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Phase 3a Medicine > Psych > Flashcards

Psych Flashcards

1
Q

What are concrete concepts?

A

Real objects or situations (e.g. tremor)

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2
Q

Real objects or situations

A

What are concrete concepts?

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3
Q

What are defined concepts?

A

Classes of concepts (e.g. delusions)

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4
Q

What are concept systems?

A

Sets of related concepts (e.g. schizophrenia)

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5
Q

What is an illusion?

A

A wrong or misinterpreted perception of a real stimulus

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6
Q

What is a hallucination?

A

Disorder of perception

An experience involving the apparent perception of something not present.

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7
Q

What are hypnagogic hallucinations?

A

Vivid and frightening episodes/sensory phenomena whilst falling asleep.

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8
Q

What are hypnopompic hallucinations?

A

Unusual sensory phenomena experienced just before or during awakening.

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9
Q

What are extracampine hallucinations

A

Hallucinations outside the realms of what is feasible.

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10
Q

What are pseudo hallucinations?

A

An involuntary sensory experience vivid enough to be regarded as a hallucination but considered by the person as subjective and not real.

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11
Q

What is an overvalued idea?

A

An preoccupying idea to the extent of dominating the sufferers life
May be swayed by reason

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12
Q

Name 3 features is a delusion?

A

Firmly held belief
Not affected by rational argument or evidence
Not a conventional belief

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13
Q

Persecutory delusion

A

Believes other people are out to get them.

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14
Q

Grandiose delusion

A

Person believes they are indestructible/inflated self-importance

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15
Q

Self-referential delusion

A

Incidental information that the patient uses in reference to themselves.

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16
Q

Nihilistic (Cotard’s) delusion

A

Patient believes they are dead.

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17
Q

Capgras delusion

A

Misidentification

Believes a someone they recognise has been replaced by an imposter

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18
Q

Fregoli delusion

A

A delusional belief that different people are a single individual who changes appearance or is in disguise.

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19
Q

Subjective doubles

A

A person believes they have a Doppelganger with the same appearance, usually with different character traits.

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20
Q

Delusional perception

A

Delusion from a real stimulus - believing a percept has a special meaning for him or her.

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21
Q

Hypochondriacal delusion

A

Firm belief they have a disease

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22
Q

What are 2nd person auditory hallucinations?

A

A person talking to them

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23
Q

What are 3rd person auditory hallucinations?

A

A person talking about them

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24
Q

What are Charles Bonnet hallucinations

A

Visual hallucinations associated with eye disease

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25
Q

What is a delusion?

A

Disorder of thought

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26
Q

What is a delusional perception?

A

Delusional belief resulting from a real stimulus.

Will be completely unrelated.

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27
Q

What is psychosis?

A

Severe mental disorder in which thoughts and emotions are impaired
Lost connection with external reality
May involve delusions and hallucinations

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28
Q

What is neurosis?

A

Mild mental illness caused by organic disease

No radical loss of touch with reality

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29
Q

What symptoms of stress are seen with neurosis?

A

Depression
Anxiety
Obsessive behaviour
Hypochondria

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30
Q

What is passivity phenomena?

A

Disorder of thought and perception

Feeling that one’s actions/thoughts are controlled by someone else

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31
Q

What is somatic passivity?

A

Passive recipient of bodily sensations by external force

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32
Q

What is catatonia?

A

Significantly excited/inhibited motor activity

Waxy flexibility and posturing

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33
Q

When is ECT indicated?

A

Treatment resistant severe depression
Manic episodes
An episode of moderate depression know to respond to ECT in the past
Life threatening catatonia

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34
Q

What may be seen with catatonia?

A

Repetitive or purposeless overactivity, or catalepsy, resistance to passive movement, and negativism

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35
Q

What is stupor?

A

Loss of activity with no response to stimuli

May mock progression of motor retardation

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36
Q

What is psychomotor retardation?

A

Slowing of thoughts and movements.

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37
Q

Name 5 types of thought alienation.

A 
Thought insertion
Thought withdrawal
Thought broadcast
Thought echo
Thought block
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38
Q

What is a thought disorder?

A

Disordered thinking
Thoughts and conversations appear lacking in sequence and illogical
May de delusional contents

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39
Q

What is loosening of association?

A

Lack of logical association between thoughts giving rise in incoherent speech

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40
Q

What is circumstantiality?

A

Non-linear thought pattern

Rambling and convoluted speech but often reaches the point

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41
Q

What is perseveration?

A

Repetition of particular response in absence or cessation of stimulus

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42
Q

What is confabulation?

A

Gives false account to fill gaps in memory

Without conscious intent to deceive

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43
Q

What is tangeality?

A

Tendency to talk about things unrelated to the topic

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44
Q

What is flight of ideas?

A

Rapidly skipping from one thought to another, often with tentative relation

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45
Q

What is echolalia?

A

Meaningless repetition of another person’s spoken words

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46
Q

What are clang associations?

A

Ideas linked by rhyme or similarity of words

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47
Q

What is neologism?

A

New word formation.

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48
Q

What is somatisation disorder?

