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Psych Flashcards

1
Q

What are some differentials for symptoms of low mood other than depression?

A

HYPOthyroidism
Sleep disorder
Low blood sugar

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2
Q

Which medications should be avoided when taking SSRIs, and why?

A

Aspirin
Warfarin
NSAIDs

SSRIs increase risk of GI Haemorrhage

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3
Q

What are some differentials for the symptom of anxiety and what questions may you ask regarding each one?

A

GAD - Nervous all the time, on edge, worrier?

OCD - Ritualistic? Thoughts they cannon get out of their head?

Panic - Sudden onset of panic, feeling of impending doom? Out of the blue? How long does it last

Phobia - Triggers? Place, person, thing?

Depression with anxiety - Any low mood? Could you be depressed?

HYPERthyroidism - changes in weight or appetite? Fluctuations in intensity of anxiety?

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4
Q

There are 6 types of delusions that should be questioned about in a psych history where there are symptoms of hallucinations and delusions emitted?

Name all 6 and a question or two that may cover it.

A

Persecutory - Do you feel like people are out to get you? Has anyone ever tried to harm you?

Reference - Do you feel like the TV, newspaper or signs outside leave messages just for you?

Perception - do you see things in the same way as others?

Grandeur - do you feel like you have special abilities or powers?

Passivity - Is anyone trying to control your actions or feelings?

Control - Is anyone trying to control you?

Nihilistic - do you feel like your organs are rotting? Do you feel like things around you are dying or rotting?

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5
Q

What are the first ranked symptoms of schizophrenia ICD-10?

A

Auditory hallucinations

Delusions of perception
Delusions of control

Thought echo
Thought withdrawal
Thought insertion
Thought broadcast

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6
Q

What are some common side effects of olanzapine?

A

Drowsiness

Weight gain

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7
Q

What are some other side effects of olanzapine?

A

Stiffness or uncontrollable movements
Raised blood sugar (DM) and cholesterol levels
Swollen leg and ankle
Dry mouth

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8
Q

What aspects will require monitoring by the GP for someone who is on olanzapine (or any other antipsychotic)?

A 
Weight
Blood sugar
Cholesterol and Lipids
LFT
ECG
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9
Q

What are some defining features of mania?

A 
Inflated self-esteem or grandiosity
 Decreased need for sleep
 Pressured speech
 Racing thoughts or flight of ideas
 Distractibility
 Increased activity
 Excess pleasurable or risky activity.
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10
Q

What is the diagnostic criteria for bipolar affective disorder?

A
  • 3 or more symptoms of mania*
  • 1 week duration
  • Disturbance of normal functioning
*
 Inflated self-esteem or grandiosity
 Decreased need for sleep
 Pressured speech
 Racing thoughts or flight of ideas
 Distractibility
 Increased activity
 Excess pleasurable or risky activity.

Marked impairment not due to a substance or medical condition

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11
Q

What areas need covering in the risk assessment of someone with mania?

What questions may you ask when investigating these areas?

A

OVERSPENDING - Do you go on shopping binges? How are things financially?

POLICE - Have you gotten into trouble with the law recently? If so why?

SELF HARM / SUICIDE - Have you ever tried to harm yourself? Have you tried to use your special powers, and if so, how?

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12
Q

What 3 other diagnoses should you consider in a patient presenting with mania and what questions may you ask?

A

Bipolar - I know you feel fantastic now but have you ever felt depressed in the past?

Anxiety - Do you feel particularly worried or anxious about anything?

Psychosis - Have you seen or heard things you couldn’t quite explain?

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13
Q

What is the starting dose of lithium and what time of day is it usually taken?

A

200-400mg, titrated up to lowest dose that stops symptoms

Best taken at night, same time every day

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14
Q

What are some side effects of lithium?

What simple measure can be taken to reduce chance of side effects?

A 
Nausea
Fine tremor
Metalic taste in mouth
Polyuria and polydipsia
Swollen ankles

Keep well hydrated especially when weather is hot or when ill with an infection (increased risk of dehydration)

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15
Q

What side effects should alert someone on lithium to seek urgent medical care?

A 
BLURRED vision
Loss of appetite
D and V
Muscle weakness
Drowsiness
Convulsions or slurred speech
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16
Q

What extra items will be provided on initiation of lithium therapy?

