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Phase 3a > Psych 2 - Neuroses and Drugs > Flashcards

Psych 2 - Neuroses and Drugs Flashcards

1
Q

What personality disorder is associated with generalised anxiety disorder?

A

Avoidant

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2
Q

What is the ICD-10 diagnostic criteria for anxiety?

A

Excessive anxiety and worry occurring on more days than not for 6 months
Difficult to control
3/6 of: restlessness, fatigue, impaired concentration, irritability, muscle tension, sleep disturbance

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3
Q

How many extra features e.g. fatigue is required for diagnosis of anxiety in children?

A

1

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4
Q

Give three autonomic symptoms of anxiety

A 
Palpitations
Increased heart rate
Sweating
Trembling
Dry mouth
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5
Q

What are the differentials for GAD?

A

Panic disorder
Phobia anxiety disorder
OCD
Hypochondrial disorder

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6
Q

What is the psychological management of GAD?

A

Low intensity psychological support and self help

CBT/applied relaxation

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7
Q

What is the pharmacological management of GAD?

A

SSRI: sertraline –> SNRI –> pregabalin

Short term: diazepam

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8
Q

What is OCD?

A

A non-situational preoccupation in which there is a subjective compulsion despite conscious resistance

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9
Q

What are the two main features of OCD?

A

Ruminations and rituals

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10
Q

What are the risk factors for OCD?

A

Childhood trauma
Personality
Genetic

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11
Q

Is insight maintained in OCD?

A

Yes

Patients recognize ruminations and rituals as silly but are unable to stop

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12
Q

Give an example of OCD rituals (compulsions)

A

Checking and counting

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13
Q

What is the management of OCD?

A
  1. CBT and exposure and response prevention (ERP)

2. SSRI

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14
Q

Give an example of a traumatic event which might cause someone to have PTSD

A

Natural disasters
Combat
Victims of torture

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15
Q

What are the three categories of symptoms in PTSD?

A

Re-experiencing - flashbacks, nightmares
Avoidance - memory suppression
Hyperarousal - startle response, decreased sleep

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16
Q

What is the neurobiology of PTSD?

A

Decreased hippocampal volume (mediates conscious memory)

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17
Q

What is the first line treatment of PTSD?

A

Trauma-focused CBT (TF-CBT) or EMDR - eye movement desensitization and reprocessing

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18
Q

When is pharmacological treatment initiated in PTSD?

A

2nd line - venlafaxine or sertraline

THEN, risperidone

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19
Q

What is the name of the condition associated with anxiety and panic symptoms experienced in places or situations where escape may be difficult or embarrassing?

A

Agoraphobia

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20
Q

What is the treatment of agoraphobia?

A

CBT and SSRI
Short term - BDZs - diazepam
3rd line - imipramine or clomipramine

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21
Q

What are the five subtypes of phobias?

A 
Animals
Aspects of the natural environment
Blood/injection/injury
Situational
Other
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22
Q

How are phobias managed?

A

Exposure therapy and anxiety management (CBT and SSRI)

BDZs if severe

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23
Q

When do patients present with social phobias?

A

5 years
11-15 years
30 years

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24
Q

What are the symptoms of social phobia?

A

Somatic - blushing, trembling, dry mouth, excessive fear of embarrassment
Difficulties in relationships or vocational problems

