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Psych Flashcards

1
Q

What is a delusion?

A

Fixed firmly held belief that is held despite evidence to the contrary and cannot be reasoned away. It is out of keeping with the person’s sociocultural norms.

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2
Q

What is a delusion of reference?

A

Thinking every day things (neutral events) have a special meaning or personal message behind them

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3
Q

What is a persecutory delusion?

A

Thinking that others are out to get them

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4
Q

What is a grandiose delusion?

A

Belied that they have special talents, are famous or particularly important

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5
Q

What is a depressive delusion?

A

Belief that they are guilty, worthless, end of the world is coming

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6
Q

What is delusional jealousy?

A

Preoccupation with thought that their spouse is being unfaithful without having logical proof

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7
Q

What is a delusion of control

A

Feeling under the control of a force or power

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8
Q

Describe thought withdrawal

A

Feeling that thoughts are being taken out of their head so mind left blank

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9
Q

What is thought broadcast

A

Thoughts transmitted, everyone can hear

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10
Q

What is thought echo?

A

Thoughts repeated like an echo!

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11
Q

What is thought insertion?

A

Someone else putting thoughts into the mind

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12
Q

What physical disorders can present like psychosis?

A 
Dementia 
Thyrotoxicosis
Cushing's 
Epilepsy of temporal lobe 
Drug misuse
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13
Q

What are the hallmark symptoms of psychosis?

A

Hallucinations
Delusions
Thought disorder
Lack of insight

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14
Q

What are the first rank symptoms of schizophrenia

A

Delusions of one type
Auditory hallucinations- echo, third person voices, running commentary
Thought disorder - insertion, withdrawal, broadcast
Passivity experiences

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15
Q

What are the negative symptoms of schizophrenia

A 
Under activity 
Poverty of speech 
Low motivation 
Social withdrawal
Emotional flattening 
Self neglect
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16
Q

What are the signs of schizophrenia on MSE

A

Appearance and behaviour: withdrawal, self neglect, stereotypical behaviours, responding to unseen stimuli
Speech: poverty of speech, loosening of associations
Emotion: flat affect
Thoughts: delusional beliefs, passivity, thought disorders
Perceptions: auditory hallucinations
Insight: lack!

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17
Q

According to ICD 10, which four symptoms do people need to experience one of for a diagnosis of schizophrenia?

A

Thought disorder
Delusions of control, passivity or influence
Hallucinatory voices - running commentary, third person,
Persistent delusions

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18
Q

What is the differential diagnosis for schizophrenia?

A 
Delirium
Drugs
Mood disorder with psychotic symptoms 
Delusional disorder
Schizoaffective 
Dementia
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19
Q

What is the treatment for schizophrenia

A

First line: atypical - risperidone, olanzapine

Then: typical - haloperidol

Then: clozapine

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20
Q

How quickly does schizophrenia improve following initiation of antipsychotic treatment?

A

After first few days excitement and irritability improve

After few weeks, hallucinations and delusions improve

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21
Q

What is schizoaffective disorder?

A

Schizophrenic and mood symptoms, both severe enough to reach ICD 10 criteria

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22
Q

How long do symptoms of schizophrenia need to be present for a diagnosis to be made?

A

One month

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23
Q

What is delusional disorder?

A

Delusion for at least 3 months

No presence of other symptoms

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24
Q

What are the core symptoms of depression

A

Anhedonia
Low mood
Lack of energy

For at least 2 weeks

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25
Q

What are some depressive cognitions?

A 
I am worthless
Guilt
Hopelessness
Constant worries about health
Poor concentration 
Suicidal ideation
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26
Q

State the biological symptoms or depression

A 
Early morning wakening
Diurnal mood variation 
Lack of appetite
Weight loss
Loss if libido
Psychomotor agitation or retardation
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27
Q

What is the ICD 10 classification for the severity of depression?

A

Mild - 2 core, 2 others
Moderate - 2/3 core, 3/4 others
Severe - 3 core, 4 others

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28
Q

What is the difference between grief reaction and depression?

