Psych Flashcards
Units in a bottle of red wine
10
Recommended Tx plan for pt injecting heroine mixed with crack
- # 1: Confirm opiates + titrate onto methadone
Initial dose is determined by titration: give them small amount and watch, and increase dose until the withdrawal Sx are gone
-#2: harm reduction: needle exchange + HIV test
Define dependence syndrome
3 or more at once in the last year:
- Strong desire or compulsion to use
- Persistent use despite adverse consequences
- Difficulty controlling use
- Neglect of other activities
- Withdrawal symptoms
- Tolerance to effects o the drug
Normal changes to raging brain
- Ventricle size increases
- Cortical weight decreases
- Nerve cell loss in cortex/hippocampus/cerebellum/fewer cell connection
- Amyloid plaques, protein tangles, Lewy bodies = this doesn’t result in Sx
Features required to diagnose dementia
Triad:
- Cognitive decline (eg poor MoCA score)
- Functional decline
- Irreversible
(+ not organic cause)
Delirium
Disturbance of CONSCIOUSNESS and change in COGNITION that develop over SHORT period of time
Types of hallucination most common in dleirium
Visual or Tactile
Mx of delirium
- Prevention - hydration,
- Review medications
- Tx the cause
- Environmental management - access to natural light, remind them of time place person
Sx-atic Tx: only if necessary for SAFETY or DISTRESS of patient
e.g. small doses of Benzos or Antipsychotics
1 Mx for someone with high risk of developing Wernicke’s
High potency vitamins - Pabrinex
Frontal lobe dementia suspected. What abnormal findings would you expect to be elicited: - L R disorientation - Alexia - Impaired understanding of proverbs - Word salad -
- Impaired understanding of proverbs
How to assess cognition and consciousness - give 4 egs
GCS
Orientation to TPP
AMTS
MMSE
6 key things to ask in suspected dementia
Memory Orientation Judgment/problem solving In home Outside home
How to assess attention/executive function?
Take 7 from 100
How to test memory
Apple
Pen
Table
^ ask them if they’ve heard it, then recall
3 features of frontal lobe problems
Disinhibition
Poor motivation
Perseveration
How to test frontal lobe function
Can you say as many words as you can beginning with F
- test vocabulary, if they say fuck (disinhibition),
How to test abstract thinking
“Too many cooks spoil the broth”
what do you think this means?
Frontal lobe dysfunction –> will take it way too literally
Define psychosis
Loss of contact with reality
First rank Sx of schizophrenia
- Controlled by others
- Thought disorder
- Running commentary/thought echo
- 3rd person hallucinations
Risk of relapse in a pt with 1st episode psychosis with a family of highly expressed emotion
60%
What is the disorder:
“The train rain braine me. He ate the skate, inflated yesterdays”
Clang associations
Capgras Syndrome
Delusions that someone you know has been exchanged for someone else - a fixed belief
“I know it sounds silly but i can’t get it out of my head that my baby has been exchanged for my neighbour’s little girl”
OCD
Ekbom’s syndrome
Delusional parasitosis
Simple schizophrenia
Made up entirely of -ve Sx
Name the 4 affective disorders
Manic episode
Depression
BPAD
Recurrent depressive episodes
Hypomania vs Mania
Mania = uncontrollable and the focus can’t be maintained on anything
Organic causes of mania
Amphetamines, steroids, antidepressants, dopamine
Hyperthyroidism
Treatment of acute mania
Benzodiazepines and atypical antipsychotics
What constitutes severe depression
affects FUNCTION - stop caring for others or themselves
Organic causes of depression
B-blockers Digoxin Anti epileptics Cushings Addisons Hypothyroidism
indications for ECT
Severe depression
Severe mania
Catatonia
Lithium toxicity - at what level? 4 Sx?