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25
What is the treatment of social phobias?
CBT and SSRI Group CBT Atenolol for autonomic arousal
26
What is panic disorder?
A disorder involving multiple episodes of intense fear and discomfort (panic attacks)
27
What are the characteristics of panic attacks?
``` Palpitations Sweating Trembling Globus hystericus Chest/abdo pain Dizziness Hyperventilation ```
28
What are the four theories of panic disorder?
Serotoninergic model Noradrenergic model GABA model Lactate model
29
Which sex is more likely to be affected by panic disorder?
Female
30
What are the possible first line treatments of panic disorder?
CBT or self help or SSRI
31
What is the second line treatment of panic disorder?
Imipramine or clomipramine
32
What is the name of the condition that occurs when an individual is unable to adjust or cope with a stress/major life event?
Adjustment disorder/situational depression
33
When must situational depression occur in relation to the timing of the life event?
ICD-10 - within 1 month | DSM-IV - within 3 months
34
What is the management of adjustment disorder?
Psychotherapy Support groups Pharmacotherapy if prolonged
35
What is meant by dissociation and conversion?
Conversion - a loss or disturbance of normal sensory or motor control Dissociation - repression of unacceptable conscious impulses converted to physical symptoms
36
What are the variable presentations of dissociative disorders?
``` Flaccid paralysis Aphonia Dissociative amnesia Dissociative fugue Sensory loss Non-epileptic seizures Dissociative stupor ```
37
What is a dissociative fugue?
Dissociative amnesia and purposeful travel away from home
38
What is Hoover's test?
In dissociative paralysis, active movement is impossible, but patient can raise the affected limb against resistance
39
How is dissociative disorder diagnosed?
Suspect if clinical signs are not anatomical or are inconsistent
40
What is the management of dissociative disorder?
CBT
41
What is Ganser's syndrome?
Giving ridiculous answers to questions | Type of dissociation
42
What is dissociative identity disorder?
2 or more personalities exist within the person
43
What may precipitate dissociation?
Physical illness Negative life events Relationship conflict
44
What is hypochondrial disorder?
The persistent belief of the presence of one or more serious physical illnesses
45
What is a predisposing factor for hypochondrial disorder?
Parental/childhood illness
46
What is the treatment of hypochondrial disorder?
Fluoxetine and CBT
47
What is the name of the chronic syndrome of multiple somatic symptoms?
Somatization disorder/Briquet's syndrome/St Louis hysteria
48
What symptoms are required for diagnosis of somatization disorder?
2 GI symptoms 4 pain symptoms 1 sexual symptom other than pain 1 pseudoneurological symptom e.g. difficulty swallowing
49
What is somataform pain disorder?
Complaint of persistent, severe, and distressing pain, in the absence of physical findings
50
What are the characteristics of pain in somataform pain disorder?
Inconsistent anatomically Continuous throughout the day Prevents sleep but does not cause wakening
51
What is the treatment of somataform pain disorder?
CBT and relaxation Pain clinics Anti-Ds and nerve blocks
52
What are the five patterns of drug use?
``` Experimental Situational Recreational Polydrug use Dependant use ```
53
What are the five categories of drugs?
``` Opiates Depressants Stimulants Hallucinogens Others - cannabis ```
54
What is the physiology of heroin?
Binds to endorphin receptors | Cortical inhibitory effects
55
What are the effects of heroin use?
Diminished pain sensation Euphoria Relaxation
56
What are the symptoms of opiate withdrawal?
6-24 hours after last dose Sweating, dilated pupils, piloerection Diarrhoea, tachycardia, HTN, n+v, cramps
57
What are the symptoms of opiate overdose?
Respiratory depression Pin prick pupils Loss of consciousness
58
How is opiate overdose reversed?
Naloxone
59
What symptomatic medication can be used in opiate withdrawal?
Loperamide Lofexidine (alpha-adrenergic antagonist) Metoclopramide
60
Give an example of a medication use in opiate detoxification regimes?
Methodone
61
What is the biophysiology of benzodiazepines?
Enhance GABA transmission | Anxiolytic and euphoriant effects
62
What occurs in BDZ withdrawal?
Seizures and delirium | Insomnia, tremor, headache, sweating
63
What are the side effects of BDZ?
Decreased concentration Depression Forgetfulness
64
How is BDZ withdrawal managed?
Diazepam reducing regime
65
What are the effects of stimulants?
Increased alertness and endurance Diminished need for sleep Sense of wellbeing
66
What are the acute side effects of cocaine use?
Arrhythmias, anxiety | Impulsivity and impaired judgement
67
What are the chronic effects of cocaine use?
Necrosis of nasal septum Panic and anxiety disorders Psychosis
68
What are the symptoms of cocaine withdrawal?
Tiredness Tremor Depressed moos Food cravings
69
Name some stimulant drugs
``` Cocaine Crack cocaine Amfetamines MDMA Caffeine ```
70
What are the effects of MDMA use?