A 
In grief reaction:
still have ability to feel pleasure, 
grief comes in waves, 
no thoughts of worthlessness of hopelessness, 
able to look forward to future
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29
Q

Management of mild to moderate depression

A

CBT

Then antidepressant if persists or if history of depression

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30
Q

Treatment of moderate to severe depression

A

Antidepressants

  • SSRI
  • different SSRI or SNRI
  • mirtazapine or augment with lithium/quetiapine

AND

CBT/ IPT

ECT can be used if fast treatment needed, or situation is life threatening

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31
Q

Describe mania according to ICD 10

A

Mood which is predominantly elevated, expansive or irritable and definitely abnormal for the individual concerned.
Prominent and sustained for at least a week or severe enough to require admission to hospital

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32
Q

State some of the symptoms of mania

A 
Increased activity
Increased talkativeness
Flight of ideas
Loss of social inhibitions 
Less sleep
Inflated self esteem
Distract ability 
Reckless behaviour 
Sexual energy

Also psychotic symptoms

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33
Q

What is the difference between mania and hypo mania?

A

Hypo mania
only four days
Only some interference with personal functioning (mania there will be severe interference)
No psychotic symptoms in hypomania

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34
Q

What is the difference between bipolar I and bipolar II

A

I - manic episodes plus major depressive episodes

II - hypo mania plus depressive episodes

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35
Q

What could be differential diagnosis for bipolar?

A

Schizophrenia - in mania the content of delusions and hallucinations changes quickly
Dementia
Endocrine - hyperthyroid!
Drug misuse

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36
Q

Describe treatment of bipolar disorder episode

A

Admission is likely to be needed

Pharmacological
Mania: antipsychotic (olanzapine, quetiapine, risperidone, haloperidol), if two fail then lithium, if fails then sodium valproate

Depression: antipsychotic (quetiapine), then olanzapine + fluoxetine, then lithium, then SSRI

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37
Q

Why are SSRI used with caution in those with bipolar depression?

A

Switching to Mania

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38
Q

Describe how bipolar relapses are prevented

A

Continuation therapy: lithium first line, then add valproate.
Lamotrogine or carbamezepine also

Education of early signs of relapse

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39
Q

What are the early signs of relapse in bipolar?

A 
Reduced need for sleep
Over spending
Increased activity
Racing thoughts
Elated mood
Irritability
Unrealistic plans
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40
Q

What are the psychological a symptoms of anxiety?

A 
Racing thoughts
Increased alertness
Feeling of dread
Restlessness
Inability to focus
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41
Q

What are the physical symptoms of anxiety

A

Palpitations
Sweating
Breathlessness
Shaking

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42
Q

What is GAD

A

Worries about worries

Maintained by belied that worries are helpful

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43
Q

What is social anxiety disorder

A

Fear of negative evaluation by others
Avoidance of feared situations
Unhelpful evaluation following social encounters

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44
Q

What is adjustment disorder?

A

Subjective distress and emotional disturbance, interfering with social functioning and performance, arising in period of adaption to significant life change.

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45
Q

What is a grief reaction?

A

Develops within three months of stressor

Does not persist for more than 6 months after stressor is no longer present

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46
Q

What is agoraphobia

A

Fear of leaving home, going to public places, travelling alone on public transport

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47
Q

What is an obsession in OCD?

A

Recurrent unpleasant thoughts or images
Ego dystonic
Coming from person’s mind, recognised as being excessive or unreasonable

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48
Q

What is a compulsion in OCD

A

Action or ritual related to the obsession
Person tries to resist, but feels driven to perform them
It is not pleasurable to carry out

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49
Q

What is the management for anxiety disorders?

A

CBT

SSRI

Anxiolytics in short term

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50
Q

What are the core symptoms of PTSD

A

Re-experiencing
Avoidance or rumination
Hyper-arousal

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51
Q

How is PTSD treated

A

Trauma focused CBT
EMDR

Drug treatment as adjunct or if not able to do CBT
Paroxtine, mirtazapine

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52
Q

What is a personality disorder?

