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Psych Flashcards

1
Q

what are the 5 As of dementia?

A 
aphasia
amnesia
apraxia
agnosia
associated
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2
Q

how long must symptoms be present for to diagnose dementia?

A

6 months, must have no change in consciousness and symptoms must impair ADLs

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3
Q

what is BPSD

A

behavioural psychological symptoms of dementia

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4
Q

what are the areas of cognition?

A 
only the prettiest people can actually make love continuously
Orientation to 
Time
Person
Place
Concentration
Attention
Memory
Language
Construction
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5
Q

what are contraindications to acetylcholinesterase inhibitors?

A

bradycardia
peptic ulcers
COPD/ asthma

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6
Q

if no response to acetylcholinesterase inhibitors what could you try?

A

NMDA receptor agonist- memantine (not in epilepsy, parkinsons medication)

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7
Q

what are the 5 pathological findings in Alzheimer’s?

A 
neurofibrillary tangles
Tau proteins
B amyloid plaques
reduced levels of ACh
cerebral atrophy
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8
Q

what genetic condition increases your risk of Alzheimer’s?

A

Down’s

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9
Q

which medications are protective for Alzheimer’s?

A

statins, NSAIDs (long term), HRT

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10
Q

what is echolalia?

A

repeats what you are saying

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11
Q

what is palilalia?

A

repeats own words

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12
Q

what is perseveration?

A

patient continues to answer the same question despite a new question being asked

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13
Q

what is confabulation?

A

patient invents things without noticing

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14
Q

what is concrete thinking?

A

focusing on the facts, and the here and now

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15
Q

which assessment can be used to assess the areas of cognition?

A

primary care- GPCOP, 6-CIT

secondary care- MOCA, ACE III

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16
Q

what can be used to assess frontal lobe function?

A

luria hand test, tap test

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17
Q

other than medication what else should be considered in Alzheimer’s?

A

referral to memory team for cognitive rehabilitation/ training
emotional support
carer support
treat co-morbid anxiety/ depression
occupational therapy
social care (financial support, daycare, sitting, respite care, dementia cafe etc)

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18
Q

why should antipsychotics be avoided in BPSD?

A

increased risk of stroke, antidepressants especially mirtazapine

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19
Q

what are the non-core symptoms of lewy body dementia?

A

sleep REM disorder (acting out dreams)
severe neuroleptic sensitivity
SPECT (DaT) scan changes

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20
Q

what are the 3 core features of LBD?

A

fluctuations in cognition
spontaneous motor features of parkinsons
visual hallucinations

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21
Q

what are the Ninds-Airden criteria?

A

diagnosis if vascular dementia- presence of dementia, presence of cerebrovascular disease and relationship between the 2 inferred by; onset of dementia within 3 months following the stroke, abrupt or stepwise progression

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22
Q

Life expectancy of Alzheimers/ LBD/ Vascular dementia?

A

Alzheimer’s 6-8 years
LBD 6 years
Vascular 3-5 years

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23
Q

what type of dementia has the earliest onset?

A

frontotemporal, 45-60

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24
Q

what are the main differences between dementia and delirium?

A

speed of onset, no change in consciousness in dementia

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25
Q

for how long should a patient have symptoms of dependence for a diagnosis?

A

12 months

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26
Q

what are the 6 diagnostic criteria for dependence?

A 
cravings
withdrawal symptoms
tolerance
impaired ability to control use
neglect of pleasures/ other interests in favour of alcohol
persistent use despite evidence of harm
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27
Q

other than the CAGE questionnaire what other tools can be used to assess alcohol dependence?

A

CIWA, AUDIT

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28
Q

what are the withdrawal symptoms of alcohol?

A

6-12 hours: “shakes”, retching, insomnia
12-24 hours: hallucinations- tactile/ auditory
24-48 hours: DT- Delirium, seizures, persecutory delusions, coarse tremor, autonomic disturbances, insomnia
3-4 days: exhaustion and patchy amnesia

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29
Q

what is Wernicke’s?

A

caused by low thiamine, delirium, ataxia, nystagmus, ophthalmoplegia

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30
Q

what is korsakoff’s?