Serotonin release, hallucinogenic properties Increased camaraderie Pleasurable agitation relieved by dancing Decreased fatigue
71
What are the side effects of MDMA use?
Acute - dehydration, sweating, hyperthermia | Chronic - neuro and hepatotoxicity
72
What are the effects of LSD use?
Euphoria Sense of detachment Sense of novelty and wonder at the familiar and normal
73
Can you overdose on LSD?
No | No overdose, dependence, or withdrawal
74
What is the most commonly used illegal drug?
Cannabis
75
What is the most important psychoactive canniboid present in cannabis?
THC
76
What are the effects of cannabis use?
``` Mild euphoria Enhanced wellbeing Relaxation Altered time sense Increased appetite ```
77
What are the health risks of cannabis use?
All the health risks of smoking Accidents from delayed reaction time Precipitation of an episode/relapse of schizophrenia
78
What are the aims of substitute prescribing?
Enable detoxification from a dependent drug | Acutely reduce or prevent withdrawal symptoms
79
What complicates alcohol withdrawal syndrome?
Seizures
80
What are the features of uncomplicated alcohol withdrawal?
``` Coarse tremor Sweating Insomnia Nausea and vomiting Hallucinations or illusions Increased craving for alcohol ```
81
How long do alcohol withdrawal symptoms last for?
2-5 days
82
What type of seizures occur with complicated alcohol withdrawal?
Tonic-clonic
83
What is the name of the acute confusional state secondary to alcohol withdrawal?
Delirium tremens
84
What are the features of delirium tremens, in addition to features of uncomplicated withdrawal?
``` Clouding of consciousness and disorientation Amnesia for recent events Psychomotor agitation Hallucinations Worse at night ```
85
What is the treatment of delirium tremens?
IV Chlordiazepoxide (long acting BDZ)
86
What is the triad of delirium tremens?
Acute confusional state Tremor Vivid and disturbing perceptual abnormalities
87
What is the cause of Wernicke-Korsakoff psychosis?
Neuronal degeneration secondary to thiamine deficiency
88
What is the triad of Wernicke encephalopathy?
Acute confusional state Ocular signs (nystagmus, opthalmoplegia) Ataxic gait
89
What is the treatment of Wernicke encephalopathy?
IV pabrinex (parenteral vitamin B1 replacement)
90
How long does it take for Wernicke encephalopathy to convert to Korsakoff psychosis, if untreated?
2 weeks
91
What is the presentation of Korsakoff psychosis?
Anterograde and retrograde amnesia Confabulation Working memory unaffected
92
What is the treatment of Korsakoff psychosis?
Oral thiamine replacement and multi vitamin supplementation for up to 2 years
93
What are the characteristics of dependence syndrome?
``` Primacy (drug seeking behaviour) Narrowing of repertoire Tolerance Loss of control of consumption Withdrawal when attempting abstinence Anticipation of withdrawals Continued use despite negative consequences ```
94
What are the alcohol misuse stages of change?
``` Pre-contemplation Contemplation Decision Action Maintenance Relapse ```
95
How is alcohol dependence assessed?
CAGE questions | Alcohol Use Disorders Identification Test (AUDIT) >8
96
How long should PTSD symptoms be present for in order to diagnose?
Longer than 1 month
97
What is the management of delirium tremens?
Lorazepam/chlordiazepoxide Haloperidol 2nd line Start thiamine
98
What is semantic memory?
Refers to knowledge base Is unrelated to experiences or events E.g. capital of australia
99
What is Ganser's syndrome?
Approximate but incorrect answers are given to questions | How many legs does a cow have? 5
100
What is an illusion?
A misinterpretation of a perception
101
What is an extracampine hallucination?
Occurs beyond the usual range of sensation | E.g. hearing someone speak from Finland
102
What is derailment?
Disjointed thoughts with no meaningful connections
103
What is logoclonia?
Repeating the last syllable of a word unnecessarily | Seen in Parkinson's
104
What blood test result will be seen in people with alcohol dependence?
``` Raised MCV (mean corpuscular volume) Raised gamma GT Raised carbohydrate deficient transferrin ```
105
What are the symptoms of pellagra?
Diarrhoea Dermatitis Depression
106
What is residual schizophrenia?
Late stage schizophrenia | Positive symptoms replaced by negative symptoms
107
What causes neuroleptic malignant syndrome?
``` Dopamine blockade in: The hypothalamus (pyrexia) Skeletal muscles (stiffness) Nigrostriatal pathway (tremor and rigidity) ```
108
What is a risk of skeletal muscle breakdown in neuroleptic malignant syndrome?
Exacerbates stiffness | Rhabdomyolysis and renal failure
109
What are the pros and cons of aripiprazole?
Fewer side effects in terms of weight gain and increased prolactin production Nausea and insomnia
110
What is used for rapid tranquilization?
IM lorazepam
111
Define neurosis
An inappropriate emotional or behavioural response to a perceived stressor
112
What is a conversion disorder?
Manifestation of psychological illness as neurologic pathology Weakness, numbness, blindness, paralysis as a result of underlying psychiatric illness Not bothered by symptoms - la belle indifference

Phase 3a (18 decks)

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