A

Deeply ingrained and enduring behaviour patterns
Present since adolescence
Stable over time
Manifests In different environments
Significant deviation from average
Associated with distress and problems with social performance
Recognised by friends and acquaintances

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53
Q

What are the features of dissocial personality disorder?

A 
Incapacity to maintain enduring relationships 
Disregard for consequences of actions
Disregard for social norms, rules and obligations 
Incapacity to experience guilt
Disregard for others feelings
Criminal behaviour 
Comorbid depression and anxiety
Drug and alcohol use
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54
Q

When can dissocial personality disorder be diagnosed?

What can be diagnosed before this?

A

After age 18

Conduct disorders - antisocial, aggressive or defiant behaviour. Persistent and repetitive

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55
Q

How would someone with EUPD present?

A 
Relationship difficulties
recurrent self harm
Threats of suicide
Depression
Impulsivity
Social difficulties
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56
Q

What are the features of EUPD?

A

Unstable and intense interpersonal relationships
Poorly controlled impulses
Fear of abandonment and rejection
Strong tendency towards suicide and self harm

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57
Q

What is the treatment for personality disorders?

A

Psychotherapy - long term

Drug treatment for comorbidies

Crisis plan

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58
Q

What is somatisation disorder

A

multiple physical SYMPTOMS present for at least 2 years

patient refuses to accept reassurance or negative test results

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59
Q

What is hypochondrial disorder

A

persistent belief in the presence of an underlying serious DISEASE

patient refuses to accept reassurance or negative test results

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60
Q

What is a conversion disorder

A

symptoms present despite lack of organic cause

the patient doesn’t consciously feign the symptoms (factitious disorder) or seek material gain (malingering)

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61
Q

What is factitious disorder

A

Munchausen’s syndrome

the intentional production of physical or psychological symptoms

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62
Q

What is malingering

A

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

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63
Q

What are some predisposing factors in depression

A

genetic factors (higher risk if first degree relative), childhood abuse, parental loss

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64
Q

What are some precipitating factors in depression

A

life event
substance abuse
severe physical illness

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65
Q

what are some perpetuating factors in depression

A 
social withdrawal
stress
finances
work
lack of confiding relationship
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66
Q

State some differentials for depression

A

grief reaction
dementia
substance misuse - anabolic steroids, alcohol, cannabis
hypothyroidism
bipolar disorder
drug side effects - benzodiazepines, POCP
schizophenia (if depression with psychosis)

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67
Q

What investigations should be carried out in depression

A

TFTs

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68
Q

What questions about secondary symptoms in depression are important to ask?

A 
how is your sleep?
appetite?
concentration?
Mood throughout the day
memory?
thoughts about the future/self?
relationships?
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69
Q

For patients with mild/moderate depression, when can the use of antidepressants be considered?

A

a past history of moderate or severe depression

initial presentation of subthreshold depressive symptoms that have been present for a long period (at least 2 years)

subthreshold depressive symptoms or mild depression that persist(s) after other interventions

if a patient has a chronic physical health problem and mild depression complicates the care of the physical health problem

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70
Q

Which antidepressant is most suitable in thetreament of children and young people?

A

fluoxetine

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71
Q

What are the side effects of SSRIs

A 
GI: bleeds, nausea, dyspepsia, bloating, flatulence, diarrhoea and constipation
Sweating
Tremor
Rashes
Extrapyramidal
Sexual dysfunction
Sleepiness
Hyponatraemia
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72
Q

What are the advantages of SSRI’s compared to TCAs

A

less toxic in overdose
less sedative
less cardiotoxic

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73
Q

How long do SSRI’s take to have their full effect

A

6-8wks

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74
Q

How long should someone take an SSRI for depression

A

at least 6 months

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75
Q

Define alcohol intoxication

A

chracterised by slurred speech, impaired coordination and judgement and labile affect

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76
Q

Describe the characteristics of acute alcohol withdrawal

A 
•	Insomnia and fatigue.
•	Tremor.
•	Mild anxiety/feeling nervous.
•	Mild restlessness/agitation.
•	Nausea and vomiting.
•	Headache.
•	Excessive sweating.
•	Palpitations.
•	Craving for alcohol.
seizures
hallucinations
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77
Q

What are the signs of alcohol dependence?

