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3A GH > Psych > Flashcards

Psych Flashcards

1
Q

Personality Disorder definition

A

attitudes, beliefs, behaviours cause longstanding problem in daily life.

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2
Q

Sx of Personality Disorder

A

cant control emotions

struggle with friendships

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3
Q

type A Personality Disorder

A

suspicious

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4
Q

type B Personality Disorder

A

emotional and impulsive

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5
Q

type C Personality Disorder

A

anxious

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6
Q

causes of delirium

A

UTI, RTI, steroids/analgesics, dehydration, anaemia, metabolic disturbance, liver/kidney dysfn, alcohol/ drugs withdrawal, constipation

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7
Q

Sx of delirium

A 
confusion
[hypoactive] clouding of consciousness, decreased awareness/disorientation,
drowsy/lethargic, speech difficulty
vivid dreams
[hyperctive] illusions/hallucination
paranoia
agitation/ restless
anxious/frightened/irritable
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8
Q

difference between delirium and dementia

A

progressive vs fluctuating

chronic vs acute

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9
Q

management of delirium

A

treat the cause - hydration, Abx
re-orientate [clock, Xmove rooms]
reassurance, family presence

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10
Q

medical management of aggressive pateint

A

IM lorazepam

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11
Q

confusion, poor mobility, hemiparesis, recent fall. Ix? looking for?

A

CT head, subdural heamatoma

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12
Q

recent DM Dx, aggression & confusion. cause and Ix?

A

hypoglycaemia, blood glucose

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13
Q

76 yr old, ^confusion, urine incont. Ix?

A

mid stream urine culture

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14
Q

disregard for social obligations/ feelings of others. what type of PD?

A 
type A (suspicious) -
 antisocial/dissocial
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15
Q

misinterpretation of ext stimuli

A

illusion

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16
Q

assault, says he felt an alien guide his movements. What type of delusion?

A

delusion of passivity

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17
Q

depression, Hx of cardiac arrythmia. amitryptilline or fluoxetine?

A

fluoxetine. Amitr. is cardiotoxic

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18
Q

weight loss, Xeating/drinking 3/7, psychomotor retardation, pov of speech, flat affect. Mx?

A

ECT

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19
Q

mania Tx

A

olanzapine

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20
Q

low mood 5yrs, tired, depressed, no other Sx, able to cope day to day. Dx?

A

dysthymia (doesnt fulfil criteria for depressive episode)

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21
Q

depression, started hearing the voice of the devil. Dx?

A

psychotic depression

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22
Q

Sx of lithium toxicity

A

anorexia, nausea, diarrhoea, muscle weakness, drowsy, ataxia, coarse tremor, muscle twitching

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23
Q

cheese + phenelzine (MAOI)

A

hypertensive crisis

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24
Q

overdose of diazepam causes what problem

A

resp depression

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25
Q

euphoria, hypervigilance, dilated pupils,cardiac arrhythmia. What drug?

A

amphetamine

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26
Q

apathy, pupil constrict, drowsy, slurred speech. drug?

A

opoid

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27
Q

labile mood, slurred speech, unsteady gait, nystagmus. drug?

A

alcohol

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28
Q

opoid agonist used in dependence management

A

methadone

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29
Q

alcohol dependence Tx, causes Rn when take alcohol

A

disulfiram

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30
Q

anxiolytic used for alcohol withdrawal Sx

A

chlordiazepoxide (librium)

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31
Q

name a recreational drug that is a CNS stimulant, and can cause paranoid psychosis

A

amphet

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32
Q

name a recreational drug that causes euphoria, sociability, death due to hyperthermia

A

ecstasy

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33
Q

name a recreational drug that is a hallucinogen, and causes synaesthesia

A

LSD

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34
Q

believes news is talking about him

A

delusion of reference

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35
Q

thoughts sucked out of head by alien

A

thought withdrawal

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36
Q

army satellites direct sun beams that make my arm move

A

somatic passivity

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37
Q

^antipsychotic dose, sustained contraction of one muscle group

A

acute dystonic reaction

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38
Q

haloperidol reaction. fever, fluctuating consciousness, rigidity, tachycardia, raised creat phos

A

neuroleptic malignant syndrome

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39
Q

abnorm chewing movements, grimacing, Hx haloperidol

A

tardive dyskinesia

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40
Q

define generalized anxiety disorder

A

excessive worrying for 6/12

and 3 of the following: sleep disturbance, poor concentration, muscle tension, fatigue, irritable, restless

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41
Q

Difference between GAD and panic disorder

A

Panic: Recurring and regular panic attacks often for no apparent reason. Nausea, sweating, trembling, SOB.
GAD: feel anxious all the time about everyday events