A

untreated Wernicke’s: hallucinations, amnesia, confabulation

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31
Q

treatment in acute alcohol withdrawal

A

thamine (pabrinex), chlordiazepoxide 20mg QDS to prevent seizures, lorazepam if seizing, motivational interview, counselling

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32
Q

treatment in chronic alcohol withdrawal

A

disulfram (antabuse)
acamprosate- must be continued for 6 months, reduces cravings
AA, CBT

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33
Q

how does alcohol affect the brain?

A

GABA agonist, depressant

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34
Q

what is a delusion?

A

a false unshakeable belief
despite evidence to the contrary
not shared by others in the same culture
held with intense personal conviction

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35
Q

what is a hallucination?

A

a perceptual experience without a stimulus but believed to be real (if know not real ie “in mind’s eye then is a pseudohallucination)

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36
Q

give an example of 1st person auditory hallucination

A

thought echo

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37
Q

what is 2nd person auditory hallucination?

A

someone talking to you eg command

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38
Q

what are 3rd person hallucinations?

A

talking about you eg running commentary

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39
Q

what are hallucinations as you fall asleep called?

A

hypnagogic hallucinations

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40
Q

how long must symptoms be present for a diagnosis of schizophrenia?

A

> 1 month

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41
Q

what are Schneider’s 1st rank symptoms

A 
thought echo
thought insertion
thought withdrawal
thought broadcasting
delusional perception
delusions of control/ passivity (actions/ emotions/ somatic)
3rd person auditory hallucinations
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42
Q

what are positive symptoms of schizophrenia?

A

hallucinations
delusions
thought disorder

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43
Q

which part of the dopamine pathway is responsible for positive symptoms?

A

increased dopamine in mesolimbic

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44
Q

which part of the dopamine pathway is responsible for negative symptoms?

A

mesocortical (reduced dopamine)

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45
Q

which part of the dopamine pathway is responsible for EPSEs?

A

nigrostriatal pathway

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46
Q

which part of the dopamine pathway is responsible for hyperprolactinaemia?

A

tuberoinfundibular pathway

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47
Q

what are the negative symptoms of schizophrenia?

A 
avolition (reduced motivation)
anhedonia
alogia (poverty of speech)
asociality
blunted affect
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48
Q

when can schizophrenia not be diagnosed?

A

if concurrent affective disorder (unless schizophrenia preceded this-> psychoaffective disorder)
during periods of intoxication/ withdrawal
not in presence of overt brain disease (eg epilepsy)

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49
Q

what are the medical treatments for schizophrenia?

A

antipshychotics

short term- hypnotics for sleep such as zopiclone, fluids/ TPN?

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50
Q

what non-medical treatments are there for schizophrenia?

A 
educate- avoid alcohol, sleep deprivation, drugs
CBT
family therapy
CRISIS team intervention first
crisis plan for relapse
supported employment
drug counselling
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51
Q

poor prognosis factors for schizophrenia?

A 
early age of onset
male
single
drug use
abnormal premorbid personality
Family history
delay in treatment
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52
Q

name some typical antipsychotics?

A

haloperidol

prochlorperazine

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53
Q

what are contraidications to typical antipsychotics?

A

elderly- increased risk of stroke

parkinsons

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54
Q

what do antipsychotics interact with?

A

QT prolonging drugs- SSRIs, quinines, macrolides

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55
Q

what are acute dystonic reactions?

A

Parkinsonian movements/ muscle spasms, treat with procyclisine

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56
Q

what is akithisia?

A

feeling of inner restlesness, treat with beta blockers

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57
Q

what is tardive dyskinesia?

A

pointless repetitive movements, may not stop on stopping antipsychotic. treat with procyclisine

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58
Q

what is neuroleptic malignant syndrome?

A

rare life-threatening response to antipsychotics. rigidity, confusion, autonomic dysregulation, pyrexia, increased risk in LBD

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59
Q

name some atypical antipsychotics?

A

quetiapine
olanzapine
risperidone
clozapine

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60
Q

which class of antipsychotics work better on negative symptoms?

A

atypical/ 2nd generation

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61
Q

What are some side effects of atypical antipsychotics?

A

if end in “-pine” metabolic SEs-> weight gain, DM, lipid changes
risperidone- hyperprolactinaemia-> breast symptoms and sexual dysfunction
all- prolonged QT
clozapine- agranulocytosis

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62
Q

which atypical antipsychotic is most effective?