A

Compulsion to drink
Aware of harms but persist
Neglect other activities
Tolerance to alcohol

Stopping causes withdrawal
Stereotyped patterm on drinking
Time preoccupied wiht alchohol
Out of control of use
Persistent futile wish to cut down
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78
Q

What are tools used to screen for alcohol dependence?

A

FAST
AUDIT
CAGE

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79
Q

State the components of the CAGE questionnaire

A

o Have you ever felt the need to Cut down?
o Have people Annoyed you by criticising your drinking?
o Do you ever feel Guilty about your drinking?
o Ever had an Eye-opener to steady your nerves in the morning?

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80
Q

What signs on examination can be seen in alcohol dependency

A 
palmar erythema
gynecomastia
ascites
jaundice
spider naevi
81
Q

How is classical conditioning modelled in alcohol dependancy?

A

feeling good after having a drink

(association between drinking and pleasure)(

82
Q

How is operant conditioning modelled in in alcohol dependencu

A

avoiding withdrawal symptoms

83
Q

What are some predisposing factors for alcohol dependency

A 
genetics
family history
occupation
impulsive traits
culutre
84
Q

What are some precipitating factors for alcohol dependency

A

divorce or relationship problems
psychiatric illness
peer pressure
economic situation

85
Q

What are some perpetuating factors of alcohol dependency

A

no motivation to change
social reinforcement
avoiding withdrawal symptoms
association with pleasure activates dopaminergic reward pathway

86
Q

What is Wernicke’s encephalopathy due to?

A

thiamine deficiency damaging mamilliary bodies

87
Q

What are the signs of Wernicke’s encephalopthy?

A

ataxia
nystagmus
opthalmoplegia
acute confusion

88
Q

What are the neuropsychiatric complications of alcohol dependency

A 
wernicke's
peripheral neuropahty
ED
cerebellar degeneration
dementia
89
Q

What are the social complications of alcohol dependency

A 
unemployment
family breakdown
prostitution
debt
domestic violence
road accidents
suicide
90
Q

What are the features of foetal alcohol syndrome

A 
decreased muscle tone
poor cooridnation
developmental delay
heart defects
facial abnormalities
91
Q

What is delirium tremens?

A

most severe form of alcohol withdrawal manifested by altered mental status (global confusion) and sympathetic overdrive (autonomic hyperactivity), which can progress to cardiovascular collapse.

begins 24-72 hours after alcohol consumption has been reduced or stopped

92
Q

What are the features of delirium tremens

A
  • Hallucinations (auditory, visual, or olfactory).
  • Confusion.
  • Delusions.
  • Severe agitation.
  • Seizures
93
Q

What is the management of Wernicke’s encephalopathy?

A

IV thiamine

94
Q

How is acute alcohol detoxification managed?

A

admission to hospital - risk of delerium tremens/seizures
sedation for symptoms of withdrawal - benzodiazepines
Vitamin B complex is given as IV Pabrinex® to inpatients for a couple of days and then patients are given oral thiamine and multivitamins to prevent Wernicke’s encephalopathy

95
Q

What is the treatment for delerium tremens

A

ITU admission
control blood glucose
benzodiazepines
prevent Wernicke’s with thiamine

96
Q

What are some treatment for alcohol dependence

A

motivational interviewing
self help groups
psychological therapies
meds - disulfiram or acamprosate

97
Q

What is the mechanism of action of disulfiram

A

inhibition of acetaldehyde dehydrogenase.

so alcohol intake causes severe reaction due to Patients should be aware that even small amounts of alcohol (e.g. In perfumes, foods, mouthwashes) can produce severe symptoms.

therefore promotes abstinence

98
Q

What is the mechanism of action of acamprosate

A

activates GABA system and reduces NMDA receptor excitation to reduce cravings for alcohol and risk of relapse.

