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Phase 3a Jess > Psych > Flashcards

Psych Flashcards

1
Q

How long do depressive symptoms have to persist to make a diagnosis of depression?

A

2 weeks

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2
Q

What are the 3 key symptoms of depression?

A
  1. Low mood
  2. Anhedonia
  3. Energy loss
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3
Q

How do you define mild depression?

A

5 symptoms of depression AND mild functional impairment

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4
Q

How do you define severe depression?

A

Most symptoms, marked functional impairment with or without psychotic symptoms

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5
Q

Give two ways of assessing depressive symptoms

A
  1. Patient Health Questionnaire 9 (PHQ-9)

2. Hospital Anxiety snd Depression Scale (HAD score)

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6
Q

What might happen if you mix SSRI with MAO inhibitor?

A

Serotonin Syndrome

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7
Q

What key condition should tricyclics be avoided in?

A

Heart failure

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8
Q

Give and example of a MAO inhibitor

A

Phenelzine

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9
Q

What is the risk of using MAO inhibitors?

A

Hypertensive crisis

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10
Q

What might trigger bad side effects in patients on MAOis?

A

Tyrosine (avoid cheese, red wine, broad beans)

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11
Q

What drug class is Mirtazipine?

A

Noradrengergic and specific seretonergic antidepressant

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12
Q

What 4 drugs might cause serotonin syndrome?

A

SSRIs
MAO inhibitors
Amphetamines
Ecstasy

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13
Q

Give some autonomic symptoms of serotonin syndrome

A 
Tachycardia
Sweating
Fever
Tachypnoea
Fever
Arrhythmia
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14
Q

Give some cognitive symptoms of serotonin syndrome

A

Agitation
Confusion
Hallucination

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15
Q

Give some neuromuscular symptoms of serotonin syndrome

A

Tremor
Ataxia
Seizures

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16
Q

How long does hypomania need to last diagnostically?

A

<4 days

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17
Q

How to long does mania need to last diagnostically?

A

> 7 days

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18
Q

What is the DSM-IV-TR definition of ‘Bipolar’?

A

Manic episode +/- depressive

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19
Q

What must you be careful about when initiating treatment for someone with a long Hx of psych problems, but only just being diagnosed with bipolar?

A

Make sure you stop any SSRI treatment!!!!

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20
Q

What type of medication is given for people with bipolar?

A

Mood stabilisers

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21
Q

Give 3 different examples of mood stabilisers

A
  1. Lithium
  2. Antiepileptics (valproate, carbamazepine)
  3. Antipsychotics (used in acute mania)
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22
Q

Why is lithium the favoured medication for bipolar?

A

It treats both mania and depression

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23
Q

Why do patients on lithium need to be closely monitored?

A

Lithium has a very narrow therapeutic range

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24
Q

What do you need to monitor if a patient is on lithium?

A
  1. Renal function (creatinine, U+E)

2. TFT’s (hypothyroidism)

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25
Q

What are the side effects of lithium?

A 
L - Leukocytosis
I - Insipidus
T - Tremor
H - Hypothyroid
I - Increased 
U - Urine
M - Mums - teratogenic
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26
Q

What are some signs of lithium toxicity?

A

Blurred vision, weakness, coarse tremor, ataxia, nausea, vomiting, oliguria, coma

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27
Q

According to WHO, what 4 domains are affected in schizophrenia?

A
  1. Thinking
  2. Language
  3. Perception
  4. Sense of self
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28
Q

How long do symptoms need to last in order to get diagnosed with schizophrenia?

A

1 month

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29
Q

What are some 1st rank symptoms in schizophrenia?

A 
Delusional perception
Auditory hallucinations - 3rd person
Thought insertion
Thought removal
Thought broadcasting
Somatic passivity
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30
Q

What are some negative symptoms in schizophrenia?

A

Flat affect
Lack of motivation
Anhedonia
Poverty of speech

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31
Q

Side effects of of atypical antipsychotics

A 
Metabolic syndrome
T2DM
Stroke
Weight gain
Sedative
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32
Q

What are the conditions for trying clozapine?

A

Must have tried 2 drugs for 6 weeks each

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33
Q

What do you need to look out for when a patient is on clozapine?

A

Agranulocytosis

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34
Q

What happens in acute dystonia?

A
  • Facial grimacing
  • Involuntary upward eye movement
  • Muscle spasms of the tongue, face, neck and back
  • > back muscle spasms cause the trunk to arch forward)
  • Laryngeal spasms
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35
Q

What syndrome might occur when starting or increasing dose of antipsychotics?