A

Present for >2 years
Psychological distress manifesting as many unexplained physical symptoms
Refused to accept reassurance/test results

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49
Q

What is hypochondrial disorder?

A

Persistent belief of underlying physical illness

Refusal to accept reassurance/test results

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50
Q

What is conversion disorder?

A

Loss of motor or sensory function

May be indifferent (la belle indifference)

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51
Q

What is clouding of consciousness?

A

Subjective sensation of mental clouding - feeling ‘foggy’

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52
Q

What is anhedonia?

A

Inability to experience pleasure from activities usually found enjoyable.

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53
Q

What is incongruity of affect?

A

Emotional responses not mirroring situation or discussion topic

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54
Q

What is depersonalisation?

A

Feeling detached from the body

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55
Q

What is dissociation?

A

Disruptions in aspects of consciousness, identity, memory,

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56
Q

What is tardive dyskinesia?

A

Involuntary repetitive jerky movements of the head and neck

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57
Q

What may be seen with tardive dyskinesia?

A

Grimacing, lip smacking, tongue protrusion.

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58
Q

What causes tardive dyskinesia?

A

Long term antipsychotic use.

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59
Q

What is dissociative disorder?

A

Progress of separative of certain memories from normal consciousness

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60
Q

What are the symptoms of dissociative disorder?

A

Amnesia, fugue (loss of awareness of one’s identity), stupor

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61
Q

What is stupor?

A

State of near-unconsciousness or insensibility.

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62
Q

What is Munchausen’s syndrome?

A

Factitious disorder

Intentional production of physical or psychological symptoms

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63
Q

What is malingering?

A

Fraudulent stimulation or exaggeration of symptoms with the intention of financial or other gain

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64
Q

Where does the dopamine pathway start?

A

Substantia nigra

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65
Q

Where does the serotonin pathway start?

A

Raphe nuclei

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66
Q

What are the functions of the serotonin pathway? (4)

A

Mood
Memory
Sleep
Cognition

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67
Q

What is the function of the dopamine pathway? (5)

A 
Reward (motivation)
Pleasure, euphoria
Motor function (fine tuning)
Compulsion
Perseveration
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68
Q

What causes schizophrenia?

A

Excess dopamine production

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69
Q

What symptoms does mesolimbic produce?

A

Positive

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70
Q

What symptoms does mesocortical produce?

A

Negative

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71
Q

Following antipsychotic treatment, what pathway can cause excess prolactin?

A

Tuberoinfundibular

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72
Q

What pathway is responsible for EPSE?

A

Nigrostriatal

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73
Q

What is a acute reaction to antipsychotic therapy?

A

Acute dystonic reaction

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74
Q

What symptoms may be seen hours after starting antipsychotics?

A

Muscle spasm
Acute torticollis (wry neck)
Ocular gyrate crisis

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75
Q

What may be seen 4 weeks after starting antipsychotics?

A

Parkinsonism
Bradykinesia
Rigidity
Tremor

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76
Q

When does akathisia occur?

A

6-60 days following starting antipsychotics`

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77
Q

What is akathisia?

A

Movement disorder - restlessness and inability to stay still.

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78
Q

When does tardive dyskinesia occur?

A

Long term usage of antipsychotics (months-years)

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79
Q

What is the treatment for acute dystonia/parkinsonism?

A

Procyclidine

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80
Q

What can be used to treat akathisia?

A

Propranolol

+/- cyproheptadine

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81
Q

What is the treatment for tardive dyskinesia?

A

Tetrabenazine

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82
Q

Name 2 first generation antipsychotics.

A

Haloperidol

Chlorpromazine

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83
Q

Name 4 2nd generation antipsychotics.

A

Olanzapine
Risperidone
Quetiapine
Aripiprazole

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84
Q

What receptors do newer/atypical antipsychotics act on?

A

D2 and 5-HT2a

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85
Q

What SE are seen with atypical antipsychotics?

A

EPSE
Hyperprolactinemia
Weight gain

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86
Q

What symptoms are seen due to hyperprolactinemia?

A

Galactorrhoea - lactation
Amenorrhoea/infertility
Sexual dysfunction - arousal, libido, ED, anorgasmia

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87
Q

What are the side effects of olanzipine?

A 
Hyperprolactinemia 
Weight gain
Diabetes
CV disease 
EPSE
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88
Q

What second generation antipsychotic has the least side effects?

A

Aripiprazole

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89
Q

What are the side effects of clozapine?

A

Agranulocytosis
Reduced seizure threshold
Myocarditis
Constipation

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90
Q

What causes neuroleptic malignant syndrome?

A 
Antipsychotic medication 
(or withdrawal from dopaminergic medication e.g. levodopa)
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91
Q

When does NMS usually occur?

A

Insidious onset within the first 4-11 days of treatment

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92
Q

What are the symptoms of NMS?

A 
Lead pipe rigidity
Dysphagia/dyspnoea
Hyporeflexia
Normal pupils
Autonomic dysfunction (hyperthermia, sweating, tachycardia, unstable BP)
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93
Q

What may be seen in blood results of NMS and SS?

