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MSRA > Psych > Flashcards

Psych Flashcards

1
Q

PTSD mx

A

trauma-focused cognitive behavioural therapy or EMDR

If CBT or EMDR therapy are ineffective in PTSD, the first line drug treatments are venlafaxine or a SSRI

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2
Q

Tangentiality

A

Person’s response to a question is irrelevant or veers off topic. The person doesn’t return to the original point or answer the initial question.

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3
Q

Mx of panic disorder

A

SSRI

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4
Q

Measurements taken before starting antipsychotic medication

A

weight, waist circumference, pulse and BP, bloods (including fasting glucose, HbA1c, lipids and prolactin), assessment of movement disorders and nutritional status.

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5
Q

Monitoring of patients on antipsychotics

A

Annual- FBC, urea, electrolytes, LFT

Fasting glucose, prolactin- 6 months

Lipids, weight- 3 months

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6
Q

SSRI in pregnancy

A

Use during the first trimester gives a small increased risk of congenital heart defects
- Use during the third trimester can result in persistent pulmonary hypertension of the newborn
- Paroxetine has an increased risk of congenital malformations, particularly in the first trimester

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7
Q

Clozapoine SE

A

weight gain
excessive salivation
agranulocytosis
neutropenia
myocarditis
arrhythmias
reduced seizure threshold - can induce seizures in up to 3% of patients

Dose adjustment of clozapine might be necessary if smoking is started or stopped during treatment.

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8
Q

Atypical antipsychotics

A

clozapine
olanzapine: higher risk of dyslipidemia and obesity
risperidone
quetiapine
amisulpride
aripiprazole: generally good side-effect profile, particularly for prolactin elevation

These drugs have a more complex mechanism of action that includes blocking serotonin (5-HT2A) receptors in addition to dopamine receptors.

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9
Q

Alcohol withdrawal timeline

A

symptoms: 6-12 hours-tremor, sweating, tachycardia, anxiety

seizures: 36 hours

delirium tremens: 72 hours
oarse tremor, confusion, delusions, auditory and visual hallucinations, fever, tachycardia

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10
Q

Antidepressant length of treatment

A

Antidepressants should be continued for at least 6 months after remission of symptoms to decrease risk of relapse
12 months in the elderly and 2 years in those with a history of recurrent depression

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11
Q

Stopping SSRI

A

dose should be gradually reduced over a 4 week period (this is not necessary with fluoxetine). Paroxetine has a higher incidence of discontinuation symptoms.

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12
Q

Discontinuation symptoms

A

increased mood change
restlessness
difficulty sleeping
unsteadiness
sweating
gastrointestinal symptoms: pain, cramping, diarrhoea, vomiting
paraesthesia

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13
Q

Classification of depression

A

‘less severe’ depression:
a PHQ-9 score of < 16

‘more severe’ depression:
a PHQ-9 score of ≥ 16

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14
Q

Mx of depression

A

Less severe
Psychological

More severe
Antidepressant and SSRI

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15
Q

Acute dystonic reaction sx and mx

A

Oculogyric crisis- neck is fixed backwards and laterally, and her eyes are deviated upwards. She is unable to control her gaze.

tongue protrusion and jaw spasm.

Treatment is usually IV procyclidine and withdrawal of the causative medication.

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16
Q

Tardive dyskinesia

A

Side effect of antipsychotics that occurs after many years. It typically affects the face and involves repetitive, involuntary, writhing movements such as grimacing, tongue protrusion and lip smacking.

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17
Q

Clang associations

A

ideas are related to each other only by the fact they sound similar or rhyme.

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18
Q

Word salad vs Knight’s move thinking

A

completely incoherent speech where real words are strung together into nonsense sentences.

oosening of associations, where there are unexpected and illogical leaps from one idea to another. It is a feature of schizophrenia.

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19
Q

Obsessive-compulsive personality

A

Perfectionism at the expense of completing tasks
(Anankastic personality disorder)

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20
Q

OCD vs OCPD

A

It is different to obsessive-compulsive disorder in a number of ways, one being that in OCD, thoughts and behaviours are seen as unwanted/unhealthy, being the product of anxiety-inducing and involuntary thoughts, whereas in OCPD they are egosyntonic

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21
Q

Paranoid, schizoid and schizotypal PD

A

Paranoid
Hypersensitivity and an unforgiving attitude when insulted
Unwarranted tendency to questions the loyalty of friends
Reluctance to confide in others
Preoccupation with conspirational beliefs and hidden meaning

Schizoid
Indifference to praise and criticism
Preference for solitary activities
Lack of interest in sexual interactions
Lack of desire for companionship
Emotional coldness

Schizotypal
Odd beliefs and magical thinking
Paranoid ideation and suspiciousness
Odd, eccentric behaviour
Lack of close friends other than family members
Inappropriate affect
Odd speech without being incoherent

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22
Q

Neuroleptic malignant syndrome

A

life-threatening reaction to antipsychotic drugs characterized by fever, altered mental status, muscle rigidity, and autonomic dysfunction.