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42
Q

GAD risk factors/ aetiology

A 
women
35-59
alcohol and drug use
Family history/ Genetics
Serotonin and noradrenaline imbalance
Traumatic events – child abuse, domestic violence
Chronic illness
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43
Q

describe the psychodynamic psychological theory

A

Conscious AND UNCONSCIOUS desires determine personality. Childhood experience shapes personality. Id [devil], superego [angel], ego [reality].
based on past

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44
Q

describes the cognitive behavioural psychological theory

A

thoughts determine behaviour. Dysfunctional thoughts lead to extreme emotions.
based on present

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45
Q

investigations for GAD

A

urine drug screen
TFTs
pheochromocytoma [BP, blood/urine metadrenaline/ normetadrenaline]
ECG

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46
Q

Mx for GAD

A

CBT, mindfulness, relaxation
SSRIs [sertraline], SNRIs, pregabalin
caffeine, alcohol, exercise

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47
Q

recurrent, multiple unexplained physical symptoms, with no medical cause found. Diagnosis?

A

somatisation disorder

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48
Q

young man who visited a prostitute on one occasion is convinced he has gonorrhoea despite recurrent tests being negative. Diagnosis?

A

hypochondriacal delusion

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49
Q

name 6 Sx of mania

A 
mood elevation 
irritability
grandiosity
decreased sleep
talkative
flight of ideas
^sociability
distractibility
psychomotor agitation
sexual disinhibition
risk taking
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50
Q

name 6 Sx of depression

A 
low mood
anhedonia
anergia
poor sleep
EMW
decreased appetite
feelings of worthlessness
suicidal thoughts
self harm
poor concentration 
psychomotor retardation
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51
Q

risk factors for mood disorders

A 
genes
family member
childhood trauma/abuse
serotonin deficiency 
hypothyroidism
stress
Socio-economic status
menopause
COCP
alcohol/drug use
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52
Q

bipolar disorder. Treatment mood stabiliser

A

lithium carbonate

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53
Q

Outline the categories of the Mental State Examination in psychiatry

A 
ASEPTIC
appearance and behaviour
speech
emotion [mood]
perceptions
thoughts
insight
cognition
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54
Q

components of the personal history in psychiatry

A 
early development
childhood behaviour
education
employment
relationships
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55
Q

what are the 3 levels of psychiatric patient “insight”

A
  1. awareness of abnormal experience
  2. result of a disease process
  3. open to intervention
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56
Q

what are the components of a psychiatric risk assessment

A 
risk to self [suicide/SH]
thoughts of harming others
accidental risk to self/others
self-neglect
vulnerability
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57
Q

3 core Sx of depression

A

Low mood
anergia
anhedonia

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58
Q

Sx of depression, other than the 3 core Sx

A 
sleep disturbance(EMW)
Change in appetite
Change in libido
Diurnal mood variation
Agitation 
Loss of confidence
poor concentration
Guilt
Hopelessness
Suicidal ideation
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59
Q

describe some of the psychotic symptoms you might see in depression with psychosis

A

nihilistic and guilt delusions

derogatory voices

60
Q

define bipolar 1 and 2

A

Bipolar I – mania + depression

Bipolar II – more episodes of depression, only mild hypomania

61
Q

1st rank Sx of schizophrenia

A

Thought alienation
Passivity phenomena
3rd person auditory hallucinations
Delusional perception

62
Q

secondary Sx of schizophrenia

A 
Delusions
2nd person auditory hallucinations
Hallucinations in any other modality
Thought disorder
Catatonic behaviour
Negative symptoms
63
Q

list 4 positive Sx [schizophrenia]

A 
Hallucinations
Delusions
Passivity phenomena
Thought alienation
Lack of insight
Disturbance in mood
64
Q

list 4 negative Sx [schizo]

A 
Blunting of affect 
Amotivation
poverty of speech 
Poverty of thought
Poor non-verbal communication
Clear deterioration in functioning
self neglect
Lack of insight
65
Q

name 5 physical Sx of panic disorder

A 
Palpitations
chest pain
choking
Tachypnoea
Dry mouth
Urgency of micturition
Dizziness
Blurred visions
Parasthesiae
66
Q

define hallucination

A

perceiving something that isnt there in the abscence of external stimuli

67
Q

define illusion

A

perceiving something that isnt there with external stimuli

68
Q

define delusion

A

abnormal belief, doesn’t follow societies norms

69
Q

how do the auditory hallucinations differ between functional psychosis and depression

A

psychosis - 3rd person auditory

depresison - 2nd person auditory

70
Q

name 2 organic causes of hallucinations

A

brain tumour

temporal lobe epilepsy

71
Q

schizophrenia- auditory/visual halluinations?