A

Elevated creatinine kinase
WCC
Deranged LFTs
Metabolic acidosis

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94
Q

What is the treatment for NMS?

A

Bromocriptine

Dantrolene

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95
Q

What causes serotonin syndrome?

A

SSRIs
MAOIs
Ecstacy

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96
Q

What are the symptoms of SS?

A 
Increased activity
Clonus/myoclonus
Hyperreflexia
Tremor
Muscle rigidity (less severe than NMS)
Dilated pupils
Autonomic dysfunction (tachycardia, unstable BP)
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97
Q

When does SS occur?

A

Within 1-2 doses of SSRI

Normally combination of SSRI and MAOI

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98
Q

What is used to to treat SS?

A

Cyproheptadine

Benzodiazepines

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99
Q

What is cyproheptadine?

A

5HT-2a antagonist

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100
Q

What is dependance?

A

Physiological, behavioural and cognitive phenomena

Substance takes higher priority than other behaviours that once had greater value

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101
Q

How many ICD-10 features are needed to diagnose dependance?

A

3

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102
Q

What are the ICD-10 features of alcohol dependance. (5)

A 
Compulsion
Tolerance 
Difficulty controlling consumption
Physiological withdrawal
Neglect of alternatives to drinking
Persistent use despite harm
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103
Q

What 4 classes of substances are often misused?

A

Stimulants
Depressants
Hallucinogens
Opiates

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104
Q

Risk factors for substance misuse.

A 
Males
Low education
Unemployment
Younger age of usage
Mental illness
Peer pressure
Low self esteem
High stress
FHx
Genetic suseptibility
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105
Q

What CAGE score indicated problem drinking?

A

2

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106
Q

What is the AUDIT questionnaire?

A

Alcohol use disorder identification test

10 item questionnaire

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107
Q

What does AUDIT assess?

A

Alcohol consumption
Drinking behaviours
Alcohol-related problems

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108
Q

What AUDIT score indicates hazardous drinking?

A

8 - 15

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109
Q

What AUDIT score indicates harmful drinking?

A

16 - 19

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110
Q

What AUDIT score indicates high risk or dependant drinking?

A

> 20
High risk - dependance score <4
Dependant - dependance score >4

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111
Q

What alcohol score is used in A+E?

A

FAST

Score of 3 or more for first 4 questions is positive.

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112
Q

What is TWEAK?

A

Screening tool for alcohol abuse, max score of 7.

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113
Q

What does TWEAK stand for?

A 
Tolerance - >6 drinks = 2
Worried/complained = 2
Eye-opener = 1
Amnesia = 1
Cut down = 1
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114
Q

What advice should be given to patients about alcohol?

A

Max 14 units per week

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115
Q

What is classified as hazardous drinking?

A

10-35 - women

10-50 - men

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116
Q

How many units per week is classified as harmful drinking?

A

35 - women

50 - men

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117
Q

What should be asked in an alcohol history?

A 
Whether the patient believes they have a problem
Intake
Current drinking pattern
Cost
Dependency and tolerance symptoms
Withdrawal signs
Effect on ADLs
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118
Q

What physical complications can alcoholism cause?

A 
Liver damage
Pancreatitis
Cancer
GI ulcers/varices/malnutrition/reflux
CNS disturbance
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119
Q

What social complications can alcoholism cause?

A

Crime
Violence
Relationship/occupation problems

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120
Q

What psychological complications can alcoholism cause?

A

Anxiety, depression, personality disorder, risk of suicide

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121
Q

What chronic signs of alcohol abuse may be seen on examination?

A 
Clubbing
Hepatomegaly
Palmar erythema
Asterixis
Spider naevi
Gynaecomastia
Dupuytren's contracture
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122
Q

What acute signs of alcohol abuse may be seen on examination?

A 
Vomiting/nausea
Ataxia
Mood changes/agitation
Sweating
Unsteady gait
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123
Q

What anaemia is seen in those who abuse alcohol?

A

Macrocytic

Raised MCV due to vitamin B12 and folate deficiency

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124
Q

What may be seen on FBC of a person who abuses alcohol?

A

Thrombocytopenia

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125
Q

What liver enzymes are looked at for alcohol abuse?

A

ALT
AST
GGT (gamma-glutamyl transferase)

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126
Q

What is used to reduce alcohol cravings?

A

Acomprosate

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127
Q

What is used to give hangover SE of alcohol?

A

Disulfiram (antabuse)

128
Q

What does disulfiram inhibit?

A

Acetaldehyde dehydrogenase

129
Q

What is used to reduce the pleasure alcohol brings?

A

Naltrexone.

130
Q

What is the acute management of alcohol withdrawal?

A

Chlordiazepoxide
IV Pabrinex
Thiamine 100mg BD

131
Q

When do symptoms of alcohol withdrawal develop?

A

6 - 12 hours after cessation

132
Q

What are the symptoms of alcohol withdrawal?

A 
Tremor
Sweating
Nausea/vomiting
Mood disturbance
Hypertension
DTs
Seizures (36 hours)
133
Q

When is delirium tremens seen?

A

72 hours after stopping alcohol

134
Q

What are the symptoms of DTs?

