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3A > Psych > Flashcards

Psych Flashcards

1
Q

How long after their last drink may someone develop seizures

A

36 hours

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2
Q

How long after their last drink may someone develop delirium tremens

A

72 hours

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3
Q

How does SSRI discontinuation syndrome present?

A

increased mood change
restlessness
difficulty sleeping
unsteadiness
sweating
GI symptoms- pain, cramping, diarrhoea, vomiting
paraesthesia

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4
Q

How should SSRIs be stopped and why?

A

gradually reduced over 4 weeks (not necessary with fluoxetine)- can cause SSRI discontinuation syndrome

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5
Q

What SSRI is most likely to cause long QT syndrome

A

citalopram

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6
Q

RF for bipolar disorder

A

adverse childhood experiences
exposure to viruses in utero
cannabis and cocaine use
recent childbirth
family history (first degree relatives have a 5x greater risk than the general population)

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7
Q

what is bipolar

A

A disorder characterised by recurrent episodes of depression and mania/hypomania

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8
Q

What is a manic episode?

A

excessively elevated mood and energy which significantly impacts normal functions.
Lasts at least one week and causes marked impairment in social or occupational functioning, or includes psychotic features such as delusions or hallucinations

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9
Q

what features may be preset in a manic episode?

A

abnormally elevated mood
increased energy
decreased sleep
grandiosity
disinhibition and sexually inappropriate behaviour
flight of ideas
pressure speech
increased libido
psychosis
irritability

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10
Q

what is a hypomanic episode

A

an episode characterised by milder symptoms of mania without a significant impact on function
Only needs to last 4 days and does not include psychotic features

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11
Q

based on DSM-5 what is bipolar type 1

A

depression and at least one episode of mania

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12
Q

based on DSM 5 what is bipolar type II

A

at least one episode of major depression and one of hypomania

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13
Q

what is cyclothymia

A

mild symptoms of hypomania and low mood- not enough to cause significant disruption to functioning

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14
Q

1st line treatment of an acute manic episode

A

antipsychotic medications - onlanzapine, quetiapine, risperidone

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15
Q

second line management of a manic episode

A

lithium or sodium valporate

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16
Q

management of a depressive episode in bipolar

A

olanzapine plus fluoxetine

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17
Q

Long term management of bipolar

A

lithium - mood stabilised
alternate- sodium valporate

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18
Q

what is a potential complication of lithium therapy in bipolar

A

lithium toxicity

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19
Q

what is the therapeutic range of lithium

A

0.4 to 1 mmol/l

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20
Q

at what concentration of lithium can toxicity occur

A

1.5

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21
Q

How does lithium toxicity present?

A

coarse tremor
hyperreflexia
acute confusion
polyuria
seizure coma

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22
Q

what may precipitate lithium toxicity

A

dehydration
drugs- diuretics, NSAIDs, ACEi
renal failure

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23
Q

how does tardive dyskinesia present?

A

chewing, blinking, jaw pouting, lip smacking

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24
Q

how does schizotypal personality disorder present?

A

‘magical thinking’ and odd beliefs
ideas of reference
unusual perceptual disturbances
odd eccentric behaviour
lack of close friends
odd speech but not incoherent

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25
Q

what are clang associations

A

ideas related only by rhyme or being similar sounding

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26
Q

what is tangentiality

A

wandering from one topic to the next without returning

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27
Q

what is circumstantiality

A

the inability to answer a question without giving an excessive, unnecessary detail
They will eventually circle back to the point which differs from tangentiality

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28
Q

what are neologisms

A

new word formations that might be formed by combing two words

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29
Q

what is word salad

A

completely incoherent speech where real words are strung together in a nonsense sentence

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30
Q

what is knights move thinking

A

a severe type of loosening of associations where there are unexpected and illogical leaps from one idea to the next

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31
Q

what is flight of ideas

A

a feature of mania where there are leaps from one topic to another but with discernible links between them

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32
Q

what is echolalia

A

repetition of someone elses speech

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33
Q

what differs between hypochondria and somatisation disorder

A

somatisation is where a person is concerned by persistent unexplained symptoms whereas hypochondrial disorder the patient is concerned with a specific diagnosis such as cancer

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34
Q

what are long term complications of lithium use

A

hyperparathroidism and hypercalcaemia - bones stones groans and psychic moans

35
Q

what physiological abnormalities can occur in anorexia

A

hypokalaemia
low FSH, LH, oestrogen and testosterone
raised cortisol
raised testosterone
impaired glucose tolerance
hypercholesterolaemia
hypercarotinaemia
low T3

36
Q

what medication is preferred to chlordiazepoxide in alcoholics with severe liver cirrhosis

A

lorazepam

37
Q

why can chlordiazepoxide cause problems in liver cirrhosis

A

chlordiazepoxide undergoes hepatic oxidation by the cytochrome P450 system which is impaired with cirrhosis

38
Q

what is the strongest risk factor for suicide

A

a previous suicide attempt

39
Q

what type of antipsychotics can lead to glucose dysregulation and diabetes

A

atypical antipsychotics (clozapine, olanzapine, risperidoe)