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23
Q

Section 135 and 136

A

Section 135
a court order can be obtained to allow the police to break into a property to remove a person to a Place of Safety

Section 136
someone found in a public place who appears to have a mental disorder can be taken by the police to a Place of Safety
can only be used for up to 24 hours, whilst a Mental Health Act assessment is arranged

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24
Q

Section 2 vs 3

A

Section 2
admission for assessment for up to 28 days, not renewable
an Approved Mental Health Professional (AMHP) or rarely the nearest relative (NR) makes the application on the recommendation of 2 doctors
one of the doctors should be ‘approved’ under Section 12(2) of the Mental Health Act (usually a consultant psychiatrist)
treatment can be given against a patient’s wishes

Section 3
admission for treatment for up to 6 months, can be renewed
AMHP along with 2 doctors, both of which must have seen the patient within the past 24 hours
treatment can be given against a patient’s wishes

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25
Q

Section 5(2) vs 5(4)

A

Section 5(2)
a patient who is a voluntary patient in hospital can be legally detained by a doctor for 72 hours

Section 5(4)
similar to section 5(2), allows a nurse to detain a patient who is voluntarily in hospital for 6 hours

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26
Q

Antisocial, Borderline (Emotionally Unstable), Histrionic and Narcissistic PD

A

Antisocial
Impulsiveness or failure to plan ahead;
Irritability and aggressiveness, as indicated by repeated physical fights or assaults;
Reckless disregard for the safety of self or others;
Consistent irresponsibility
Lack of remorse

Borderline
Unstable interpersonal relationships which alternate between idealization and devaluation
Unstable self image
Impulsivity in potentially self damaging area

Histrionic
Inappropriate sexual seductiveness
Need to be the centre of attention
Rapidly shifting and shallow expression of emotions
Suggestibility

Narcissistic
Grandiose sense of self importance
Preoccupation with fantasies of unlimited success, power, or beauty
Sense of entitlement
Taking advantage of others to achieve own needs
Lack of empathy

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27
Q

Obsessive compulsive, avoidant and dependent PD

A

OC- details, rules, lists, order, organization, or agenda to the point that the key part of the activity is gone
Demonstrates perfectionism that hampers with completing tasks
Is extremely dedicated to work and efficiency to the elimination of spare time activities

Avoidant
Avoidance of occupational activities which involve significant interpersonal contact due to fears of criticism, or rejection.
Preoccupied with ideas that they are being criticised or rejected in social situations
Restraint in intimate relationships due to the fear of being ridiculed

Dependent
Difficulty making everyday decisions without excessive reassurance from others
Need for others to assume responsibility for major areas of their life
Difficulty in expressing disagreement with others due to fears of losing support
Lack of initiative

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28
Q

Unexplained symptoms conditions

A

Somatisation = Symptoms
hypoChondria = Cancer

29
Q

Association with poor prognosis schizo

A

strong family history
gradual onset
low IQ
prodromal phase of social withdrawal
lack of obvious precipitant

30
Q

Which class of antidepressants are now less commonly used due to their toxicity in overdose?

A

TCA
narrow therapeutic index and therefore become potent cardiovascular and CNS toxins in moderate doses.

prolonged hypotension, cardiac arrhythmias, and seizure

31
Q

Breast tenderness, breast enlargement and lactation on antipsychotic and mx

A

Hyperprolactaemia

Switch to Aripiprazole

32
Q

Risk of antipsychotics are used in elderly patients

A

increased risk of stroke
increased risk of venous thromboembolism

33
Q

Experiencing sedation with mirtazipine

A

Increase the dose

Mirtazapine is generally more sedating at lower BNF doses

34
Q

Section 4

A

72 hour assessment order
used as an emergency, when a section 2 would involve an unacceptable delay
a GP and an AMHP or NR
often changed to a section 2 upon arrival at hospital

35
Q

Length of time for classification of depressive episode

A

2 weeks

36
Q

Depressive episode sx

A

loss of interest in things you would normally find pleasure in (anhedonia), and reduced energy levels (anergia).

37
Q

Affect vs mood

A

Affect is the current, observed emotional state of the patient (what you see), whereas mood is the more pervasive, predominant state over a longer period (what you ask about)

38
Q

Schneider’s First Rank Symptoms

A

A - Auditory hallucination
B - Broadcasting of thought
C - Control delusions (passivity of affect, volition, impulse, somatic)
D - Delusional perception
E - Entry / Exit of thought (thought insertion, withdrawal)

39
Q

Meds interacting with SSRI

A

NSAIDs: NICE guidelines advise ‘do not normally offer SSRIs’, but if given co-prescribe a proton pump inhibitor
warfarin / heparin: NICE guidelines recommend avoiding SSRIs and considering mirtazapine
aspirin
triptans - increased risk of serotonin syndrome
monoamine oxidase inhibitors (MAOIs) - increased risk of serotonin syndrome

40
Q

When to start clozapine

A

indicated for patients with schizophrenia who have not responded adequately to at least 2 antipsychotics

41
Q

Delusion vs schizo

A

Delusion- fixed false beliefs

Schizo -additional symptoms such as hallucinations, disorganised thinking, or significant functional impairment.