A 
Altered consciousness
Vivid hallucinations/illusions
Paranoid delusions
Tremor
Autonomic arousal
135
Q

What hallucinations may be experienced by people with DT?

A

Lilliputian - visual hallucinations of children/animals

Formication - insects crawling on skin

136
Q

What is Wernicke’s encephalopathy?

A

Acute brain injury due to thiamine deficiency

137
Q

What is the symptom triad of Wernicke’s encephalopathy?

A

Delirium - acute confusion state
Ocular signs - ophthalmoplegia, nystagmus
Wide base gait ataxia

138
Q

What is Korsakoff’s syndrome?

A

Chronic state of thiamine deficiency

139
Q

What is the triad of symptoms of Korsakoff’s syndrome?

A

Anterograde amnesia
Confabulation
Psychosis

140
Q

What are the symptoms/signs of opiate intoxication?

A 
Drowsiness
Mood change
Bradycardia
HTN
Pupil constriction
Respiratory depression
Low body temperature
141
Q

How is Wernicke’s treated?

A

IV Pabrinex and chlordiazepoxide

142
Q

What is Pabrinex?

A

High potency B1 replacement

143
Q

What % of patients develop Korsakoff’s if WE remains untreated?

A

70%

144
Q

Hoe is Korsakoff’s treated?

A

IV Pabrinex

145
Q

What are the symptoms of opiate withdrawal?

A 
Muscle cramps
Low mood
Insomnia
Agitation
Diarrhoea
Shivering
Flu like symptoms
146
Q

What are viral complications of opioid misuse?

A

Needle sharing
HIV
Hep B and C

147
Q

What are bacterial complications of opioid misuse?

A 
Secondary to injection
IE
Septic arthritis 
Septicaemia
Necrotising fasciitis
148
Q

What physical problems can occur with opioid misuse?

A

VTE
Respiratory depression and death
Cravings

149
Q

What is the acute management of opioid overdose?

A

Naloxone - rapid onset and short acting

150
Q

How is opioid dependency managed?

A

Detoxification: 4 weeks in residential, 12 weeks in community
Methadone
Buprenorphine

151
Q

What are the common causes of delirium?

A 
PINCH ME
Pain
Infection/intoxication
Nutrition (thiamine, nicotinic acid, B12/folate deficiency)
Constipation
Hypoxia, deHydration
Medication, drugs, substance misuse
Environmental
Other: post-op, vascular, metabolic, endocrine pathology, head trauma, epilepsy
152
Q

Describe hypoactive delirium.

A

Apathy
Withdrawal
Quiet confusion
(Often misdiagnosed as depression)

153
Q

Describe hyperactive delirium.

A 
Agitation
Lack of cooperation
Delusions
Disorientation
(often confused with schizophrenia)
154
Q

What is mixed delirium?

A

Features of both hypo and hyperactive delirium

155
Q

What symptoms are seen with delirium?

A 
Inattention
Clouding of consciousness
Disorientation
Anterograde amnesia
Visual hallucinations
Paranoid delusions
156
Q

How is delirium differentiated from dementia?

A

Delirium:
Acute onset, improves, impaired attention/consciousness, fluctuating symptoms throughout the day

Dementia:
Gradual onset, cannot improve, remain alert, preserved consciousness, minor fluctuations throughout the day

157
Q

What are the investigations are done for a patient with delirium?

A 
Identifying cause/exclude:
Bloods/cultures/gas
MSU
CXR
ECG
CT/LP
158
Q

How is delirium managed?

A

Identify cause, treat and address exacerbating factors

159
Q

What education and support measures are put in place for a patient with delirium?

A

Educate those in contact

Side room, sleep hygiene, lighting, clocks/calendars, hearing aids/glasses

160
Q

When should you give sedatives for delirium?

A

Severely agitated
Needed to minimise risk
Give haloperidol/olanzapine

161
Q

How would you measure cognitive impairment to monitor delirium?

A

MMSE

162
Q

What is GAD?

A

Anxiety that is generalised and persistent - not isolated to specific environmental circumstances
PResent for >6 months

163
Q

What are the clinical features of GAD and how many are needed for diagnosis?

A 
3 of:
Restlessness
Irritability
Easily fatigued
Difficulty concentration
Muscle tension
Sleep disturbance

(+4 other features)

164
Q

What autonomic features are seen in GAD?

A

Tachycardia/palpitations
Sweating
Shaking
Dry mouth

165
Q

What chest/abdomen features are seen with GAD?

A

Nausea
Trouble breathing
Chest pain

166
Q

What are the RF for GAD?

A

35-54 years
F > M
Divorced/separated
Living alone

167
Q

What are protective for GAD?

A

16-24 years

Cohabiting

168
Q

What must be excluded in GAD?

A

Hyperthyroidism
Pheochromocytoma
Cardiac disease

169
Q

What medication can mimic GAD symptoms?

A 
Salbutamol
Theophylline
Corticosteroids
ADs
Caffeine
170
Q

What are the first step in GAD management?

A

Education and active monitoring
Stop smoking/drinking
Exercise

171
Q

What is the second step in GAD management?