A

Information leaflet

Lithium ALERT CARD
- Details of treatment, dose, brand, GP address, NHS number, Contact of doctor under care

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17
Q

What questions are asked during a CAGE questionnaire?

A

C - Have you ever felt you should CUT DOWN on your drinking?

A - Does other peoples criticism ANNOY you?

G - Do you every feel GUILTY about drinking?

E - Do you need alcohol first thing in the morning as an EYE-OPENER?

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18
Q

What is the ICD-10 criteria for dependence?

A

3 out of the 6 below over a 12 month period

  1. COMPULSION, CONSEQUENCES and no CONTROL
  2. PRIMACY - Is drinking your main priority in life
  3. PREVIOUS TREATMENT - Detox? Relapses?
  4. TOLERANCE built
  5. WITHDRAWAL
  6. LOSS OF INTEREST in activities
19
Q

What questions should you ask in Past Alcohol History?

A

When did you START drinking?
What was your LONGEST PERIOD OF ABSTINENCE?
Does anyone else in the FAMILY have alcoholism?
Have you ever tried a DETOX?
Have you ever tried THERAPY such as AA?

20
Q

What questions should you ask when investigating SOCIAL COMPLICATIONS of alcohol abuse?

A

RELATIONSHIPS: Friends, family, partner

WORK and FINANCE: Job, income, expenditure

LIVING: Home, flat, who with

LAW: Police, driving, violence, self harm

21
Q

What questions should you ask when investigating MEDICAL COMPLICATIONS of alcohol abuse?

A

Physical - Weight loss, appetite, memory

Depression / Anxiety

Psychosis

Self harm and suicide

22
Q

In an alcohol history, how would you inquire about MAINTAINING factors and MOTIVATION TO CHANGE?

A

Maintaining

  • Access to alcohol
  • Motivation to drink? Social isolation, avoiding withdrawal, coping mechanism

Motivation to change
- Has the Pt expressed a desire to change?

23
Q

What investigations would you carry out in an intoxicated alcoholic?

Talk about

  • Physical exam
  • Bloods
  • Further investigations for pathologies
A

Physical exam: Assess malnurishment, signs of liver disease and heart disease (AF and alcoholic cardiomyopathy)

Bloods: Alcohol level, FBC (marcocytic), Vitamin (THIAMINE), Glucose, U&Es, CRP, LFTs, y-GT, Clotting, Lipids,

Further investigations: Abdominal USS & CT/MRI for liver disease, Echo for CVD

24
Q

What medication may be given in acute alcohol withdrawal to negate the effects of agitation and tremor in delirium tremens?

A

Chlordiazepoxide (aka Librium)

A type of long-acting benzodiazepine

25
Q

What is the clinical triad of Wernicke’s Encephalopathy?

A

Mental status changes
Ophthalmoplegia
Gait dysfunction

26
Q

What medication may be given to help control cravings when abstaining from alcohol?

A

Acamprosate

27
Q

What medication is used as an adjunct in the treatment of alcohol dependence by causing an accumulation of acetaldehyde in the body?

A

Disulfiram

Causes extremely unpleasant systemic reaction to even small amounts of alcohol

28
Q

What are the SCOFF (screening tool) questions for eating disorders?

A

Sick: Do you make yourself sick because you are uncomfortable full?

Control: Do you worry you have lost control over how much you eat?

One stone: Have you lost more than 6kg (~1 stone) in the past 3 months?

Feel fat: Do you believe you are fat despite others thinking you are thin?

Food dominates: Would you say food dominates your life?

29
Q

What are the WAIF questions for assessing eating disorder?

A

Weight: Do you mind me asking how much you weight and how tall you are (calculate BMI)

Amenorrhea: Have you been having regular periods?

Induced vomiting: Have you made yourself throw up after eating? Do you exercise, and if so, how much?

Fear of fatness: How would you feel if you gained weight?

30
Q

What are the features of anorexia nervosa?

A
  1. Underweight (BMI < 17.5)
  2. Distorted body image
  3. Food dominates
  4. Utilisation of methods for weight loss
  5. Fear of gaining weight
  6. Amenorrhoea / Oligomenorrhoea as hormones are affected by diet
31
Q

What are the features of bulimia nervosa and how may you manage it?