99
Q

What is korsakoff’s psychosis?

A

chronic memory disorder (amnesic disorder with confabulation) caused by severe deficiency of thiamine

100
Q

What are the features of opioid dependency

A 
rhinorrhoea
needle track marks
pinpoint pupils
drowsiness
watering eyes
yawning
101
Q

Define delirium

A

acute onset of impaired consciousness and attention
+ perceptual or cognitive disturbance
+evidence it may be related to a physical cause

102
Q

State how dementia and delirium can be differentiated

A

dementia:
slow deterioration
slowly progressive course, alert consciousness, impoverished thought content, hallucinations not common

delirium:
acute onset, fluctuating course, clouded consciousness, vivid and complex thought content, , visual hallucinations very common

103
Q

What investigations should be done in suspected delirium

A

Urinalysis, ECG
FBC, U+E, glucose, TFTs, LFTs, calcium, folate, B12
CXR

104
Q

What can cause delirium?

A 
renal or hepatic failure
thiamine, B12 or folate deficiency
trauma
UTI
pneumonia
sepsis
surgery
alcohol
thyroid probs
glucose - high or low
105
Q

How should delirium be managed?

A

environmental - clear signage, clocks and calenders, staff explanations, appropriate lighting, sleep hygiene

if distressed or a risk to self or others, short term haloperidol is given

106
Q

What is dementia

A

acquired, progressive, usually irreversible global deterioration of higher cortical function in clear consciousness

107
Q

What features need to be present for a diagnosis of dementia

A

multiple cognitive deficits - memory, orientation, language, reasoning, judgement

impairment in activities of daily living

clear consciousness

108
Q

What are the importnant questions to ask when taking a dementia history?

A 
onset
short and long term memory
orientation to time place and person
sleep
cooking/cleaning
adaptions
mood/personality change
medical and drug history
109
Q

Describe the pathophysiology of Alzheimer’s

A

amyloid cascade hypothesis states that AD is caused by an imbalance of (too much) brain Aβ production and (too little) Aβ clearance leading to amyloid plaques and neurofibrillatory tangles

110
Q

What are the macroscopic

cerebral features of Alzheimer’s

A

cortical atrophy
increased sulcal widening
enlarged ventricles

111
Q

Describe the pathophysiology of Vascular dementia

A

mulitple infarcts lead to loss of cortical parenchyma

112
Q

Describe the pathophysiology of Dementia with Lewy bodies

A

Lewy bodies (abnormal deposits of protein inside nerve cells). and neurites in basal ganglia and cortex

113
Q

What are the classic features of vascular dementia

A

step wise progression

focal neurologcial sx

114
Q

What are the classic features of dementia with lewy bodies

A

parkinsonian features

fluctuation of cognition and alertness

115
Q

What are the classic features of fronto-temporal dementia

A

early personality changes

intellectual sparing

116
Q

What tests should eb done to exclude physical causes of memory loss in suspected dementia?

A

FBC, U&E, LFTs, calcium, glucose, TFTs, vitamin B12 and folate levels.
neuroimaging (e.g. Subdural haematoma, normal pressure hydrocephalus)

117
Q

What are important differentials tp consider in dementia

A 
hypothyroidism
delirium
normal pressure hydrocephalus
subdural haematoma
psychosis
depression
thiamine deficiency
B12 deficiency
hearing or visual problems
118
Q

How can Alzheimer’s be managed?

A

mild/moderate:
AChE inhibitors - donepezil, galantamine or rivastigmine
o Side effects include nausea, dizziness, headache, diarrhoea

moderate/severe: memantine - NMDA receptor antagonist

119
Q

What factors increased he risk of depression in the elderly

A 
dementia
physcial illness
soical isolayion
bereavement
being a carer
loss of independence
120
Q

How can depression be distinguished from dementia in the elderly?