A

Low intensity psychological support
Non-facilitated/self-guided help
Psycho-educational groups

172
Q

What is step 3 in GAD management?

A

CBT
Relaxation techniques
Medication

173
Q

What is the first line treatment of GAD?

A

Sertraline

174
Q

What is the second line treatment of GAD?

A

TCA - Clomipramine

175
Q

What is panic disorder?

A

Recurrent panic attacks

176
Q

What is a panic attack?

A

Period of intense fear
Develop rapidly, reach peak at 10 minutes, < 30 mins
Spontaneous or situational

177
Q

What physical symptoms occur with PAs?

A 
Palpitations
Chest pain
Choking
Tachypnoea/SOB
Dry mouth
Urgency 
Dizziness
Blurred vision
Sweating
178
Q

Psychological

A

Feeling of impending doom
Fear of dying/losing control
Depersonalisation
Derealisation

179
Q

What are the RF for panic disorder?

A 
15-24 years, 45-54 years
Separated from partner
Living in a city
Limited education
Early loss
Physical/sexual abuse
180
Q

What comorbidities are seen with PD?

A

Agoraphobia
Other anxiety disorders
Substance misuse
Bipolar

181
Q

What are the 5 management steps for PD?

A

1 - recognition and diagnosis
2 - CBT, sertraline
3 - review, consider alternative treatment
4 - review, referral to specialist
5 - care in specialist mental health services

182
Q

What is agoraphobia?

A

Anxiety/panic symptoms associated with place or situations where escape may be difficult/embarrassing - leads to avoidance

183
Q

Who is more likely to have agoraphobia?

A

M:F = 1:3

Those with other panic/anxiety/depressive disorders, alcohol and substance misuse

184
Q

What is the pharmacological management of agoraphobia?

A

SSRi

May consider short term benzos

185
Q

What behavioural methods of management is there for agoraphobia?

A

Behavioural - graded exposure, relaxation training

186
Q

What cognitive methods of management is there for agoraphobia?

A

Coping strategies - teach about bodily responses associated with anxiety

187
Q

What is a phobia?

A

Recurring excessive and unreasonable psychological/autonomia symptoms of anxiety in presence of a specific object or situation - leads for avoidance

188
Q

What is social phobia?

A

Symptoms of incapacitating anxiety restricted to certain social situations

189
Q

What are the somatic symptoms of social phobia?

A

Blushing
Trembling
Dry mouth
Perspiration

190
Q

What are the symptoms of social phobia?

A

Somatic symptoms
Fear of humiliation, others noticing anxiety, embarrassment
Avoidance - relationship/vocational/educational problems
Suicidal thoughts

191
Q

What is the psychological treatment of social anxiety?

A

CBT - individual or group

Graded exposure therapy

192
Q

What is the pharmacological treatment of social anxiety?

A

Beta-blockers - reduce autonomia arousal
SSRIs
Possible benzos if needed

193
Q

What are compulsions?

A

Senseless, repeated rituals i.e. mental acts or behaviours (may be used to reduce obsessions)

194
Q

What are obsessions?

A

Unwanted intrusive thoughts, images or urges that come into a person’s mind

195
Q

What qualities do obsessive thoughts usually have?

A 
Unpleasant 
Repetitive  
Intrusive
Irrational
Recognised as patients own thoughts
196
Q

Examples of compulsive acts.

A 
Checking
Washing
Counting
Symmetry
Repeating certain words/phrases
197
Q

What is the treatment for OCD?

A

CBT - exposure and response prevention (ECP)
SSRI - fluoxetine/sertraline
TCA - clomipramine (specific non-obsessional action)

198
Q

What is PTSD?

A

Severe psychological disturbance following traumatic event.

199
Q

What are symptoms of PTSD?

A 
Involuntary re-experience in vivid dreams/flashbacks
Avoidance
Anxiety and panic attacks
Hyperarousal
Irritability
Sleep disturbance
Poor concentration
Emotional numbing
200
Q

What is the cause of PTSD?

A

Psychological - fear response
Biological - neuro physical changes as result of chronic stress/persistent re experience
Genetic

201
Q

What may be seen on neuroimaging of PTSD patients?

A

Reduced hippocampal volume

202
Q

What is the DD of PTSD?

A

Acute stress reaction - transient condition lasting hours-days
Immediate dissociation followed by mixed emotions, anger, anxiety and confusion.

203
Q

What is the ICD-10 classification of PTSD?

A

Symptoms within 6 months of precipitating event
Symptoms present for at least 1 month
Significant distress/impairment in social, occupational or other areas of functioning

204
Q

How is PTSD treated?

A

CBT

Eye movement desensitisation and reprocessing

205
Q

What is the 2nd line treatment for PTSD?

A

SSRI - sertraline

206
Q

How is PTSD prevented?

A

Rehearse teamwork and techniques of stress inoculation and desensitisation

207
Q

What is the diagnostic criteria for anorexia nervosa?

A
  1. Weight <85% predicted
    or BMI <17.5 kg/m2
  2. Intense fear of gaining weight/becoming fat with persistent behaviours to prevent this
  3. Feeling fat when thin
208
Q

What are the signs of AN?