40
Q

How long do symptoms of PTSD need to be present for diagnosis

A

4 weeks

41
Q

first line antidepressant in children

A

fluoxetine

42
Q

describe a schizoid personality disorder

A
  • few activities if any provide pleasure
  • emotional coldness, flattened affect
  • apparent indifference to praise or criticism
  • little interest in sexual experiences
  • lack of close friends or desire for relationships
43
Q

first line treatment of PTSD

A

trauma focused CBT or eye movement desensitisation and reprocessing therapy (EMDR)

44
Q

what is conversion disorder

A

functional neurological disorder- the patient presents with neurological symptoms such as paralysis, blindness or seizures without an explained cause

45
Q

which antipsychotic has the most tolerable side effect prophile

A

aripiprazole

46
Q

describe paranoid personality disorder

A

hypersensitivity and an unforgiving attitude when insulted
unwarranted tendency to question the loyalty of close friends
reluctance to confide
preoccupation with conspirational beliefs and hidden meaning

47
Q

first line drug treatment for PTSD

A

venlafaxine

48
Q

what medication for alcohol dependence acts as a deterrent by causing patients to vomit on ingestion of alcohol

A

disulfiram

49
Q

what medication for alcohol dependence acts as an anti-craving medication

A

acamprosate

50
Q

which medication for opioid dependence can be used instead of methadone as a tablet under the tongue

A

buprenorphine

51
Q

a PHQ score above what suggests severe depression

A

greater than or equal to 16

52
Q

what may be shown on the ABG of someone with bulimia nervosa

A

metabolic alkalosis

53
Q

what may be shown of the ECG of someone with bulimia

A

first degree heart block
tall P waves
flattened T waves

occurs due to hypokalaemia

54
Q

what medication can be used to treat acute dystonia secondary to antipsychotic use

A

procyclidine

55
Q

are pseudohallicinations part of the normal grieving process

A

yes

56
Q

how does serotonin discontinuation syndrome present?

A

diarrhoea
vomiting
abdominal pain

sweating
restlessness
inability to sleep

57
Q

what are the key features of PTSD

A

re-experiencing = flashbacks, nightmares, repetitive and distressing intrusive imagaes
avoidance= avoiding people and situation resembling the associated event
hyperarousal = hypervigiliance for threat, exaggerated startled response, sleep problems, irritability, difficulty concentrating
emotional numbing= lack of ability to experience feelings

58
Q

what prescribed medication can cause a sudden onset of psychosis

A

steroids

59
Q

what lifestyle change could cause clozapine blood levels to rise

A

smoking cessation

60
Q

what antipsychotic can cause seizures

A

clozpien

61
Q

what is thought withdrawal

A

a belief that someone is removing thoughts

62
Q

how long does a period of depression need to occur for for it to be classified as a depressive episode

A

2 weeks

63
Q

how does catatonia present?

A

stopping of voluntary movement or staying still in an unusual position

64
Q

second line options for anxiety

A

different SSRIs- paroxetine, escitalopram
SNRIs- venlafaxine, duloxetine

65
Q

how does tardive dyskinesia present

A

lip smacking, difficulty swallowing, excessive blinkingh

66
Q

how can you differentiate between knights move and flight of ideas

A

there is discernible links between ideas in flight of ideas- there are not in knights move

67
Q

what is the mechanism of duloxetine

A

serotonin and noradrenaline reuptake inhibitor

68
Q

over how long should an SSRI be stopped?

A

over 4 weeks

69
Q

when should lithium levels be checked

A

7 days after a dose change- 12 hours after last dose

70
Q

what antidepressant might be prescribe to have the additional effect of increasing appetite

A

mitrazapine

71
Q

how does the dose of SSRIs differ in treating OCD and in treating depression

A

usually a higher dose is needed in OCD

72
Q

how long do SSRIs need to be taken to see a benefit in OCD

A

12 weeks

73
Q

what is the risk of taking SSRIs in the third trimester

A

persistent pulmonary hypertension of the newborn

74
Q

in patients under 25 how long after starting SSRIs should they be reviewed

A

1 week

75
Q

which type of antipsychotics can cause acute dystonia

A

typical antipsyhotics

76
Q

what is the first line treatment of borderline personality disorder

A

dialectical behavioural therapy

77
Q

differentials for generalised anxiety disorder

A

aged 35-54
being divorced or separated
living alone
being a lone parent

78
Q

can sumatriptans be taken with SSRIs

A

no - risk of serotonin syndrome

79
Q

first line drug treatment of panic disorder?

A

SSRI

80
Q

if clozapine is stopped for more than 48 hours how does it need to be restarted

A

it needs to restarted slowly and retitrated up to the correct dose

81
Q

SE of zopiclone in elderly

A

increased risk of falls

82
Q

first line management of OCD if functional impairment is mild

A

CBT including exposure and response therapy

83
Q
A

3A (33 decks)

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