A

Neuroleptic Malignant Syndrome

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36
Q

What are the symptoms of Neuroleptic Malignant Syndrome?

A 
Autonomic instability
Fever
Stiffness (lead pipe)
Seizures
Coma
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37
Q

What would you expect from an ABG of someone with neuroleptic malignant syndrome?

A

Metabolic Alkalosis

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38
Q

What blood marker might be raised in neuroleptic malignant syndrome?

A

Creatinine kinase

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39
Q

How would you treat neuroleptic malignant syndrome?

A

IV fluids - prevent AKI
Benzodiazepines
Bromocriptine
Muscle relaxants

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40
Q

Name 5 anxiety disorders

A
  1. Generalised anxiety disorder
  2. Panic
  3. Post-traumatic stress
  4. Phobias
  5. Obsessive compulsive
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41
Q

How do you define the obsessions of OCD?

A

Uncontrollable, intrusive, recurrent thoughts of distressing nature

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42
Q

What is a phobia?

A

A strong, irrational fear or something that poses little or no real danger

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43
Q

Symptoms of PTSD (6)

A 
Intrusive thoughts of traumatic event
Nightmares
Flashbacks
Isolation
Angry outbursts
Hypersensitivity
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44
Q

What is a personality disorder?

A

Rigid, maladaptive traits that cause great distress or an inability to get along with others

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45
Q

What type of behaviours do cluster A PD have?

A

Odd or eccentric

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46
Q

What are 3 examples of cluster A PD?

A

Paranoid
Schizoid
Schizotypical

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47
Q

What type of behaviours do cluster B PD have?

A

Emotional, dramatic or erratic

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48
Q

What are 4 examples of cluster B PD?

A

Borderline
Antisocial
Histrionic
Narcissistic

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49
Q

What type of behaviours do cluster C PD have?

A

Anxious or fearful

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50
Q

What are 3 examples of cluster C PD?

A

Obsessive compulsive
Dependent
Avoidant

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51
Q

Features of schizoid PD?

A

Detached and cold
Doesn’t interact with others
Rich fantasy world
No eye contact

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52
Q

Features of schizotypical PD?

A

Odd ideas and behaviour
Lack or inappropriate emotion
May have hallucinations/delusions but not significant to diagnose schizophrenia

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53
Q

Features of antisocial PD?

A

Incapable of empathy
Manipulative behaviour
Impulsive
Aggressive (quick temper)

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54
Q

Features of BPD?

A

Low self esteem, intense feeling of rejection
Develops very intense feelings for people very quickly
Find it hard to control emotions they feel very intensely -> emotional rollercoaster
Often self-harm, engage in risky behaviour
Associated with depression, alcohol abuse
Finds it difficult to cope with life stresses

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55
Q

Name risks for suicide

A 
Sex - male
Age under 19, or over 45
Depression
Previous suicide attempt
Ethanol abuse / drug abuse
Rational thinking loss - psychosis etc.
Separated from partner
Organised, well thought out attempt
No social support
Sickness e.g. chronic illness
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56
Q

What are the elements of capacity?

A
  1. Can understand information
  2. Can retain information
  3. Can weigh up pros and cons
  4. Can formulate and communicate a decision
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57
Q

How long does a section 2 last?

A

28 days

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58
Q

What is a section 2 used for?

A

Assessment - under section

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59
Q

What is required during a section 2?

A

The opinion of 2 doctors. One psychiatrist and one other doctor who has prior knowledge of the patient

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60
Q

Can a section 2 be renewed?

A

No

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61
Q

How long does a section 3 last?

62
Q

What is a section 3 used for?

A

Treatment (admission)

63
Q

What is required for a section 3?

A

2 doctors. One psychiatrist and one doctor who has prior knowledge of the patient

64
Q

Can a section 3 be renewed?

65
Q

What is a section 4 used for?

A

Emergency situations when only one person is available for assessment - to detain until another can be found

66
Q

How long does a section 4 last?

A

Up to 72 hours - patient must be seen in this time

67
Q

What is a section 5?

A

To detain when a patient is already in hospital

68
Q

Who can give a section 5?

A

Nurse or doctor

69
Q

What is a section 135 used for?

A

Allowing police to enter private property to take someone to a place of safety

70
Q

How long does a section 135 last?

71
Q

What is a section 136 used for?

A

Allowing police to take person from public place to place of safety

72
Q

How long does section 136 last?

73
Q

How do you diagnose panic disorder?

A

4 unexpected episodes in 4 weeks

74
Q

What treatment can you sometimes use in panic disorder/generalised anxiety, that you cannot use in PTSD?