A 
Fatigue
Decreased cognition
Cold intolerance
QT prolongation
Bradycardia
Laguno hair
Constipation
Failure of secondary characteristics
Amenorrhoea
209
Q

What would be seen on FBC of a patient with AN?

A

Low WCC
Low Hb
Low platelets

210
Q

What endocrine/metabolic changes may be seen with AN?

A 
Low glucose
Low K+
Hyperthyroidism
High LFT/amylase
High cortisol, CCK, cholesterol
211
Q

What are features of the SCOFF questionnaire?

A 
Sick - make yourself
Control - lost over eating
One stone loss in 3 months
Feel fat - when others think you're thin
Food - dominates life
212
Q

What are red flags for AN?

A 
BMI < 13 or below 2nd centile
Weight loss > 1kg per week 
Temperature < 34.5
BP < 80/50
SaO2 < 92%
Long QT, flat T
Weakness in muscles
213
Q

How is AN managed in children?

A

1st line - anorexia focussed family therapy

2nd line - CBT

214
Q

How is AN managed in adults?

A 
Restore nutritional balance
Treat complications of starvation
Involve family/carers
If severe, admit for refeeding
ED-CBT
Maudsley anorexia nervosa treatment for adults (MANTRA)
215
Q

What is refeeding syndrome?

A

Drop in phosphate due to rapid initiation of food following undernutrition for >10 days.

216
Q

What are the signs of refeeding syndrome?

A 
Rhabdomyolysis 
Resp/cardiac failure
Low BP
Arrhythmia
Seizures
217
Q

How is refeeding syndrome managed?

A

Slow refeeding
Thiamine, vitamin B complex, multivitamin
Monitor for low phosphate/K, high glucose/Mg

218
Q

What is bulimia?

A

Recurrent episodes of binge eating

219
Q

What features are seen in bulimia?

A

Binge eating and regular episodes to overcome this e.g. vomiting, starving, laxatives, excessive exercise

220
Q

What signs are seen in bulimia?

A 
Same as anorexia plus 
Oesophagitis
Russell's sign
Oedema (laxative, diuretics)
Gastric dilation
Cardiomyopathy (with laxatives)
221
Q

What is Russell’s sign?

A

Calluses on the back of the hands from self induced vomiting

222
Q

What biochemical changes may be seen in bulimia?

A

Metabolic alkalosis
Low Cl- and K+
Metabolic acidosis if laxatives used

223
Q

How is mild bulimia treated?

A

Support, self-help books and food diary

224
Q

How is moderate/severe bulimia treated?

A

Referral to EDU
Fluoxetine to reduce binges/purging
CBT can help

225
Q

What are the 3 core symptoms of depression?

A 
Low mood
Low energy (anergia)
Loss of enjoyment (anhedonia)
226
Q

How long must symptoms have been present to diagnose depression?

A

Every/nearly everyday for 2 weeks, without change

227
Q

Other than the 3 core symptoms, what are some other features of depression?

A 
Poor sleep/early morning waking
Lack of motivation
Loss of concentration
Lack of confidence
Change in appetite
Guilt/hopelessness/worthlessness
Agitation
Self-harm, suicide ideation
Psychotic symptoms if severe
228
Q

What are the criteria for mild, moderate and severe depression?

A

Mild - 2 core, 2 other
Moderate - 2 core, 3 other
Severe - 3 core, 4 other

229
Q

What are some risk factors for depression?

A

Bio - genetics, reduced monoamines
Psycho - childhood experience, personality traits,
Social - marital status, adverse life events/disruption, low socio-economic class,

230
Q

What % of patients with depression meet criteria for another psychiatric disorder?

A

66%

231
Q

How is depression assessed in primary and secondary care?

A

PHQ-9 - patient health questionnaire

HADs - hospital anxiety and depression scale

232
Q

What lifestyle changes can be used to manage depression?

A 
Sleep hygiene 
Anxiety management 
Exercise/diet
Socialising
Psychotherapy
Meditation
Yoga
Reduce stress
233
Q

Other than lifestyle modification, what else can help manage mild depression?

A 
Computerised CBT (self referral)
Psychoeducation
234
Q

How is moderate depression managed?

A

Lifestyle
Antidepressants
High intensity psychological therapies - CBT via IAPT

235
Q

What can be features of severe depression?

A

Psychosis
High risk of suicide
Atypical depression

236
Q

How is severe depression managed?

A

Rapid specialist mental health assessment
Consider inpatient admission
Electroconvulsive therapy

237
Q

What are features of atypical depression?

A

Mood lift in response to positive events/good news
Sleeping too much
Heavy arms and legs
Sensitivity to rejection/criticism

238
Q

What is the first line treatment for depression?

A

SSRI - fluoxetine

239
Q

Which SSRI prolongs the QT interval?

A

Citalopram

240
Q

How should SSRI use be monitored?

A

Monitor FBC and U+E

SSRIs can cause hyponatraemia

241
Q

What drugs SSRIs interact with?