42
Q

Adjustment disorders

A

low mood and stress began in response to a clear external stressor (job loss). The symptoms are relatively mild and short-term, and there is no history of more severe mood disturbances

43
Q

Alcohol withdrawal mechanism

A

Alcohol withdrawal results from decreased inhibitory GABA and increased NMDA glutamate transmission

44
Q

Mania vs hypomania

A

Mania
Lasts for at least 7 days - Causes severe functional impairment in social and work setting
May require hospitalization due to risk of harm to self or others
May present with psychotic symptoms e.g. delusions of grandeur, auditory hallucinations

Hypomania
Lasts for < 7 days, typically 3-4 days. Can be high functioning and does not impair functional capacity in social or work setting
Unlikely to require hospitalization
Does not exhibit any psychotic symptoms

45
Q

PTSD sx

A

re-experiencing: flashbacks, nightmares, repetitive and distressing intrusive images
avoidance: avoiding people, situations or circumstances resembling or associated with the event
hyperarousal: hypervigilance for threat, exaggerated startle response, sleep problems, irritability and difficulty concentrating
emotional numbing - lack of ability to experience feelings, feeling detached

46
Q

Extrapyramidal side-effects (EPSEs)

A

Parkinsonism
acute dystonia
sustained muscle contraction (e.g. torticollis, oculogyric crisis)
may be managed with procyclidine
akathisia (severe restlessness)
tardive dyskinesia (late onset of choreoathetoid movements, abnormal, involuntary, may occur in 40% of patients, may be irreversible, most common is chewing and pouting of jaw)

47
Q

SSRI post MI

A

Sertraline

48
Q

Most common SE of olanzapine

A

Weight gane

49
Q

Conversion vs somatisation

A
  • conversion: stress is converted into a neurological symptoms
  • somatisation: so many symptoms for such a long time (2yr)
    This condition involves multiple unexplained physical symptoms across different body systems, causing significant distress and impairment in daily functioning. These symptoms cannot be explained by any medical condition or substance use.
50
Q

What can cause a rise in clozapine levels

A

Smoking cessation

51
Q

SSRI causing torsades

A

Citalopram- prolonges QT

52
Q

Cortard syndrome

A

Patients believes they are dead

53
Q

Capgras syndrome

A

europsychiatric phenomenon in which patients believe that a partner/family member/friend has been replaced by an imposter.

54
Q

SNRIs

A

Venlafaxine and duloxetine

55
Q

Anorexia nervose biochem

A

most things low
G’s and C’s raised: growth hormone, glucose, salivary glands, cortisol, cholesterol, carotinaemia

56
Q

Mx of suicidal pt who is suicidal as GP

A

CRISIS team

57
Q

When to use ECT

A

patients with severe depression refractory to medication (e.g. catatonia) those with psychotic symptoms. The only absolute contraindications is raised intracranial pressure.

58
Q

SE of ECT

A

Short-term side-effects
headache
nausea
short term memory impairment
memory loss of events prior to ECT
cardiac arrhythmia

Long-term side-effects
some patients report impaired memory

59
Q

Section 17

A

A community treatment order (CTO) can be used to recall a patient to hospital for treatment if they do not comply with conditions of the order in the community, such as complying with medication

60
Q

On warfarin which antidepressant

A

Mirtazipine

61
Q

SE more common in atypical than typical

A

Weight gain

62
Q

Adverse effects of lithium

A

nausea/vomiting, diarrhoea
fine tremor
nephrotoxicity: polyuria, secondary to nephrogenic diabetes insipidus
thyroid enlargement, may lead to hypothyroidism
ECG: T wave flattening/inversion
weight gain
idiopathic intracranial hypertension
leucocytosis
hyperparathyroidism and resultant hypercalcaemia

63
Q

Monitoring lithium

A

Level taken 12 hrs after dose
once established, lithium blood level should ‘normally’ be checked every 3 months
after a change in dose, lithium levels should be taken a week later and weekly until the levels are stable.
thyroid and renal function should be checked every 6 months

64
Q

How to differentiate between organic and non organic leg paresis

A

Hoover sign

In non-organic paresis, pressure is felt under the paretic leg when lifting the non-paretic leg against pressure, this is due to involuntary contralateral hip extension

65
Q

What type of incontinence do TCA cause

A

Overflow- anticholinergic

66
Q

Mx of diazepam addiction

A

switch patients to the equivalent dose of diazepam
reduce dose of diazepam every 2-3 weeks in steps of 2 or 2.5 mg
time needed for withdrawal can vary from 4 weeks to a year or more

67
Q

Malingering

A

fraudulent simulation or exaggeration of symptoms with the intention of financial or other gain

68
Q

Munchausen’s syndrome/Factitous

A

the intentional production of physical or psychological symptoms

69
Q

Dissociative disorder

A

dissociation is a process of ‘separating off’ certain memories from normal consciousness

MSRA (10 decks)

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