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Psych Flashcards

1
Q

Indications for ECT

A
  1. Mania (long lasting episode)
  2. Depression that is life-threatening
  3. Catatonia
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2
Q

Side Effect of olanzapine

A

Weight gain (possibly give metformin to combat this)

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3
Q

Examples of opioids (narcotics)

A

Heroin, oxycodone, morphine

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4
Q

What substances cause pinpoint pupils

A
  1. Opiods
  2. Alcohol
  3. Benzo (valium)
  4. barbiturates
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5
Q

What substances cause dilated pupils

A
  1. Hallucinogens (pot, LSD, mushrooms)
  2. Stimulants (cocaine, acid, meth)
  3. A.D
  4. Amphetamines
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6
Q

Opiod withdrawal treatment

A

methadone

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7
Q

Opiod overdose

A

Naloxone

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8
Q

Alcohol withdrawal treatment

A

benzodiazepine

such as chlordiazepoxide hydrochloride or diazepam,

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9
Q

Drug used to induce vomitting if you drink alcohol

A

disulfiram (used to treat chronic alcoholism, NOT detox)

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10
Q

Anti-alcohol drugs (other than disulfiram)

A

Acamprosate
Naltrexone
These both decrease the effect of alcohol

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11
Q

Chlorpromazine vs Clomipramine

A 
Chlorpromazine = anti-psychotic 
Clomipramine = TCA
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12
Q

Side effects of typical anti-psychotics

A
  1. Parkinsonism
  2. Tardive Dyskinesia (lip smacking)
  3. Akathisia (severe restlessness)
  4. Acute dystonia (torticollis, oculogyric crisis)
    Hyperprolacinaemia - galactorrhea in men and amenorrhoea in women
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13
Q

Names of typical anti-psychotics

A
  1. Chlorpromazine

2. Haloperidol

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14
Q

Names of atypical anti-psychotics

A
  1. Olanzapine
  2. Risperidone
  3. Aripiprazole
  4. Clozapine
  5. Quetiapine
  6. Amisulpiride
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15
Q

How do atypical anti-psychotics works?

A

the atypical antipsychotics integrate with the serotonin (5-HT), norepinephrine and dopamine (D) receptors in order to effectively treat schizophrenia. An activated 5-HT2A receptor upregulates the D2 receptor, which can cause schizophrenia in humans. Therefore, many antipsychotics block the 5-HT2A receptor. Some also directly block dopamine
One theory of atypicality is that the newer drugs block 5-HT2A receptors at the same time as they block dopamine receptors and that, somehow, this serotonin-dopamine balance confers atypicality.

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16
Q

How do typical anti-psychotics work?

A

Are dopamine antagonists

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17
Q

Can hypothyroidism and phenylketonuria cause LD

A

Yes they can, but they are both preventable

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18
Q

Fragile X

A

More common in males
Most common inherited disease causing LD
Causes learning disability and cognitive impairment
LD can be very mild or severe

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19
Q

Cognitive Deficits

A

It is an inclusive term used to describe impairment in an individual’s mental processes that lead to the acquisition of information and knowledge, and drive how an individual understands and acts in the world. The following areas constitute domains of cognitive functioning: Attention

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20
Q

What are the main causes of death in a person with schizophrenia

A

CVD, respiratory issues, diabetes

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21
Q

Side effects of atypical antipsychotics

A

Metabolic side effects (heart disease, diabetes, weight) DVT and VTE

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22
Q

Management of first episode of psychosis

A

give minimum effective dose medication (atypical or typical) for 2 weeks. If no response after 4 weeks consider changing med. If partial response, reassess after 8 weeks

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23
Q

When to stop medication after the remission of the first psychotic episode

A

a duration maintenance treatment with antipsychotics should be at least 18 months

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24
Q

When to offer Clozapine

A

After treatment on 2 antipsychotics (including a SGA)

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25
Q

Bloods for Clozapine

A

weekly for 18 weeks
fortnightly for 1 year
monthly for life

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26
Q

Side effects of Clozapine

A
  1. Agranulocytosis
  2. Constipation
  3. Hypersalavation (give hyosine)
  4. Lowers seizure threshold (give Na valproate)
  5. myocarditis, pericarditis, cardiomyopathy
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27
Q

What is capgras syndrome?

