of individuals taking lithium during the first month of therapy
Fine tremor
Management of specific phobias
Graded exposure
Features of schizotypical PD
Socially withdrawn
Reduced capacity for close relationships
Eccentric behaviour or beliefs and possibly paranoid ideas
Delusions of reference where they believe something innocuous in the public domain (e.g. newspaper) has a special reference to them
What is bupropion used for and what is the mechanism of action
Smoking cessation
Noradrenaline dopamine reuptake inhibitor
What is cotard syndrome
Hallmark is nilhilistic delusions concerning ones own body, which range from believing that one person is missing organs or limbs to the belief that one is dead
Symptoms of benzodiazepine withdrawl
Anziety
insomnia
psychosis
seizures
What is acrophobia
Extreme or irrational fear of heights
What is agoraphobia
Irrational fear of open spaces, crowds or umfamilial settings
How to switch from selegiline (MAOI) to paroxetine (SSRI)
Stop selegiline, wait 14 days, then start paroxetine
To minimise risk of serotonin syndrome
What is isolation
Seperation of thought from its attached emotional tone, thereby making it tolerable
Well described during highly stressful events such as death of a loved one
What is conversion disorder
Motor or sensory deficit
Although no organic cause is identified for the deficit
WHat is hyochondriacal disorder (also known as illness anxiety disorder)
Persistent preoccupation with the possibility of having a serious disease
How long do the baby blues usually last for
Occur 4-5 days after birth for about 2-3 days
What is used (drug treatment) for maintenance of abstinence from alcohol vs physiological alcohol dependence
- maintenance of abstinence - acamprosate
- physiological alcohol dependence - disulfiram
Test for fragile X syndrome
Molecular genetic testing of the FMR1 gene
What is alot more common in vascular dementia than alzheimers
Seizures
Also more acute onset, occurs in a step like manner with acute exacerbations
Treatment of neuroleptic malignant syndrome
Dantrolene (mulscle relaxant)
Dopamine agonists (bromocriptine)
IV fluids
Pathology of lithium induced nephrogenic diabetes insipidus
Decreased aquaporin-2 expression
Treatment for psychotic symptoms in PD
- Quetiapine
- if fails - clozapine
What proteins accumulate in alzheimers disease
Tau
Treatment of lithium overdose (with a level > 5)
Haemodialysis
Features of adjustment disorder
Short term, stress related, non psychotic disturbance as a result of e.g. a traumtic event
Absent features of PTSD such as replaying the event
Features consistent with depression
What would make you think of schizoaffective disorder
Hallucinations with intermittent periods of depression
What is ethylene glycol
anti-freeze
treatment of antifreeze (ethylene glycol) overdose and how does this work
Fomepizole
Inhibitor of alcohol dehydrogenase
Treatment of HTN for patients already on lithium therapy
CCBs e.g. amlodipine
NOT VALSARTAN OR RAMIPRIL
Which PD drug causes risk taking behaviours
Ropinirole
What time frame is adjustment disorder before it turns into depression
adjustment - 3 - 6 months
depression - after 6 months
Features of charles bonnet syndrome
Complex visual hallucinations
- repeated geometric patterns of people or patterns for example, standing at the edge of the bed
Reduced visual acuity
Presentation of MDMA toxicity
Agitation
Pyrexia
HTN
Tachycardia
Thirsty
Rhabdomyolysis in severe toxicty
Treatment ladder of tourettes
- Psychoeducation
- CBT
- Clonidine
- Risperidone
