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Psych Flashcards

1
Q

4 features of Neuroleptic Malignant Syndrome + common meds involved (3)

A
  1. EPSE - rigidity, dystonia, dysphagia
  2. Temperature dysregulation - >39
  3. Autonomic side effects - tachycardia, hypertension, sweating
  4. CNS effects - drowsiness, confusion
    Meds - Metoclopramide, prochlorperazine, domperidone
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2
Q

Neuroleptic malignant syndrome Mx steps in ED (5)

A
  1. Stop any offending medications
  2. Commence bromocriptine +- in consultation with clinical toxicologist
  3. Insert 2x large bore cannulas
  4. Cooloing with ice packs
  5. Sedation with low dose BZD
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3
Q

Exam: Outpatient management of acute psychosis- acutely psychotic, psych review 2-3days, not at high risk?

A

-> If possible delay anti-psychotic to allow for assessment and diagnosis
-> If interim Rx needed for acute agitation = oral diazepam 5-10mg Q4H (Max40mg daily)

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4
Q

KFP: DDx for psychotic symptoms (4+4+4)

A
  1. Psychotic disorders
    - Schizophreniform disorder (<6mo)
    - Schizophrenia (>6mo)
    - Substance-induced psychotic disorder (long than intoxication, but <4wks)
    - Schizoaffective disorder (Schizophrenia Sx with prominent mood Sx)
  2. Other psychiatric disorders
    - Acute mania
    - Post-partum-psychosis
    - Psychotic depression
    - Personality disorder
  3. Medical/other
    - Dementia (with Lewy body)
    - intracerebral mass
    - Delirium
    - Tertiary syphillis
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5
Q

3 primary psychotic disorders that differ with timing?

A
  1. Brief psychotic disorder (resolve <1mo)
  2. Schizophreniform disorder (1mo-<6mo)
  3. Schizophrenia (>6mo)
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6
Q

KFP: Hx to assess risk of suicide in patient with SI, but no intent or plan? (6)

A
  1. Past hx of SI or DSH
  2. Access to firearms (or similar lethal method)
  3. Lack of social support
  4. History of concurrent substance use
  5. Compensatory behaviours (giving away belongings)
  6. Exposure to suicide of family member or loved one
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7
Q

KFP: Pt with depressive symptoms, also has better periods. Hx to assess possibility of mania/Type 2 Bipolar (5)

A
  1. Decreased need for sleep
  2. Delusions of grandiosity
  3. Increased sexual disinhibition (grouped with all risk taking behaviour)
  4. How long did this period last for (Hypomania >4days)
  5. Hallucinations?
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8
Q

Possible AEs with lithium use (5)

A
  1. Renal (impacts concentrating ability -> thirst + polyuria)
  2. Thyroid (reduces availability of thyroxine)
  3. Parathyroid (causes hyperCa from 2ndry hyperPTH)
  4. Weight gain (~5%)
  5. Teratogenic (consult obs/gyn)
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9
Q

KFP. 28F presents in clear mania. Mx actions (3)

A
  1. Urgent referral to ED for psychiatric review
  2. Schedule under MHA if does not consent to voluntary treatment
  3. Discuss with psychiatrist on call
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10
Q

Pharmacological management of acute mania (2)

A

Anti-psychotic PLUS mood stabliser
eg. olanzapine + lithium
Anti-psychotic for acute mania symptoms, and stop once settles
Concurrent mood stabliser for long term

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11
Q

Safest anti-depressant for pregnancy

A

Sertraline

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12
Q

48M, history of HTN, hypercholesterolaemia and schizophrenia. On perindopril, atrovatastatin and clozapine. Presents with fever 38.2, unclear focus. Co-incidentally had FBE yesterday which was normal. What needs to be considered and investigated?

A

Clozapine AE-
- neutropaenia +- myocarditis
Needs urgent ECG, trop + CRP if present with fever >38

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13
Q

KFP: Examples of drugs associated with serotonin syndrome (1+4)

A
  1. SSRI + SNRIs
    PLUS
  2. some TCAs (clomipramine)
  3. some opioids (tramadol, tapentadol, methadone)
  4. Stimulants (cocaine, meth, ecstasy)
  5. mood stabilizer (lithium)
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14
Q

3 features of serotonin syndrome

A

anyone CAN get serotonin syndrom
1. Cognitive - agitiation, confusion
2. Autonomic - hypertension, tachycardia, fever
3. Neurological - hyperreflexia, tremor, seizure

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15
Q

3 pharma options for alcohol dependency with main contraindications or consideration?

A
  1. Naltrexone (liver disease, opioid use)
  2. Acamprosate (renal disease)
  3. Disulfiram (ongoing drinking)
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16
Q

Management of acute insomnia in patient who otherwise seems stable - eg. grieving widow, that doesnt have high risk features?