A

AKA imposter syndrome

Someone they know (spouse, friend) has been replaced by an imposter

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28
Q

What is de clerambault’s syndrome

A

Delusional love

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29
Q

Features of de clerambault’s syndrome

A

More common in females

Have a desire for a sexual relationship

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30
Q

hebephrenia

A

Disorganised schizophrenia
Disorganized behavior and speech (see formal thought disorder), including loosened associations and schizophasia (“word salad”), and flat or inappropriate affect. In addition, psychiatrists must rule out any possible sign of catatonic schizophrenia.

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31
Q

paraphrenia

A

mental disorder characterized by an organized system of paranoid delusions with or without hallucinations (the positive symptoms of schizophrenia) without deterioration of intellect or personality (its negative symptom).

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32
Q

Symptoms in generalised anxiety disorder

A
  1. Apprehension
  2. Motor tension
  3. Autonomic overactivity
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33
Q

SSRI discontinuation syndrome presents with…

A

Selective serotonin reuptake inhibitor discontinuation syndrome can present with a wide variety of symptoms including diarrhoea, vomiting and abdominal pain.

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34
Q

1st rank symptoms in schizophrenia

A
  1. Auditory hallucinations
  2. Thought interference
  3. Passivity phenomenon
  4. Delusional perceptions
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35
Q

wernicke syndrome.

Triad

A

brain disorder caused by lack of B-1.

Causes: Ataxia, nystagmus and confusion

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36
Q

Korsakoff syndrome

A

Consequence of prolonged wernicke syndrome. Dense short term memory loss.
Make up answers to questions (confabulation)

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37
Q

Differential diagnosis for psychosis

A 
depression with psychosis
mania with psychosis
schizophrenia
schizoaffective disorder
Puerpural psychosis
delusional disorder (mainly old people)
Acute sudden psychosis (sleep deprivation)
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38
Q

Differential diagnosis for depression

A

depression
Bipolar
Seasonal affective disorder
Post-natal depression

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39
Q

Anxiety disorders

A 
GAD
OCD
PTSD
Social anxiety
Phobias
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40
Q

Neurodevelopment disorders that cause mental health issues

A 
kleinfelters (psychosis)
turners (depression)
Huntingtons (sexually disinhibited)
ADHD
Autism (increase risk of schizo)
learning disability
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41
Q

Types of personality disorders (10)

A
  1. Avoidant
  2. Schizotypal- little nuts
  3. Schizoid
  4. boarder-line
  5. OCD
  6. Paranoid
  7. Histrionic
  8. Narcissistic
  9. Anti-social
  10. Dependant
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42
Q

Weight decrease in anorexia nervosa

A

15% decrease (due to avoidance)

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43
Q

upper or lower class have anorexia?

A

upper class

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44
Q

Risk of death by suicide in anorexia

A

20%

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45
Q 
Anorexia features:
HR
BP
Growth hormone
Glucose intolerence
Salivary glands
Cortisol
Cholesterol
A 
Anorexia features:
HR decrease
BP decrease
Growth hormone increase
Glucose intolerence increase
Salivary glands increase
Cortisol increase
Cholesterol increase
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46
Q

Eating disorder associated with over eating

A

bulimia

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47
Q

How do people with bulimia counteract overeating ?

A

vomiting
purging
exercise
starvation

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48
Q

Bulimia is associated with which neurodevelopment disorder

A

ADHD

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49
Q

Appetitive pathway involves which system

A

dopamine

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50
Q

Aversive pathway involves which system

A

serotonin

51
Q

Baby blues within how long

A

2 weeks

52
Q

Postnatal depression time scale

A

3-6 months

53
Q

Endocrine changes in depression

A

increased CRH

Increased TSH

54
Q

Volume of hippocampus in depression

A

decreases. Hippocampus is associated with memory, long term in particular. It is found in the medial temporal lobe

55
Q

What do SSRI work on

A

SSRIs are believed to increase the extracellular level of the neurotransmitter serotonin by limiting its reabsorption into the presynaptic cell, increasing the level of serotonin in the synaptic cleft available to bind to the postsynaptic receptor.