A

Benzodiazepines

75
Q

What are 3 key symptoms for phobia disorders?

A
  1. Anxiety
  2. Anticipatory anxiety
  3. Avoidance
76
Q

What are is the age criteria for late onset schizophrenia?

A

> 45 years

77
Q

Why might late onset schizophrenia not be diagnosed until really late?

A

Elderly people with this condition tend to isolate themselves

78
Q

What is less likely to happen in late onset schizophrenia than in younger patients?

A

Emotional blunting
Personality decline
Negative symptoms

79
Q

What is different about the hallucinations in late onset schizophrenia?

A

In multiple modalities

80
Q

Does late onset schizophrenia have better or worse prognosis?

81
Q

What would suggest delusional disorder rather than late onset schizophrenia?

A

Long standing delusions, but no persistent hallucinations

82
Q

What would suggest psychotic depression rather than late onset schizophrenia? (4)

A
  1. Nihilistic delusions (Cotard’s syndrome)
  2. 2nd person derogatory auditory hallucinations
  3. Pain - somatic delusions
  4. Depression
83
Q

What is Charles Bonnet Syndrome?

A

When blind people have complex visual hallucinations

84
Q

What 3 conditions is ECT used in?

A
  1. Depression
  2. Catatonia
  3. Mania (only if not responding to Tx)
85
Q

What are the side effects of ECT?

A 
Retrograde amnesia
Prolonged seizure (>120 seconds)
Manic switch 
Headaches
Muscle pain
Mortality
86
Q

What types of disinhibition are seen in mania?

A
  1. Social
  2. Sexual
  3. Financial
87
Q

What do you need to be aware of when taking a newly diagnosed bipolar patient of antidepressants (previously used for suspected depression)?

A

Some antidepressants (e.g. paroxetine) have short half lives. Take off slowly

88
Q

What are the 3 types of acute confusion?

A

Hypoalert
Hyperalert
Mixed

89
Q

What time frame is criteria for acute confusion?

90
Q

What symptoms are in delirium that are not seen in dementia?

A

Inattention (cannot focus on tasks)

Fluctuations regularly

91
Q

How to manage delirium?

A 
Fluids
Encourage movement
Keep in own, quiet room
Keep clocks and calendars in room
Normalise sleep/wake cycle
92
Q

Name 3 different screening tools for Alzheimers

A
  1. Mini mental state exam
  2. AMTS
  3. MOCA
93
Q

What are the 2 microscopic changes in Alzheimer’s?

A
  1. Plaques (beta amyloid deposits between nerve cells)

2. Tangles (tau protein twists)

94
Q

What might you see on MRI head in Alzheimers?

A

Ventricules enlarged and cerebral atrophy

95
Q

What is different about Lewy body dementia?

A

No memory problems initially

Parkinsonisms

96
Q

Which dementia tends to present in younger patients (45-65)?

A

Fronto-temporal

97
Q

What is schizoactive disorder?

A

Psychosis AND mood disorder (depression/bipolar)

98
Q

Why might someone with anorexia have peripheral oedema?

A

Due to low albumin

99
Q

What might U and E’s show in someone with anorexia?

A

High urea

Low potassium and sodium

100
Q

What might LFTs show in someone with anorexia?

A

High ALT and AST

Low ALP

101
Q

What might a dipstick of someone with anorexia show?

102
Q

What do you need to be careful for in treatment of anorexia?

A

Refeeding Syndrome

103
Q

How might you notice re-feeding syndrome?

A

Pedal oedema due to vast fluid shifts

104
Q

What causes re-feeding syndrome?

A

Electrolyte imbalance due to too sudden change. Massive increase in insulin, which binds to cell walls and increases electrolyte absorption

105
Q

What might happen as a complication of re-feeding syndrome?

A

Prolonged QT syndrome
Weakness
Confusion
Neuromuscular dysfunction

106
Q

What is the most important thing to monitor in anorexia recovery?

A

POTASSIUM! (and other electrolytes/vital signs/ECG)

107
Q

What kind of scan might it be wise to give someone with anorexia?

108
Q

How do benzodiazepines work?

A

Increase GABA

109
Q

What are the side effects of Benzos?

A

Respiratory depression

Addiction

110
Q

What are the side effect of SSRIs?

A 
Increase bleeding
Hyponatraemia
Increase suicide potential
N and V
Insomnia
Low libido
111
Q

What are the side effects of tricyclics?

A

Sleepy

Dry mouth

112
Q

What are the side effects of 1st generation (typical) antipsychotics?

A

Parkinsonisms
Hyperprolactinaemia
Prolonged QT

113
Q

How do 1st gen (typical) antipsychotics work?