A

auditory, NOT visual

72
Q

differential diagnoses for schizophrenia

A 
drug induced psychosis
delusional disorder
head injury
schizoeffective disorder
hyperthyroid
73
Q

Ix for psychotic Sx

A

urine drug screen
CT
TFTs

74
Q

section 5(2) of mental health act

A

Dr.s holding power

75
Q

section 5(4) of mental health act

A

nurses holding power

76
Q

progression of symptoms in neurology. Give an example of a condition which would present with gradual deterioration/ intermittent exacerabtions/ rapid onset

A 
gradual deterioration (tumour)
intermittent exacerbations (MS) 
rapid onset (stroke)
77
Q

a headache worse on waking or coughing indicates?

A

raised intracranial pressure

78
Q

describe the diff between Wernicke’s and Broca’s dysphasia

A

Wernicke’s - Receptive dysphasia/speech comprehension

Broca’s - Expressive dysphasia/speech production

79
Q

tremor worse towards the end of movements suggests a problem with which part of the brain

A

cerebellum

80
Q

causes of tremor at rest

A

PD
hyperthyroidism
benign essential tremor
alcohol withdrawal

81
Q

name the 4 extrapyramidal symptoms of typical antipsychotics

A

tardive dyskinesia
dystonia
akathisia
parkinsonism

82
Q

functions of dopamine

A

reward
pleasure
fine tuning motor

83
Q

serotonin functions

A 
^mood
appetite
sleep
memory
libido
84
Q

dopamine hypothesis of schizophrenia

A

over activity -> hallucination/delusion

under activity -> blunted, apathy

85
Q

what is the pharmacology of antipsychotics that causes tardive dyskinesia?

A

D2 recpetor antagonism

86
Q

what receptors do newer antipsychotics target as opposed to D2 receptors targeted by typicals

A

serotonin

87
Q

describe the monoamine theroy of depression

A

predicts that underlying pathophysiology of depression lies in depleted serotonin and noradrenaline levels

88
Q

examples of SSRIs

A

fluoxetine
sertraline
citalopram

89
Q

examples of SNRIs

A

venlafaxine

duloxetine

90
Q

side effects of SSRIs

A

sexual dysfunction
weight gain
^bowel motility
agitation

91
Q

dietary restrictions for MAOIs and why

A 
aged cheese
beer
red wine
smoked meat/fish
contain tyramine [monoamine] -> HTN crisis
92
Q

side effects of tricyclics for depression and why?

A

dry mouth
blurred vision
urinary retention
anticholinergic [block ACh]

93
Q

lithium side effects

A

diarrhoea
tremor
dry mouth

thirsty
skin changes
teratogenic

94
Q

features of lithium toxicity

A 
coarse tremor
drowsy
vision disturbance
D+V
hypokal
ataxia
dysarthria
coma
95
Q

Mx of lithium toxicity

A

stop lithium
rehydrate
haemodialysis
[gastric lavage]

96
Q

evidence required for a section 2 MHA

A

patient suffering from mental disorder that warrants detention for assessment
danger to self or others

97
Q

evidence required for section 3 MHA

A

patient suffering from mental disorder that warrants detention for treatment
treatment in interest of self/ others safety
treatment is available

98
Q

evidence required for section 4 MHA

A

patient suffering from mental disorder that warrants detention
best interests of self/others safety
not enough time/risk to great for 2nd Dr to attend

99
Q

what kind of patient are section 5(2) and 5(4) for?

A

patient ALREADY admitted and wants to LEAVE

100
Q

describe the theory of psychodynamic therapy

A

uncovering past trauma to resolve present day symptoms

101
Q

psychodynamic therapy - how long and how often do you meet?

A

approx 1 yr. Weekly

102
Q

describe 1st, 2nd and 3rd wave CBT approaches

A

1st wave: Behaviour therapy

2nd wave: Cognitive (behavioural) therapy

3rd wave: combines mindfulness and acceptance techniques with the above

103
Q

Dialectic Behavioural Therapy mostly aimed at helping people with

A

personality disorder

104
Q

how does ICD10 define dementia

A

decline in higher cortical function

105
Q

name the 4 As of decline in cognitive function in alzheimers

A

amnesia
apraxia
agnosia
aphasia

106
Q

neuroradiological findings in an alzheimers brain

A

shrinkage of cerebral cortex
shrinkage of hippocampus
enlarged ventricles

107
Q

what kind of speech disturbance is seen in vascualr dementia

A

Expressive dysphasia

108
Q

describe some personality changes in fronto-temporal dementia

A

Apathy, disinhibition, emotional blunting, coarsening of sociability

109
Q

symptoms /disease course of lewy body dementia

A

fluctuating, rapid decline
visual hallucinations
parkinsonian signs
frequent falls