A

clozapine, but reserved for resistant cases as can cause agranulocytosis

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63
Q

what is schizotypal disorder?

A

chronic (>2 years) odd beliefs but not delusions and no hallucinations, unconventional beliefs and asocialisation

64
Q

what is chronic low mood that doesn’t fulfil the criteria for depression called?

A

dysthymia

65
Q

how long must depressive symptoms be present for diagnosis?

A

> 2 weeks

66
Q

what are the 3 core symptoms of depression?

A

anhedonia
low mood, ? worse in am
low energy

67
Q

what are the classifications of depression?

A

mild 2 core + 2 other
moderate 2 core + 3 other
severe 3 core +4 other

68
Q

what are non-core features of depression?

A 
initial insomnia
reduced appetite
reduced concentration/ attention
guilt/ hopelessness
suicidal thoughts
reduced libido
69
Q

what are the core features of mania?

A 
elevated mood
gaiety/ irritability
distractable/ impulsive
reduced concentration
flight of ideas/ pressured speech
ideas of grandeour
reduced need for sleep
70
Q

what is hypomania?

A

present > 4days, some insight, no psychosis symptoms

71
Q

what criteria should be met for a diagnosis of mania?

A

symptoms present >7 days, symptoms of psychosis, no insight, severe disruption of ADLs

72
Q

treatments of mania/ hypomania?

A

hypomania-> IAPT, CBT, IPT

mania atypical antipsychotics.mood diary

73
Q

what is a milder version of bipolar affective disorder known as?

A

cyclothymia

74
Q

what are the classifications of bipolar affective disorder?

A

type 1; at least 1 episode depression + at least 1 episode mania lasting > 7 days
type 2; at least 1 episode depression + at least 1 episode hypomania lasting > 4 days

75
Q

how is bipolar affective disorder treated?

A

mood stabilisers- Lithium, sodium valproate, carbamezapine

in depressive episode SSRI + antipsychotics (to prevent mania)

76
Q

how long must symptoms be present for a diagnosis of generalised anxiety disorder?

A

6 months- excessive worrying more days than not

77
Q

what are the non-pharmacological treatments of anxiety?

A

self-help/ psycho-education groups
CBT
applied relaxation

78
Q

what are the pharmacological treatments of anxiety?

A

SSRI
BB for peripheral symptoms?
not benzos

79
Q

criteria for diagnosis of panic disorder?

A

> 1 month of attacks of severe anxiety, + fear of attacks + behavioural changes as a result

80
Q

what advice can you give in a panic attack?

A

try to focus on objects around you
breathe in for 5 and out for 5
focus on senses eg touch something soft
stomp on the spot

81
Q

how is panic disorder treated?

A

CBT
SSRI (can often increase frequency of attacks first)
avoid caffeine/ alcohol/ substance abuse
increase exercise

82
Q

what is agoraphobia?

A

anxiety provoked by large, open spaces

83
Q

what is social phobia?

A

fear of crowded places

84
Q

What 2 criteria define OCD?

A

obsessional thoughts- recurrently enter a patients mind, knows own thoughts but can’t dismiss them
compulsive acts- repetitive behaviours, give no pleasure and recognised as pointless, often done to avoid an unlikely event

85
Q

what are the treatments for OCD?

A

combined pharmacological and non-pharmacological works best
CBT/ exposure and response prevention, repeated graded exposure
SSRI esp fluoxetine/ sertraline/ TCA

86
Q

what is an acute stress reaction?

A

emotional reaction to severe physical/ mental stress,
appears minutes- hours after event and lasts 2-3 days
may have amnesia, disorientation

87
Q

when does the onset of PTSD occur?

A

months- years after the event (usually <6months)

88
Q

name some symptoms of PTSD

A 
re-experiencing of events through "day-dreams"/ dreams
flashbacks
avoidance of activities
rumination
increased startle reaction
numbness and emotional blunting
89
Q

what is the treatment for PTSD?

A

psycho- trauma focussed CBT, eye movement desensitision + reprocessing (EMDR), relaxation therapy
bio- SSRI or mirtazipine if co-morbid depression

90
Q

how long should “normal” grief last?