A

Depression:
Poor concentration
Slowness and self-neglect
Depressed mood preceded memory problems
Poor performance in memory testing improves when interest is aroused
In depression, patients are unwilling to cooperate in interview, in dementia they are usually willing to reply to questions, but make mistakes
short history, rapid onset
biological symptoms e.g. weight loss, sleep disturbance
mini-mental test score: variable
global memory loss (dementia characteristically causes recent memory loss)

121
Q

Name some SSRIs

A

sertraline
citalopram
fluoxetine
paroxetine

122
Q

What are the side effects of SSRIs

A

GI bleeds
hyponatraemia
sexual dysfuynction
increased agitation and suicidal ideation in first 2 weejs

123
Q

Whcih SSRI is safe in unstable angina or prev MI

A

sertraline

124
Q

What are the symptoms of stopping SSRIs abruptly

A 
Gastro-intestinal disturbances, 
headache,
 anxiety, 
dizziness, 
paraesthesia, 
electric shock sensation in the head, neck, and spine, tinnitus, 
sleep disturbances, 
fatigue, 
influenza-like symptoms,
sweating
125
Q

How should SSRIs be stopped

A

tapered over at least a few weeks

126
Q

What is serotonin syndrome

A

syndrome caused due to increased serotonin -increased dose, change of SSRI

127
Q

What are the signs and symptoms of serotonin syndrome

A

neuromuscular hyperactivity - clonus, tremor, hyperreflexia, rigidity

autonomic dysfunction - BP changed, increased HR, hyperthermia, diarrhoea

altered mental state - confusion, agitation, mania

128
Q

Name some SNRI

A

venlafaxine

duloxetine

129
Q

What are the side effects of SNRIs

A

hypertension
prolonged QTc
sweating

130
Q

What is the mechanism of action of mirtazapine

A

presynaptic alpha2-adrenoceptor antagonist, increasing concentrations of NA and serotonin transmission

131
Q

What are the side effects of mirtazapine

A

dry mouth
weight gain
drowsiness

132
Q

Name some TCAs

A

amitrityline
imipramine
clomipramine

133
Q

What is the mechanism of action of TCAs

A

inhibit breakdown of NA and serotonin

134
Q

Which TCAs are more and less sedative

A

more - amitrityline, chlomipramine

less - lofepramine, imipramine

135
Q

What are the side effects of TCAs

A

fatally toxic in overdose
increased mortality from cardiac disease
anticholinergic

136
Q

Name some MAOI

A

phebelzine

137
Q

What are the significant side effects of MAOIs

A

hepatotoxicity

hypertensive crisis if interaction with tyramine ricj foods - red wine, cheese

138
Q

What is the mechanism of action of MAOIs

A

inhibition fo breakdwon of serotonin by monoamine oxidase

139
Q

Name some typical antipsychotics

A

chlorpromazine

haloperidol

140
Q

What are the extrapyramidal (antidopaminergic) side effects of antipsyhcotics

A

parkinsonism
acute dystonia
akathisia
tardive dyskinesia

141
Q

Describe parkinsonism

A

pill rolling tremor
shuffling gait
difficulty turning
rigidity

142
Q

Describe acute dystonia

A

spasm of facial muscles

grimacing

143
Q

Describe akathisia

A

restlessness
pacing
feet in constant motion

144
Q

Describe tardive dyskinesia

A

tongue protrusion
abdnormal jerking of limbs
lip smacking

145
Q

What is the management if tardive dyskinesia occurs

A

stop the drug - prevent worsening

146
Q

Which extrapyramidal side effects are reversible and which might not be

A

acute dyskinesia, akathisia and parkinsonism reversible

tardive dyskinesia might not be

147
Q

What are the signs and symptoms of hyperprolactinaemia

A 
sexual dysfunction
decreased bone density
menstrual disturbances, 
breast enlargement, 
galactorrhoea.
148
Q

Name some atypical antipsychotics

A

olanzapine
quetiapine
clozapine
risperidone

149
Q

Which antipsychotic is proven to be more efficacious than others?