110
Q

alzheimers treatment

A

Memantine (NMDA antagonist)

donepazil, rivastigmine, galantamine

111
Q

what age constitutes late onset schoziphrenia

A

> 45

112
Q

symptoms of late onset schizophrenia

A

paranoia
delusions (partition)
hallucinations

113
Q

what symptoms are seen less in late onset schizophrenia than young

A

emotional blunting
personality decline
negative symptoms
formal thought disorder

114
Q

define formal thought disorder and give 3 examples

A

disorganised thinking evidenced by disordered speech e.g. poverty of speech, derailment, perseveration

115
Q

risk factors for late onset schizophrenia

A

Social Isolation
Sensory deficits
Reclusive and suspicious pre-morbid personality
Female

116
Q

criteria for delusional disorder

A

long standing delusions
3 months
culturally appropriate

no persistent hallucination/ not 3rd person
no passivity
no blunting of affect
no organic cause

117
Q

define Cotard delusion

A

delusional belief that they are already dead, do not exist, are rotting, or have lost their blood or internal organs.

118
Q

name 2 somatic delusions of psychotic deperession

A

pain,

can’t swallow

119
Q

main difference between charles bonnet and psychosis

A

INSIGHT

120
Q

describe attachment theory in psych

A

infant needs to develop a relationship with at least one primary caregiver for successful social/ emotional development, and to learn how to effectively regulate their feelings

121
Q

criteria for delusion

A

belief that is:

  • firmly held
  • not affected by rational argument /evidence to the contrary
  • not a conventional belief
122
Q

types of paranoid delusions

A

persecutory
grandiose
self-referential

123
Q

lady started on fluoxetine now feels better and asks to stop it. Advice?

A

continue for 6 months after remission

124
Q

Luria’s motor test is for which type of dementia

A

fronto-temporal/ picks

125
Q

what is paraphrenia?

A

late onset schizophrenia with +ve symptoms and without -ve symptoms

126
Q

tricyclic overdose investigation

A

ECG

127
Q

side effect of citalopram on the heart/seen on ecg

A

prolonged QT

128
Q

depression and insomnia. Best medication? [flouxetine, mirtazepine, diazepam]

A

mirtazepine - has drowsiness side effect

129
Q

diazepam overdose drug mx

A

flumazenil

130
Q

treatment for pcm overdose

A

n-acetyl-cysteine

131
Q

A 57 year old man presents with an ataxic gait, nystagmus, urinary incontinence and memory impairment

A

normal pressure hydrocephalus

132
Q

treatment of normal pressure hydrocephalus

A

shunt operation to improve the circulation of cerebrospinal fluid

133
Q

A 33 year old unemployed gentleman was seen in hospital for assessment of recent memory loss. He appeared malnourished and apathetic. During the course of assessment there was evidence of confabulation and gait disturbance. His partner mentioned that he spent most of his evenings drinking with friends in the pub.

A

korsakoff’s syndrome

134
Q

A 45 year old mother of two presented to her GP with a history of low mood and forgetfulness. She also complained of poor concentration, loss of interest, tiredness and poor sleep. Her Mini mental state examination score was 21 / 30. It was noticed that most of her answers were “I don’t know.”

A

pseudodementia

135
Q

management of serotonin syndrome

A

fluids, benzos

Cyproheptadine

136
Q

sx of serotonin syndrome

A

cognitive: confusion, agitation

autonomic: diarrhoea, tachycardia
fever
HTN

neuro: ^reflexes, clonus, tremor
seizure
ataxia

137
Q

define mydriasis and miosis

A

mydriasis - dilated pupil

miosis - constricted

138
Q

causes of serotonin syndrome

A

MAOI
SSRIs
ecstasy
Amphetamines

139
Q

Ix for patients on lithium

A

tft [hypo]
u and e [excretion]
ECG

140
Q

risk factors for schizophrenia

triggers

A

FH
social isolation
intrauterine infection

stress, drugs

141
Q

schizophrenia type presentation- Ix

A 
cultures
MSU
CT head
FBC
TFT
glucose
calcium
cortisol
alcohol/drug screen
142
Q

NEUROLEPTIC MALIGNANT SYNDROME (reaction after starting an antipsychotic/ ↑ dose). Management?

A

benzodiazepines
fluids
bromocriptine

143
Q

Ix in neuroleptic malignant syndrome and why

A

ABG [Met acidosis]
U and E (↑ Creatinine Kinase)
FBC [Leucocytosis]
ECG [prolonged QT]

144
Q

differences between serotonin syndrome and neuroleptic malignant syndrome

A

rapid vs gradual
mydriasis vs normal
increased vs reduced relflexes

145
Q

OCD management

A

CBT + SSRI

146
Q

management of Acute Dystonic Reaction after starting haloperidol

A

stop drug

procyclidine

147
Q

Ix to chelck before starting lithium

A

U+E
ECG
TFT

3A GH (8 decks)

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