A

NSAIDs
Warfarin/heparin
Aspirin
Triptans

242
Q

What should be offered instead of an SSRI for depressed patients taking warfarin/heparin?

A

Mirtazapine

243
Q

What is the second line treatment for depression?

A

Alternative SSRI

244
Q

What class of drug is mirtazapine?

A

NaSSA - noradrenergic and specific serotonergic antidepressant

245
Q

What class of drug is duloxetine?

A

Serotonin-norepinephrine reuptake inhibitor

BP and ECG monitoring

246
Q

What are the side effects of mirtazapine?

A

Drowsiness

Weight gain

247
Q

What is the 4th line treatment for depression?

A

TCAs

MAOIs

248
Q

What are the side effects of Amitriptyline?

A 
Tachycardia
Dry mouth
Blurred vision
Constipation
Urinary retention
249
Q

What are the baby blues?

A

Common and transient
Occurs 3-5 days after birth - tearful, anxious and irritable.
Commonly lasts 1-2 days but may persist for up to 2 weeks

250
Q

What is the treatment for baby blues?

A

Self-limiting. Reassurance from midwife and support from family.

251
Q

How many new mothers get postnatal depression?

A

10%

50% of those who have previously had PND
25% of those who have previously had bipolar/unipolar depression

252
Q

When does postnatal depression usually present?

A

Starts within 1 month, peaks at 3 months

253
Q

What is used to screen for PND?

A

Edinburgh postnatal depression scale (EPDS)

254
Q

What EPDS score may indicated PND?

A

12/30 - 77% sensitive

255
Q

What is the management for PND?

A

Reassurance and support
CBT
SSRIs - sertraline

256
Q

Which SSRI shouldn’t be used by breastfeeding mothers?

A

Fluoxetine

257
Q

What is puerperal psychosis?

A

Postpartum psychosis
Psychotic episode with prominent affective symptoms (depression or mania) occurring with rapid fluctuation.
Rapidly fluctuating symptoms, mood lability, insomnia, disorientation.

258
Q

What is the management of postpartum psychosis?

A

Hospital admission may be required
Mood stabiliser, antidepressant and ECT
Psychotic symptoms - SGA and long acting benzo

259
Q

What is the risk of recurrence of postpartum psychosis?

A

30%

40% risk of postpartum depression

260
Q

When does bipolar disorder usually present?

A

15 - 25 years

261
Q

What is required for bipolar diagnosis?

A

At least two episodes, one of which must be mania/hypomania

262
Q

What is bipolar I?

A

Mania + depression

Psychotic symptoms

263
Q

What is bipolar II?

A

Hypomania + depression
More episodes of depression
No psychosis

264
Q

What is cyclothymia?

A

Cyclical mood swings with subclinical features

265
Q

What are the signs of mania?

A 
Extreme elation
Over activity
Pressure of speech
Impaired judgement
Extreme risk taking behaviour
Social disinhibition
Grandiosity
Delusions/hallucinations
266
Q

What are the signs of hypomania?

A

Many of the signs of mania but without psychotic symptoms.
No impairment in daily function.
Does not require hospital admission.

267
Q

What is the long term treatment of bipolar disorder?

A

Lithium

268
Q

How is lithium treatment monitored?

A

Aim for plasma level 0.6-1 mmol/L
3 monthly lithium bloods
6 monthly U+E and TSH

269
Q

What are the side effects of lithium?

A

Nausea/vomiting, diarrhoea
Fine tremor
Nephrotoxicity: polyuria, secondary to nephrogenic diabetes insipidus
Thyroid enlargement, may lead to hypothyroidism
ECG: T wave flattening/inversion
Weight gain
Idiopathic intracranial hypertension
Leucocytosis
Hyperparathyroidism and resultant hypercalcaemia

270
Q

What is lithium’s mode of action?

A

Inhibits cAMP which inhibits monoamines - increased monoamine level in body.

271
Q

How are acute manic episodes managed?

A

SGA of sodium valproate alongside lithium

272
Q

What can be given for long term management of bipolar disorder if lithium is not tolerated?

A

Sodium valporate

273
Q

What does progressively increasing plasma lithium level indicate?

A

Nephrotoxicity

274
Q

How long should pharmacotherapy last for bipolar disorder?

A

2-5 years

275
Q

What other therapies can be used for bipolar disorder?

A

CBT

ECT

276
Q

What is the strongest risk factor for schizophrenia?

A

Family history

277
Q

What are the first rank symptoms of schizophrenia?

A

3rd person hallucinations
Delusional perceptions (passivity, influence or control)
Thought disorder
Passivity phenomena

278
Q

Give examples of negative symptoms.

A 
Apathy
Decreased motivation
Withdrawal
Self-neglect
Blunted affect
279
Q

What is the ICD10 criteria for diagnosis of schizophrenia?

A

At least one first rank symptom or two of:
Any persistent hallucination
Breaks or interpolations in train of thought - knights move speech
Catatonic behaviour
Negative symptoms

280
Q

What are features of paranoid schizophrenia?

A

Delusions or auditory hallucinations predominate

281
Q

What is hebephrenic/disorganised schizophrenia?