A

clozapine

150
Q

When can clozapine be prescribed

A

when treatment with 2 other antipsychotics has been tried and not been able to control symptoms

151
Q

What are the important side effects of clozapine

A

agranulocytosis

seizures

152
Q

What should be monitored in clozapine specifically

A

FBC
every week for 18weeks
every fortnight for 1 year
then every month

153
Q

What are the side effects of antipsychotics

A 
high prolactin
weight gain
hyperglycaemia
cardiovascular - raised HR, arrhythmias, prolonged QTc
hypotension
sexual dysfunction
neuroleptic malignant syndrome
154
Q

Which antipsyhchotic has the lowest incidence of sexual dysfunction

A

quetiapine

155
Q

What are the signs and symptoms of neuroleptic malignant syndrome

A

hyperthermia,
fluctuating level of consciousness,
muscle rigidity,
autonomic dysfunction - pallor, tachycardia, labile blood pressure, sweating, and urinary incontinence

associated with recent increased in dose of antipsychotic

156
Q

What monitoring needs to be done in antipsychotic treatment?

A

pre: BP, ECG, weight. FBC, U+E, LFT, fasting glucose, blood lipids

at 3m: lipids and weight
at 6m: fasting glucose

every year: FBC, U+E, LFT, blood lipids, fasting glucose, weight

157
Q

When is a depot antipsychotic used?

A

issues with non-adherance

158
Q

What do levels 1a, 1b, 2 and 3 mean on a psychiatric ward

A 
1a = staff within an arms length at all times
1b = staff within eye contact at all times
2 =  pt checked on every 15 mins
3 = general observations
159
Q

What is the Frontal Assessment Battery

A

bedside test used to test for frontal lobe dementia

160
Q

Define formal thought disorder

A

= an impaired capacity to sustain coherent discourse, and occurs in the patient’s written or spoken language.

indicates a disturbance of the organisation and expression of thought.

161
Q

In what conditions can hallucinations occur

A 
schizophrenia
depression with psychosis
delerium
drug induced psychosis
Cushing's
epilepsy
SOL
dementia with Lewy bodies
162
Q

What is the therepeutic range for lithium in bipolar disorder

A

0.4-1mmol/L

163
Q

How is lithium excreted?

A

by the kidneys

164
Q

What are the common side effetcs of lithium

A 
nausea and vomiting
polydipsia, polyuria
fine tremor
hypothyroidism
weight gain
metallic taste in mouth
165
Q

What should women of child bearing age be advised when taking lithium

A

use effective cnootraception - teratogenic in first trimester

166
Q

What tests should be done before initiating lithium therapy?

A

ECG, BMI, weight

FBC, U+E, TFT, eGFR

167
Q

What monitoring needs to take place whilst on lithium

A

test lithium levels every week until stable therapeutic range has been reached for at least 4 weeks

then test lithium levels every 3m

test TFT, U+E, eGFR and BMI every 6m

168
Q

When should lithium levels be taken

A

12 hours after dose

169
Q

What should be gievn to patients started on lithium

A

patient information leaflet
alert card
lithium record book

170
Q

How is lithium affected by sodium levels

A

low sodium increases lithium levels

due to competitive reabsorption of sodium and lithium in the kidneys

171
Q

How should lithium therapy be stopoed

A

not suddenly - can lead to relapse

gradually - over 3m

172
Q

What level of lithium can cause toxicity

A

1.5mmol/L

but if symptomatic, can be caused by lowet

173
Q

Which drugs can cause low sodium and therefore increase risk of lithium toxicity

A

NSAIDs
ACEi
diuretics

174
Q

What are the symptoms and signs of lithium toxicity

A 
anorexia ,V + D
coarse tremor
drowsiness and restlessness
dissxiness
ataxia
175
Q

What are the symptoms and signs of severe lithium toxicity

A 
convulsion, hyperreflexia
collapse
low potassium
dehydration
circulatory failure
176
Q

What is the management fo lithium toxicity

A

mild-moderate toxicity: volume resuscitation with normal saline
haemodialysis if severe toxicity

177
Q

What is the mechanism of action of benzodiazepines

A

enhance the effect of the inhibitory neurotransmitter GABA by increasing the frequency of chloride channels.