A

Unlike anorexia, a normal or over weight

  1. Binge eating
  2. Purging
  3. Irregular eating patterns
  4. Amenorrhoea / Oligomenorrhoea
  5. Erosion of teeth, sore throat, reflux

Manage with psychotherapy (CBT or IPT). SSRIs can help with urge to binge and purge.

32
Q

What questions should you explore in the HPC of someone with an eating disorder?

A

Tell me about your eating

Typical day?

Do you binge? How do you feel afterwards? Do you do anything to counteract? What do you do? Do you make yourself sick afterwards or use laxatives?

Onset - How long has this been going on for?

Triggers? - Anything bring it on?

Home environment? - How are things at home?

33
Q

What are the 5 core diagnostic factors of PTSD?

A

Exposure and response to trauma

Intrusion symptoms: Re-experiencing aspects of event in a vivid and distressing way resulting in gross impairment in functioning.

Avoidance of symptoms: Effortful avoidance of reminders, triggers, discussion of or thinking about the event

Negative alterations in cognition and mood: Anhedonia, negative distorted beliefs, ideas of blame, inability to recall key aspects of the traumatic event

Alterations in arousal and reactivity: Hypervigilance, startled responses, irritability, angry outburst, self destructive or reckless behaviour, concentration and sleeping problems

34
Q

What symptoms should you question about in a depression / low mood history?

A

SIG E CAPS

Sleep
Interest lost
Guilt and worthlessness

Energy low

Concentration
Appetite and weight loss
Psychomotor retardation / agitation
Suicidal thoughts

35
Q

What other diagnosis should you rule out in a patient presenting with low mood?

A

Hypothyroidism

Bipolar

Psychosis

Anxiety

36
Q

What may you say ‘To Finish’ a consultation with a depressed patient?

A

Insight and support - From what you have said it seems like you have depression. Would you agree with me? Why not? There is treatment available. Does this interest you?

Follow-up - I would like to see you again. Can we arrange a time to meet, perhaps next week? We can discuss how to go on forward from here.

There is less chance of a suicide risk if the patient has something to look forward to so offer a follow up appointment the next week.

37
Q

What may low moods coupled with hallucinations and delusions indicate a likely diagnosis?

A

Schizoaffective disorder

38
Q

What is the general management of low mood and depression?

A

Regular management
Sleep hygiene
CBT
SSRIs

If high risk to self or others, admit to ward under MHA

39
Q

What are the symptoms of an acute stress reaction?

A

Sudden onset of anxiety, low mood, emotional ability developing quickly over minutes or hours post-stressful event (attack, trauma, terrorism).

Settles fairly quickly but can last for several days or weeks.

40
Q

What may be a likely differential for anxiety coupled with hallucinations, rapid onset of confusion, seizure, fever?

A

Alcohol withdrawal

Nonspecific anxiety symptoms with delirium tremens, hallucinations, fever and seizures occurring in severe cases.

41
Q

What questions should you ask when investigating symptoms of auditory hallucinations?

What about other hallucinations?

A

Open question - Can you tell me about these voices? How many are there?

True / False - Are they inside or outside of your head? Can you stop them?

Second / Third person - Do they speak to you or about you?

Commands - Do they ever tell you to do anything? What do they tell you to do?

Running commentary - Do you hear them like a running commentary?

Visual hallucinations - Can you see things that others cant? What do you see? How have things progressed since they started?

Olfactory / Gustatory - Can you smell or taste things you cant explain? When did this start? How have things progressed?

42
Q

How may you question insight in a patient presenting with hallucinations or delusions?

A

If I were to say as a doctor I thought you had a psychiatric problem, how would you feel?

Would you take treatment for this if a psychiatrist felt it appropriate?

43
Q

What are the positive and negative symptoms of schizophrenia?

A

Positive

  • Hallucinations of any modality
  • Catatonia (involuntary movements)
  • Neologism (new words created out of thin air)
  • Tangential speech

Negative

  • Anhedonia (loss of pleasure)
  • Blunted
  • Poverty of speech
  • Marked apathy (lack of interest and enthusiasm)
44
Q

What are the features of depression with psychosis?

A

Core features of depression present

  • Anhedonia
  • Low mood
  • Fatigue

Plus, DELUSIONS of

  • Persecution
  • Paranoia
  • Guilt
  • Nihilism

Patient may believe that they are being punished for a wrongdoing that they had no influence over. May include hallucinations that are heavily critical of them.

Revision (21 decks)

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