56
Q

Length of duration of hypomania to diagnose

Symptoms

A 
4 days plus. 
At least 3 of:
increase activity
decrease sleep
increase talkative
increase sex
increase spending
57
Q

Length of duration of mania to diagnose

Symptoms

A 
7 days plus
At least 3 of:
reckless money driving
marked sexual energy 
flight of ideas
grandiosity
58
Q

BP1 vs BP2

A

BP1: mania and depression
BP2: hypomania and depression (chronic) more common

59
Q

Bipolar diagnosis

A

2 or more episodes where patients mood and activity levels are significantly disturbed
If the patient has single episode of mania/hypomania = bipolar

60
Q

Brain changes in bipolar

A

Decreased grey mater volume

increased metabolism in amygdala

61
Q

Mood vs affect

A

Mood is underlying

Affect is outwardly expression

62
Q

Tests used to assess the severity of depression

A

Hamiltons rating scale for depression (HRSD)

Montgomery-Asperg depression rating scale (MADRS)

63
Q

What type of anti-depressants are associated with HTN crisis

A

MAOI- phenelzine, iproniazid.

HTN overdose can occur with thiamine containing foods- cheese, pickled herring

64
Q

What anti-depressant does not cause discontinuation syndrome

A

Fluoxentine

65
Q

What SSRI is now first line for panic disorders, OCD and anxiety

A

Setraline- most cost effective drug

66
Q

What Anti-depressant is recommended in the elder

A

Setraline

67
Q

Function of aversive/defensive system

A

promote survival in event of threat

68
Q

Function of appetitive/approach system

A

function to mediate seeking and approaching behaviours (pleasure)

69
Q

Common adverse effects of SSRI

A

abdo pain (nausea and vomiting)

70
Q

What do you have to do before giving citalopram

A

Do ECG, as citalopram has increased risk of causing long QT syndrome

71
Q

GABA. What it is? what does it do?

A

gaba binding causes opening of ion channels, allowing the flow of Cl into cells and K out of cells, resulting in hyper-polarisation

72
Q

How does lithium work?

A

inhibits gylcogen synthase kinase 3

73
Q

Symptoms of Serotonin syndrome

A

confusion, fever, irregular heart beat, seizures, D+V, sweats, headache

74
Q

Management of Serotonin syndrome

A

Hospital: fluids, benzo (agitation and seizures) and PERIACTIN- cypoheptadine (blocks serotonin production)

75
Q

PD: Antisocial

A 
failure to conform to social norms
Deceptive (always lying)
Impulsive 
Aggressive 
Lack of remorse 
Irresponsible 
FOUND IN JAIL
76
Q

PD: Which one?
Avoids interaction due to fear of rejection
Wants to be liked
restrant in intimate relationships
Social isolation but want contact
Don’t take risks due to fear of being ridiculed

A

Avoidant

77
Q

PD: Boarderline

A 
DAWN
NIGHTMARE GF/BF
impulsive
temper
recurrent suicidal behaviour
78
Q

PD:
Need reassurance from other with regards to daily decisions
Difficulty expressing disagreement
Search for relationship for added care and support

A

Dependant

79
Q

PD: histrionic

A

Inappropriate sexual seductiveness
centre of attention
self-dramatic
Physical appearance is used for attention seeking

80
Q 
PD: Grandiose sense of importance 
fantasies of unlimited success, power and beauty 
chronic envy 
Lack of empathy 
sense of entitlement
A

Narcissistic PD

DONALD

81
Q

PD: Schizotypal

A 
BIT NUTS
ideas of reference (insight is maintained)
odd beliefs 
lack of friends 
odd speech but not incoherent 
paranoid 
strange behaviour
82
Q

PD: Paranoid

A 
Hypersensitive
Unforgiving attitude 
Questions loyalty of friends 
tendency to perceive attack on character 
hidden meaning in things
83
Q 
PD:
indifferent to praise/criticism 
Likes solitary activities 
reduced interest in sex
appears cold 
no friends other than family
A