A

Block dopamine D2 receptors

114
Q

What is the main side effect of atypical antipsychotics?

A

Metabolic syndrome (weight gain, constipation, hyperlipidaemia)

115
Q

When might you consider trying Clozapine?

A

When 2 other atypicals have been tried

116
Q

What do you need to do extra for Clozapine patients?

A

Monitor FBC regularly for agranulocytosis

117
Q

What is the main complaint side effect when using clozapine?

A

Constipation

118
Q

What cannot be used alongside lithium?

A

ACEi or ibuprophen

119
Q

What causes Korsakoff’s? (1 mark)

A

Thiamine (B1) deficiency

120
Q

What can patients not do if they have Korsakoff’s?

A

Form new memories

121
Q

What are the symptoms of Korsakoff’s?

A

Can only retain old memories
Gait problems LONG TERM
Eye movement problems LONG TERM

122
Q

Where does Korsakoff’s permanently damage?

A

Cerebellum

123
Q

What are the 3 key symptoms for Wernicke’s?

A
  1. Ophthalmoplegia
  2. Ataxia
  3. Confusion
124
Q

Which muscle is most commonly affected in Wernicke’s?

A

Lateral rectus (causing lateral nystagmus)

125
Q

Where are the lesions in Wernicke’s?

126
Q

What is the treatment given during alcohol withdrawal?

A

Chlordiazepoxide

127
Q

What are some symptoms of delirium tremens?

A

Confusion, hallucinations, seizure, sweating, shaking

128
Q

What are 6 long term liver problems associated with alcohol?

A
  1. Hepatitis
  2. Clotting problems (10, 9, 7, 2)
  3. Asterixis
  4. Varices
  5. Hypoglycaemia
  6. Jaundice
  7. Low albumin
129
Q

Why do people with alcoholism end up malnourished?

A

Plugs form in the pancreatic ducts, causing blockage of digestive products and autodigestion

130
Q

Name cardiac problems associated with alcoholism?

A

Alcoholic myopathy
Hypertrophy
Atrial fibrillation

131
Q

What are the dysfunctional areas of development associated with autism?

A

Language and communication

Socialising

132
Q

What are the 2 key ASD traits?

A
  1. Social communication and interaction

2. Restricted or repetitive behaviour

133
Q

How does Aspergers differ to other autism?

A

No language or cognitive problems (just socialising and restricted behaviour)

134
Q

What are the criteria for being diagnosed with Tourette’s?

A

> 2 motor tics
1 vocal tic
Persisted for 1 year or more
Started before age 18

135
Q

What is the medication used for ADHD?

A

Methylphenidate

136
Q

What 3 key symptoms make up ADHD?

A
  1. Inattention
  2. Overly active
  3. Impulsive
137
Q

What age range is ADHD diagnosed?

A

6-12 years

138
Q

What time frame do symptoms need to persist in order to consider ADHD?

139
Q

What do you use to counteract opiate overdose?

140
Q

What do you use to counteract benzodiazepine overdose?

A

Flumazenil

141
Q

What do you use to counteract paracetamol overdose?

A

Acetylcystine

N.B. If <1h post-OD you can use activated charcoal

142
Q

What time do you need to treat paracetamol overdose in in order for there to be therapeutic benefit?

A

Under 8 hours

143
Q

Why might paracetamol overdose only present 24-72hours after the OD?

A

This is when acute liver failure occurs

144
Q

What do you need to measure in a suspected paracetamol OD?

A

Thrombin time
INR
Salicylate levels

145
Q

What symptoms would hint benzodiazepine OD?

A 
Slate grey cyanosis
Ataxia
Blurred and slurred
Euphoria
Agitated
146
Q

What conditions are antipsychotics used in (other than psychosis)?

A

ADHD
PTSD
OCD
Generalised anxiety

147
Q

What two organs are affected by lithium?

A
  1. Kidneys

2. Thyroid

148
Q

What do you need to be careful using SSRIs with? (and what do you need to do about it)

A

NSAIDs - prescribe PPI with it

Warfarin/heparin

149
Q

What is a cardiac side effect of citalopram?

A

Prolonged QT syndrome

150
Q

Give 3 extrapyramidal side effects of antipsychotics

A
  1. Parkinsonism
  2. Akathisia
  3. Tardive dyskinesia
  4. Acute dystonia
151
Q

Give 4 antimuscarinic side effects of anti psychotics?

A
  1. Dry mouth
  2. Blurred vision
  3. Urinary retention
  4. Constipation

Phase 3a Jess (8 decks)

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