A

< 2 years (would expect <6 months)

91
Q

what are the stages of grief?

A 
shock
denial
anger (self-blame?)
bargaining
depression
testing
acceptance
92
Q

what is an abnormal grief reaction?

A

delayed onset
prolonged
delay at 1 stage for a long time

93
Q

what are risk factors for an abnormal grief reaction?

A

sudden death
having to put on a brave face eg if has kids
ambivalent relationship

94
Q

what is conversion disorder?

A

anxiety causing medically unexplained neuro symptoms eg amnesia, pseudoseizures, paralysis

95
Q

what is munchausen/ facticious syndrome?

A

invents symptoms to be cared for

96
Q

what is somatisation disorder?

A

medically unexplainable symptoms

97
Q

what is malingering?

A

invention of symptoms for secondary personal gain such as avoiding prosecution

98
Q

how does hypochodrial disorder differ from somatisation?

A 
somatisation= unexplainable symptoms
hypochondria= patient thinks they have disease
99
Q

what are common types of purging?

A 
diet pills
laxatives
diuretics
exercise
vomiting
100
Q

what is the definition of anorexia?

A

weight <15% expected/ BMI <17.5

+ secondary endocrine/ metabolic disturances

101
Q

what are complications of anorexia?

A 
amenorrhoea
loss of libido
myopathy
bradycardia
hypotension
electrolyte imbalances-> arrhythmias
osteoporosis
renal failure
pancreatitis/ hepatitis
seizures
peripheral neuropathy
102
Q

what guidelines should be consulted in the management of someone with anorexia nervosa?

A

MARSIPAN guidelines

103
Q

which SSRI is most effective in bulimia?

A

fluoxetine

104
Q

borderline personality disorder

A

instability in interpersonal relationships, self-image, affect. impulsivity

105
Q

antisocial personality disorder

A

disregard for/ violation of the rights of others

106
Q

histrionic personality disorder

A

excessive emotion, attention seeking

107
Q

narcissistic personality disorder

A

grandiosity, need for admiration

108
Q

avoidant personality disorder

A

social inhibition, feelings of inadequacy, hypersensitivity to negative evaluation

109
Q

dependent personality disorder

A

clingy behaviour

110
Q

schizoid personality disorder

A

detachment from social relationships, reduced emotional expression

111
Q

paranoid personality disorder

A

distrust and suspiciousness

112
Q

obsessive-compulsive personality disorder

A

preoccupied with orderliness, perfectionism and control

113
Q

schizotypal personality disorder

A

acute discomfort in close relationships, cognitive or perceptual distortions, eccentric behaviour

114
Q

what are contraindications to SSRIs?

A

peptic ulcers, epilepsy, previous mania (can increase recurrence)

115
Q

what are side effects of SSRIs?

A

GI upset
headaches and drowsiness
increased suicide risk
withdrawal symptoms if stopped suddenly (insomnia, hyperarousal)

116
Q

which drugs do SSRIs interact with?

A

NSAIDs (increased risk of GI bleed)
QT prolonging drugs
MAOI (risk of serotonin syndrome)

117
Q

what is serotonin syndrome?

A 
autonomic hyperactivity (fever) + altered MS + muscular excitation-> tremor
seizures
118
Q

give an example of an SNRI

A

venlafaxine

119
Q

what should venlafaxine be avoided in?

A

CVD

120
Q

what class of antidepressant is mirtazipine in?

A

NaSSa

121
Q

What are 2 advantages of mirtazipine?

A

increased appetite

sedative effect

122
Q

what are some side effects of TCAs?

A

antimuscarinic (dry mouth, constipation, urinary retention, blurred vision) sedation and weight gain, prolonged QT and heart block

123
Q

when should TCAs be avoided?

A

recent MI/ CVD
severe liver disease
epilepsy
recent suicide attempt (TCAs toxic in OD)

124
Q

what foods should be avoided with MAOIs?

A

tyramine rich foods; cheese, red wine, smoked fish
also decongestants
cause a hypertensive crisis

125
Q

what is DBT used for (dialectical behavioural therapy)

A

personality disorders

126
Q

how long is a course of ECT?

A

2x a week for 12 weeks

127
Q

what is the response rate for ECT?

A

70-80%

128
Q

what are side effects of ECT?