Schizoid

BATMAN

84
Q

PD:

OCD

A

just the usual.
unwilling to pass on tasks
can’t throw out old things with sedimental value

85
Q

Type 1 simple trauma

A

events that are abrupt.

often lasting a few minutes and as long as a few hours can be referred to as short term

86
Q

Type 2 complex trauma

A

sustained and repeated trauma

87
Q

Brain response in PTSD

A

Events fail to get stored in long term memory because the limbic brain/emotional brain keeps getting triggered. They don’t want to remember but they can seem to forget

88
Q

3 key features of PTSD

A
  1. Hypervigilence
  2. Avoidance
  3. Flashbacks

others: desensitisation, emotional numbing

89
Q

Symptoms following trauma:

  1. up to 48 hours
  2. 2 days- 2 weeks
  3. 2weeks-3months
  4. 3months +
A
  1. Acute stress reaction
  2. Acute stress disorder
  3. Acute PTSD
  4. Chronic PTSD
90
Q

Treatment for PTSD

A

If least than 4 weeks - just wait and watch

EMDR (CBT)

91
Q

Egodystonic vs egosyntonic

A

Ego-syntonic refers to instincts or ideas that are acceptable to the self; that are compatible with one’s values and ways of thinking. … Ego-dystonic refers to thoughts, impulses, and behaviors that are felt to be repugnant, distressing, unacceptable or inconsistent with one’s self-concept.
E.g.
Egosyntonic: comfortable with it. putting DVD’s in order
Egodystonic: standing on one leg waiting for dishwasher to finish

92
Q

Obsessions

A

THOUGHTS: recurrent, intrusive, distressing

93
Q

Complusions

A

BEHAVIOURS: repetitive seemingly purposeful. they feel driven to do these

94
Q

OCD:
Familial?
Comorbidities:
Gender:

A

Familial: yes
Comorbidities: 90%. PD, hypochondriasis, schizo, autism
Gender: slightly higher in females

95
Q

Poor prognosis in OCD

A

male, early onset, tics and multiple symptoms

96
Q

Neuroimaging in OCD

A

increased metabolism and blood flow in the orbitofrontal cortex, caudate nucleus and cingulate cortex

97
Q

What increases your risk of developing OCD in children

A

b-haemolytic strep and auto antibodies to the basal ganglia

98
Q

Anxiolytic

A

substance which inhibits anxiety

99
Q

Withdrawal symptoms of benzo

A

Decreased appetite
perspiration
tinnitus

100
Q

How to withdrawal from benzo (valium, Xanax)

A

Put patient on equivalent dose of diazepam/chlordiazepoxide

101
Q

Antidepressants and anxiety

A

Acutely SSRI increase extra-cellular 5-HT and have antigenic properties. When given chronically anxiolytic properties appear
Other drugs for anxiety= pregabalin, BB

102
Q

What is psychosis ?

A

Qualitatively different from normal experience
Inability to distinguish between subjective experience and reality
Lack of insight
Harmful to individuals functioning and interpersonal relationships

103
Q

Brain changes in schizophrenia

A

Reduced frontal lobe volume (with widened sulci)
Reduced frontal lobe grey mater
Reduced temporal cortex (esp superior temporal gyrus)
Enlarged lateral ventricle volume
Decreased cerebral (cortical and hippocampal) volume

104
Q

Dopamine pathways (thought to be overactive in schizophrenia)

A

MESOLIMBIC/CORTICAL - motivation and reward system
NIGROSTRIATAL - extra-pyramidal motor system
TUBEROINFUNDIBULAR - control of prolactin release

105
Q

What is in nigrostriatal?

A

substantial nigra, dorsal striatum

106
Q

What is in mesolimbic/cortisol pathway?

A

hippocampus, amygdala, prefrontal cortex, ventral trigeminal area, nucleus accumben

107
Q

Functional disorders?

A

symptoms that’s are unexplained by conventional physical disease processes or injuries.
It is likely that the symptoms are triggered by emotional change
Common!!