> 1.2mM/L
- Gross tremor, fits, ataxia
- Renal failure
- GI disturbance
- Sluggishness
Hypertensive crisis due to which psych drug
Monoamine oxidase inhibitors - moclobamide
Citalopram - 3 most common side effects
Anxiety
GI side effects
Erectile dysfunction
agoraphobia
Panic attack when in a place that is difficult/embarassing to escape from
Conversion disorder vs Somatisation
Conversion disorder - “i have this abdo pain but it’s cos i have pancreatitis”
Tx of anxiety disorders
Bio: SSRIs. Can consider b-blockers, GABA
Psych: CBT.
Stereotactic cingulotomy - for what ?
severe OCD
Mindfulness awareness - what kinda therapy is this?
Dialectical behavioural therapy
monoamine oxidase inhibitors. Name 1?
Tranylcypromine
Monoamine oxidase inhibitors: which foods must be avoided?
Cheese Marmite Oxo Bovril Pickled herring
flight of ideas linked only by rhyme/similar sounding words. What is this phenomenon called?
Clang associations
management of hypomania in pt with known BPAD?
Refer to CMHT
antidepressant of choice for depressive episode in BPAD?
Fluoxetine
Mx of mania in BPAD?
Antipsychotic eg haloperidol/olanzapine
Serious side effects of clozapine - name 3
Agranulocytosis
Cardiac arrhythmia
Myocarditis
Stepwise approach to GAD?
- education + active monitoring
- Low intensity psych therapy (guided self help + group therapy)
- High intensity i.e. CBT
- Medications - SSRI
Stepwise approach to panic disorder
- education + counselling
- CBT +/- SSRI
- Alternative treatment
- Secondary care referral
Most appropriate treatment for PTSD
Trauma focused CBT
do active monitoring in first 4 weeks without constant recounting of traumatic event (could make things worse!)
Drug treatments used for severe PTSD
Paroxetine/mirtazapine
Short term side effects of ECT
Amnesia generalised convulsions Arrhythmia Headache Nausea
psych drug to avoid in those with long QT?
Citalopram
WTF is a delusional perception
‘i saw socks hanging on the washing line and i knew that meant aliens were coming’
(the socks not he washing line are legit)
Why do we worry about giving zopiclone to elderly patients?
increased falls risk
Tx for alcohol withdrawal symptoms
chlordiazepoxide
Define akathisia
Severe restlessness
useful antidepressant for patient who is losing weight
mirtazapine
Which antipsychotic can reduce seizure threshold
Clozapine
What is conversion disorder
Non-deliberate loss of function (usually motor/sensation)
Normal MMSE score
24-30
2 drug tx for PTSD
paroxetine + mertazapine (not fluox)
How does EtOH and smoking affect clozapine leels
EtOH - increases clozapine levels
Smoking - reduces clozapine levels
When is the peak incidence of delirium tremens after alcohol withdrawal?
72 hours
Memory loss in dementia vs depression
Dementia - loss of recent events
depression - global loss
Major risk of giving ssri to a patient on NSAIDs?
GI bleeding. therefore, give PPI as well
2 examples of acute dystonia
Oculogyric crises
Torticollis
When to stop giving antidepressant medication?
Continue antidepressant until 6 months post-remission
- gradually reduce dose over 4 weeks
Duloxetine - MOA?
Name a drug with the same MOA
SNRI
Venlafaxine
Cotard syndrome
Nihilistic delusion
De Cleremabut’s
Delusion that someone else is infatuated with self
Cause of highest mortality in clozapine patients
Complication of chronic constipation –> obstruction + GI perforation
Charles Bonnet SYndrome
Visual hallucinations associated with visual impairment
Which antidepressant class is associated with anticholinergic side effects? give an eg
TCA
eg amitriptyline
SSRIs in pregnancy - what risk does it pose in third trimester?
Persistent pulmonary HTN
Particular risk with antipsychotics in elderly patients?
Stroke and VTE
How to differentiate e between mania and hypomania
no psychotic sx in hypomania
what levels are raised in anorexia nervosa
Glucose GH Carotene Cholesterol Cortisol
which antipsychotic is least likely to cause hyperprolactinemia
aripiprazole
Questionnaire for depression screeing
PHQ9