A

Nausea,
headache
amnesia around time of ECT

129
Q

how long post-recovery should antidepressants be continued for?

A

6 months

130
Q

what level of Li is toxic?

A

> 1.5mmol/L (TI is 0.5-1)

131
Q

how often should Li levels be checked?

A

initially after 5 days
then weekly until stable for 4 weeks
then every 3 months

132
Q

what other bloods should be checked regularly if on Li?

A

check renal function before starting
6 monthly TFT, U&Es, Ca
pregnancy test? avoid in pregnancy

133
Q

Side effects of Lithium

A 
GI
metallic taste
fine tremor
thirst, polyuria, oedema/ weight gain
long term- hypothyroidism, renal tox, diabetes insipidus
134
Q

symptoms of Li toxicity?

A

coarse tremor, Vomiting, dysarthria, dizziness, ataxia, delirium, fits

135
Q

interactions of Li

A

avoid with NSAIDs and ACEIs/ thiazides as impair excretion

136
Q

suicidal assessment, what do you want to know about the lead-up to the event?

A
  1. precipitant eg argument with spouse
  2. was it planned
  3. final acts- note, will, cancel direct debits eg gas
  4. precaution against discovery
137
Q

suicidal assessment, what would you like to know about the event?

A
  1. method, including where procured weapon/ medication
  2. alcohol involved
  3. what was their intention
138
Q

suicidal assessment, what would you like to know about after the event?

A
  1. did they call anyone
  2. how did they feel when help arrived
  3. current mood/ intention
  4. protective factors
139
Q

in a suicidal assessment how would you screen for other mental health disorders?

A

depression: anhedonia, low mood, fatigue
psychosis: “are the thoughts to hurt yourself ever not your own?”, hear voices
alcohol dependency
anorexia

140
Q

what investigations if suscpecting dementia?

A

Bloods: FBC, U+E, LFT, ESR/CRP, B12/ folate, Ca to look for reversible causes
CT head

141
Q

AMTS questions

A
  1. Year
  2. Time
  3. Age
  4. DOB
  5. where are we
  6. give address
  7. count 20-1
  8. ww2 date
  9. current monarch
  10. name 2 people
142
Q

what symptoms should you warn someone of if starting them on galantamine/ rivastigmine/ donepazil?

A

initially GI disturbance, sleep disturbance and muscle cramps, Should settle in <3 weeks

143
Q

What imaging would you do if suspecting frontotemporal dementia and what would it show?

A

MRI, frontotemporal atrophy

144
Q

mnemonic for assessing risk

A 
DR SONEC:
Driving
Self
Others
Neglect
Exploitation
Children
145
Q

how would you treat an abnormal bereavement reaction?

A

bereavement counselling, CBT, monitor suicide risk

146
Q

pseudodementia

A

cognitive impairment arising from depression

147
Q

first line treatment for mild depression?

A

CCBT/ self help
sleep hygiene
activity programmes
social e.g- citizens advice bureau for financial issues

148
Q

when are first line treatments for mild depression not appropriate?

A

when symptoms have been present >/= 2 years or PMHx of moderate/ severe depression

149
Q

Non-pharmacological treatment of moderate depression?

A

CBT
IPT
Behavioural activation
psychodynamic therapy

150
Q

which side effect of SSRIs is it important to make men aware of?

A

erectile dysfunction (other side effects include muscarinic, and hyponatraemia)

151
Q

what is a section 2?

A

allows section for 28 days
must be signed by 2 doctors and ASW (one should know patient, ASW= Approved social worker)
cannot be renewed
for assessment

152
Q

what is a section 3?

A

for treatment, last 6 months
can be renewed
ASW must seek approval of relatives

153
Q

What is a Section 4?

A

admission for emergency
lasts 72 hours
must be signed by 1 doctor and ASW
can be converted to section 2 after review by another doctor

154
Q

What is a section 135?

A

police enter patients house and remove to place of safety for 72 hours

155
Q

what is a section 136?

A

police pick up a patient from public place and take to place of safety

156
Q

investigations pre starting an antipsychotic?

A 
ECG and HR
Prolactin, lipids, cholesterol
HbA1c
FBC, U+E, LFT
weight and BP

Psych (3 decks)

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