178
Q

What problems are associated with long term use of benzodiazepines

A

dependance

tolerance

179
Q

How long can a benzodiazepine be prescribed for

A

max of 2-4weeks

180
Q

How should the dose of benzodiazepine be withdrawn

A

in steps of about 1/8 (range 1/10 to 1/4) of the daily dose every fortnight

181
Q

what are the features of benzodiazepine withdrawal syndrome

A 
insomnia
irritability
anxiety
tremor
loss of appetite
tinnitus
perspiration
perceptual disturbances
seizures
182
Q

What are the drugs used to treat parkinsonism

A

levo-DOPA

antimuscarinics to decrease rigidity and tremor (decreases excitation of peripheral nerves)

183
Q

How should neuroleptic malignant syndrome be managed?

A

stop antipsychotic
benzodiazepiens for agitation
cooling devices
dialysis if severe AKI from muscle breakdown

184
Q

What are the dangers of rapid tranquilisation

A

respiratory depression, loss of consciousness, sedation

185
Q

Describe a section 5(2)

A

a patient who is a voluntary patient in hospital can be legally detained by a doctor for 72 hours in order to complete a MHA assessment

186
Q

What are the criteria for the implementation of the MHA

A

presence of a mental disorder
that is of a nature or severity that poases a significatn risk to their safety or others safety
there is no alternative to hospital admission

187
Q

What is a mental disoder according to the MHA

A

any disorder or disability of the mind

188
Q

Describe a section 5(4)

A

allows a nurse to detain a patient who is voluntarily in hospital for 6 hours in order to complete a MHA assessment

189
Q

Describe a section 2

A

admission for assessment and treatment for up to 28 days, not renewable

an Approved Mental Health Professional (AMHP) 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)

190
Q

Describe a section 3

A

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

191
Q

What is section 17a

A

Some patients who are detained under Section 3 are well enough to leave hospital and carry on receiving their treatment in the community.

The patient’s Responsible Clinician and an AMHP may decide that a CTO is appropriate rather than complete discharge from the section.

A patient on a CTO must keep to particular conditions and can be recalled to hospital if there are concerns about their compliance with the conditions or their deteriorating mental health.

A CTO lasts for up to six months and might be renewed for a further six months then yearly.

in teh case of relapse, The patient’s Responsible Clinician can call the patient to hospital and has up to 72 hours to decide what to do. The CTO can be revoked and the patient readmitted

192
Q

What is section 136

A

police power to remove someone to a place of safety for further assessment

193
Q

What are the four stages to consider when making a capacity assessment

A

1 = does the patient have a disorder of brain functioning? if yes = doe snot have capacity

understand
retain
weight up
communicate decision

194
Q

What are the differences between psychodynamic psychotherapy and CBT

A

psychotherapy - focusses or therapeutic relatioinship. results in understanding od unconscious conflicts adn brings resolution to these

CBT - addresses the role of dysfunctional thoughts and beliefs and what behaviours are produced and maintained. exposes and challenged thoughts

195
Q

What is transference in psychotherapy

A

the re-enactment of past relationships and emotions with the therapist

196
Q

What is paraphrenia

A

late onset schizophrenia with no negative symptoms

197
Q

What is harm minimisation

A

strategy aiming to lessen the social and physical consequences of using drugs
reduce incidence of blood borne viruses, give control help prevent overdose and help to detox

198
Q

Which illicit drugs may produce a schizophrenia like state

A

amphetamines
cocaine
cannabis
LSD

Finals (32 decks)

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