108
Q

Functional disordered are commonly associated with …

A

anxiety and depression disorders

109
Q

Examples of functional disorders

A

IBS, tension headache, fibromyalgia, chronic fatigue, irritable bladder

110
Q

Somatic features

A

Somatic symptom disorder involves having a significant focus on physical symptoms — such as pain or fatigue — to the point that it causes major emotional distress and problems functioning.

111
Q

Moderate depression vs Severe depression

A

Subthreshold depressive symptoms: Fewer than 5 symptoms of depression.

Mild depression: Few, if any, symptoms in excess of the 5 required to make the diagnosis, and symptoms result in only minor functional impairment.

Moderate depression: Symptoms or functional impairment are between ‘mild’ and ‘severe’.

Severe depression: Most symptoms, and the symptoms markedly interfere with functioning. Can occur with or without psychotic symptoms.

112
Q

What is needed for diagnosis of major depression

A

To diagnose major depression, this requires at least one of the core symptoms:

Persistent sadness or low mood nearly every day.
Loss of interests or pleasure in most activities.
Plus some of the following symptoms:

Fatigue or loss of energy.
Worthlessness, excessive or inappropriate guilt.
Recurrent thoughts of death, suicidal thoughts, or actual suicide attempts.
Diminished ability to think/concentrate or increased indecision.
Psychomotor agitation or retardation.
Insomnia/hypersomnia.
Changes in appetite and/or weight loss.

113
Q

How long to take anti-depressant for if she feels better?

A

for one episode the patient should continue taking medication for 6months- 1 year after feeling better

114
Q

Dopamine system dysfunction in psychosis?

A

Subcortical dopamine hyperactivity

115
Q

Dopamine system dysfunction resulting in negative and cognitive systems?

A

Mesocortical dopamine hypoactivity

116
Q

Grey matter function

A

Function. Grey matter contains most of the brain’s neuronal cell bodies. The grey matter includes regions of the brain involved in muscle control, and sensory perception such as seeing and hearing, memory, emotions, speech, decision making, and self-control

117
Q

What is grey matter lose due to?

A

Grey matter reductions due to reduced arborisation and not neuron loss

118
Q

D2 blockage in substantia nigra leads to…

A

Extra-pyramidal side effects

119
Q

D2 blockage in TUBEROINFUNDIBULAR leads to…

A

Hyperprolactinaemia

120
Q

Learning difficulty criteria

A

IQ <70
Age <18
Deficit in adaptive functioning

121
Q

Severity of learning difficulty

A

Mild LD IQ 50-69 (most common)

Moderate LD IQ 35-49

Severe LD IQ 20-34

Profound LD IQ < 20

Borderline LD IQ 70+

122
Q

Chromosomal abnormalities
Downs syndrome

Patau syndrome

Edwards syndrome

cri du chat

Angelman

Prader-Willi

Velo-cardiofacial syndrome

Williams syndrome

A 
Downs syndrome (Trisomy 21)  1/1000 births(maternal age 30) IQ 30-55, associated with Alzheimer Dem
94% sporadic,  3-5 % familial, 1-3% mosaicism

Patau syndrome Trisomy 13 0.2/1000 (18% survive 1 year)

Edwards syndrome Trisomy 18 0.3/1000 (10% survive 1 year)

cri du chat 5P- microcephlay severe/profound LD

Angelman 15Q- (maternally derived) LD, ataxia, paroxysms of laughter

Prader-Willi 15Q- (paternally derived) LD, over eating, self injurious behaviour

Velo-cardiofacial syndrome 22Q- 50% have LD, increased risk of schizophrenia

Williams syndrome 7Q 1/7500

123
Q 
Sex chromosomes 
turners
Trisomy X
Klinefelters
Fragile X
A 
Turners 45, XO  LD rare
Trisomy X,  47 XXX
Klinefelter    XXY 
XYY male - IQ may be slightly lower than average
Fragile X – 1/1000 
	Due to faulty FMR1 gene
124
Q

Triad for ASD

A

Language impairment
social deficit
Repetitive behaviour

medicine (8 decks)

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