A

Thought disorder and flat affect present together

282
Q

What is catatonic schizophrenia?

A

Stupor, posturing, waxy flexibility and negativism

283
Q

What is undifferentiated schizophrenia?

A

Psychotic symptoms present but criteria for paranoid, disordered or catatonic not met

284
Q

What is residual schizophrenia?

A

Positive symptoms are present at low intensity only

285
Q

What is simple schizophrenia?

A

Insidious and progressive development of prominent negative symptoms with no history of psychosis episodes

286
Q

How long do symptoms need to be present to diagnose schizophrenia?

A

> 6 months
Present much of the time for 1 month
Impairment of work/home function

287
Q

What must be excluded as a cause of psychosis before a diagnosis of schizophrenia can be given?

A

Drugs - urine screen
Alcohol - LFTs, FBC (macrocytosis and thrombocytopenia)
Syphilis - serological test
Brain lesion - CT head

288
Q

What should be assessed in risk assessment of mental illness?

A

Risk to self
Risk to others
Risk to property

289
Q

What is the first line management for schizophrenia?

A

SGA

290
Q

What is a fatal side effect of SGAs?

A

Torsades de pointes - long QT

Polymorphic ventricular tachycardia

291
Q

What is the second line management for schizophrenia?

A

First generation antipsychotic - haloperidol, chlorpromazine

292
Q

What is the third line management for schizophrenia?

A

Resistant schizophrenia

Clozapine

293
Q

What is schizoaffective disorder?

A

Symptoms of both mania/depression and hallucinations/delusions at the same time

294
Q

How is schizoaffective disorder treated?

A

Antipsychotics and mood stabilisers

295
Q

What are personality disorders?

A

Characterised by long lasting rigid patterns of thought, affect and behaviour

296
Q

What is required for diagnosis of a personality disorder? (2)

A
  1. Not attributed to brain damage or any other psychiatric disorder
  2. Requires inhibition of function (work, relationships, day-to-day life)
297
Q

How old must patients be for a diagnosis of a personality disorder?

A

Often present <18 year but must be >18 years to diagnose

298
Q

What are the RF for developing a personality disorder?

A 
Sexual/physical/emotional abuse
Neglect
Bullying
Early childhood trauma
Being expelled or suspended from school/truanting
Deliberate self-harm
Prolonged periods of misery
299
Q

How should personality disorders be managed?

A

Dialectical behavioural therapy (DBT) - combines individual and group therapy using CBT and mindfulness

300
Q

What are the three personality disorder clusters?

A

A - odd/eccentric
B - dramatic/emotional
C - anxious/avoidant

301
Q

What personality disorders fall into cluster A?

A

Paranoid

Schizoid

302
Q

What personality disorders fall into cluster B?

A

Dissocial/antisocial
EUPD
Histrionic
Narcissistic

303
Q

What personality disorders fall into cluster C?

A

Anankastic (obsessive-compulsive)
Anxious
Dependant

304
Q

Describe paranoid PD.

A

Suspicious
Preoccupied with conspiration explanations
Distrusts other
Holds grudges

305
Q

Describe schizoid PD.

A

Emotionally cold
Lacks interest in others
Rich fantasy world
Excessive introspection

306
Q

Describe dissocial/antisocial PD.

A 
Aggressive 
Easily frustrated
Lack of concern for others
Irresponsible
Impulsive
Unable to maintain relationships
Criminal activity
Lack of guilt
Conduct disorder < 18 years
307
Q

Describe EUPD.

A 
Borderline:
Feeling of 'emptiness' 
Unclear identity
Intense and unstable relationships
Unpredictable affect
Threats or acts of self harm
Impulsivity
Pseudohallucinations
Impulsive: 
Inability to control anger or plan
Unpredictable affect and behaviour
308
Q

Describe histrionic PD.

A 
Over-dramatised
Self centred
Shallow
Labile mood
Seeks attention and excitement
Seductive
Manipulative behaviour
309
Q

Describe narcissistic PD.

A 
High self importance
Lacks empathy
Takes advantage
Grandiose
Needs admiration
310
Q

Describe anankastic PD.

A 
Obsessive-compulsive
Worries and doubts
Orderedliness and control
Perfectionism
Sensitive to criticism
311
Q

Describe anxious PD.

A 
Anxious and tense
Self-conscious
Insecure
Fearful of negative evaluation by others
Timid
Desire to be liked
312
Q

Describe dependant PD.

A 
Passive
Clingy
Submissive
Needs to be cared for by others
Feels helpless when not in relationship
Hopeless and incompetent
313
Q

What is the difference between avoidant and schizoid PD?

A

Schizoid voluntarily withdraw from society

Avoidant desire companionship but can’t due to fear of rejection

314
Q

Describe avoidant PD.

A

Fear of rejection
Inadequacy
Sensitive to negative evaluations
Desire companionship

315
Q

What is the difference between OCPD and OCD?

A

OCPD - okay with the way they are, often successful professionally but not socially = EGOSYNTONIC
OCD - do not like obsessions/compulsions = EGODYSTONIC

Phase 3a Medicine (6 decks)

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