A

Short course temazepam with early follow-up ~1wk
Other options - zolpidem or zopiclone

17
Q

3 key treatment options for PTSD

A
  1. Trauma-focused CBT
  2. Eye movement desensitisation and reprocessing EMDR
  3. Medications - SSRI
18
Q

5 general principles of trauma informed care

A
  1. prioritise Safety
  2. soothe Physiological arousal
  3. Validate
  4. Collaborate and empower
  5. Ongoing Connection
19
Q

Features of adjustment disorder (3)

A
  1. Onset within 3months of stressor
  2. Resolution within 6months of stressor
  3. Significant impairment of social or occupational functioning
20
Q

Basic diagnostic criteria for mania, as opposed to hypomania (4)

A
  1. Abnormal or elevated for >1wk (most of day, nearly every day)
  2. 3+ classic symptoms
  3. Cause marked impairment or hospitalization
  4. Not explained by substance or medical condition
21
Q

Drugs that can affect lithium level

A

Think triple whammy
- ace-I, NSAIDs, diuretics

22
Q

KFP: Aspects on history that support primary psychotic disorder (7)

A
  1. Delusion +- persecutory
  2. Hallucinations
  3. Illusions
  4. Thought disorganisation - poverty, or tangential
  5. Lack of motivation
  6. Poor self care
  7. Social withdrawal
23
Q

KFP: Possible organic causes of psychotic presentation (7)

A
  1. Intra-cranial space occupying lesion
  2. Thyrotoxicosis
  3. Hyperparathyroidism
  4. Neurosyphilis
  5. Wilson Disease
  6. Systemic Lupus erythematosus
  7. Drug induced (careful of hx in stem)
24
Q

KFP: Side effects of anti-psychotics (4+3)

A
  1. EPSE
    - Acute dystonic reaction
    - Pseudo-parkinsonism (rigidity, shuffling, tremors)
    - Akathisia (restlessness)
    - Dyskinesia (invol movements)
  2. Weight gain
  3. Metabolic effects (HTN, impaired GT, dyslipidaemia)
  4. Sexual side effects (reduced libido + function)
25
KFP: Criteria for admission for pt with eating disorder (8)
1. Electrolyte abnormality (K<3.0) 2. HR <50 3. Postural HR increase >30bpm 4. Resting SBP <80mmHg 5. Postural drop >20mmHg 6. Hypothermia <35.5 7. QTc prolongation >0.45s 8. Severe dehydration
26
KFP: Possible causes for delirum (11)
1. Fracture 2. Organ failure 3. Cardiac event 4. Constipation 5. Drugs 6. Thyroid disease 7. Infections 8. Intracranial event 9. Metabolic disturbances (elecs or BSL) 10. Pain 11. Withdrawal
27
Features of PTSD (8 - 5Sx + 3 qualifiers)
1. Stressor 2. Intrusion symptoms (re-experiencing) 3. Avoidance 4. Negative alterations in cognition + mood 5. Alterations in arousal + reactivity 6. Duration >1month 7. Sx create distress or functional impairment 8. Not due to medication, substance or illness Sol got an Pharma answer wrong, which he still dreams about. He avoids questions now. And seems both sad + twitchy. ITs been going on >1month, and now he wont give lectures. what else could it be
28
Young guy, becomes incredibly worried about speaking at work meetings, otherwise ok at work. Doesnt effect him outside of work. Dx(1) + Mx (2)
Performance anxiety - similar to social anxiety disorder but only affects 1 discrete performance situation Mx - Psychoeducation through CBT, oral propanolol 30mins before activity Nb: social anxiety Mx - CBT, then SSRI
29
Treatment for Obsessive Compulsive disorder (2)
1st line - CBT with ExRP (exposure and response prevention) component Pharma - SSRI, aiming high dose NB: common to require initial pharma Rx to engage in CBT
30
PTSD Rx (2+1)
Trauma focused CBT Eye Movement Desensitisation and Reprocessing SSRI
31
Difference between acute stress disorder and PTSD
1. Acute stress disorder >2 days BUT <1mo (PTSD >1mo) Otherwise very similar
32
Management steps in Eating disorder (not meeting admission criteria) - (5)
1. Offer your support through this process 2. Perform a risk assessment 3. Discuss starvation response 4. Arrange investigations (bloods + ECG) 5. Refer for FBT (family-based therapy, for adol) OR Refer for CBT-E (enhanced CBT for adult)
33
DDx for Biploar disorder (NOT DDx for mania) - (5)
1. Cyclothymic disorder 2. Unipolar major depression 3. Shizoaffective disorder 4. ADHD 5. Borderline Personality disorder
34
Hx to illicit for possible ADHD (3+3)
1. Inattention - unable to sustain, poor organisation, distractible 2. Impulsivity - talks over the top, blurts out, difficulty waiting turn 3. Hyperactivity - fidgets, leaves seat, runs excessively 4. Timing - since before 12yo 5. Setting - across multiple settings 6. Impairment - causes significant functional impairment

CCE (18 decks)

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