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Conditions + definitions > Psych > Flashcards

Psych Flashcards

1
Q

What are the questions into a past psychiatric history?

A 
Past episodes/diagnoses
Previous treatments
Inter-episode functioning
Previous admissions
Atetmpted suicides
Previous detentions under mental health legislation
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2
Q

What are the important personal history questions?

A 
Developmental milestones
Early life
Schooling
Occupational
Relationships
Financial
Friendships, hobbies/interests
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3
Q

What is forensic history?

A

Anything relating to police/detention
Contact with police
Offences WITH sentences
Particular attention to violent or sexual crimes

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4
Q

What is pre-morbid personality?

A

Their personality before they became afflicted with mental health disorder
Ie - what would friends say they were like

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5
Q

What is the mental state examination?

A 
Appearance
Behaviour
Mood
Speech
Thoughts
Beliefs
Percepts
Suicide/homicide
Cognitive function
Insight
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6
Q

What should you comment on appearance?

A

Height/build
Clothing - appropriate? Kempt?
Personal hygiene
Make up, jewellery etc

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7
Q

What should you comment on for behaviour?

A 
Greeting
Non-verbal cues
Gesturing - normal? Bizarre?
Abnormal movements
Cooperative, rapport?
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8
Q

What should you comment on for mood?

A

Eye contact
Affect - objective manifestation of mood
Mood rating - subjective, objective
Psychomotor function

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9
Q

What should you comment on for speech?

A 
Spontaneity
Volume
Rate
Rhythm
Tone
Dysarthria
Dysphasia
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10
Q

What should you comment on for abnormal thoughts??

A

Phobias
Obesssions
Flight of ideas
Formal thought disorder

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11
Q

What are some examples of formal thought disorder?

A 
Thought blocking
Fusion
Loosening
Knight's move
Derailment
Loosening
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12
Q

What are the types of abnormal beliefs?

A

Preoccupations
Over valued ideas
Delusional beliefs

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13
Q

What are the types of abnormal perceptions?

A

Illusions (misinterpreted stimuli
Hallucinations
>Pseudo or true

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14
Q

What are te important questions in to suicide?

A 
Suicidal thoughts
Ideation
Intent
Plans - specific, vague,  in motion?
Also homicidal risk
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15
Q

How do you assess cognitive function?

A

Orientation in time, place, person
Attention/concentration
Short-term memory - 3 objects, name and address
Long term memory - personal history

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16
Q

What is insight?

A

Insight, hindsight and foresight into current condition
Are symptoms due to illness?
Is this a mental illness
Do you agree with treatment plan?

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17
Q

What are the types of delusions?

A 
Grandiose
Paranoid (persecutory)
Hypochondrical
Self referential
Nhilistic
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18
Q

What is a thought disorder?

A

A pattern of interruption or disorganisation of thought processess

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19
Q

What is important past medical history for psychiatry?

A 
Developmental problems
Head injuries
Endocrine abnormalities
Liver damage, oesophgeal caricies, peptic ulcers
>Tell you about alcohol
Vascular risk factors
Any medications?
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20
Q

What is a mood disorder?

A

A disorder of mental status and function
>Where altered mood is a core feature
Commonest group of mental disorders
Either primary problem or consequence of another disorder
Associated with anxiety symptoms/disorders
>Includes depression and mania

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21
Q

When does depression become abnormal?

A

Persistence of symptoms
Pervasiveness of symptoms
Degree of impairment
Presence of specific symptoms/signs

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22
Q

What are the three spheres of symptoms of depressive illness?

A

Psycological
Phsyical
Social

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23
Q

What is the psychological sphere?

A 
Change in mood
>Depression
>Anxiety
>Perplexity
>Anhedonia
Change in thought content
>Guilt
>Worthlesness
>Ideas of refernece
>Dellusions/hallucinations (if severe)
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24
Q

What is the physical sphere of depressive illness?

A 
Change in bodily function
>Low energy
>Sleep disturbance
>Appetite (either way)
>libido
?Constipation
Change in psychomotor functioning
>Agitation
>Retardation
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25
Q

What is the social sphere of depressive illness?

A 
Loss of interests
Irritability
Apathy
Withdrawl
Loss of concentration/memory
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26
Q

What is stupor?

A

State of extreme retardation in which consciousness is intact
Patient stops moving, speaking, eating and drinking
On recovery has memory of events

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27
Q

What are the definition guidlines for depression?

A 
Lasts at least 2 weeks
No hypomanic or manic episodes in life
Not attributable to substances/organic mental disorder
With at least 2 general criteria
And at least 4 from additional list

Moderate/severe need more criteria

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28
Q

What are the general criteria for depression?

A

Depressed mood that is abnormal for most of the day for last 2 weeks
Loss of interest or pelasure
Decreased energy/ increased fatigue

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29
Q

What is the additional criteria for depression?

A 
Loss of confidence
Unreasonable feelings of guilt
recurrent thoughts of suicide
Decreased concentration
Agitation or retardation
Change in appetite
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30
Q

What are the needs for mild/moderate/severe depression?

A

Mild - 2 general, 4 total
Moderate - 2 general, 6 total
Severe - all general, 8 total

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31
Q

What is postnatal depression?

A

Depression after giving birth

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32
Q

What are the differentials of depression?

A 
SAD
Dysthymia
Cyclothymia
Bipolar
Stroke, tumour, dementia
Hypothyroidism
Infections
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33
Q

How do you treat depression?

A 
Antidepressants
>SSRIs
>SNRIs
>TCAs
Psychological treatments
>CBT
Physical treatmetns
>ECT
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34
Q

What is mania?

A

Term describing state of feeling/mood that can range from normal to a severe life threatening illness
Considered a pathological, inappropriate elevated mood
Rarely a symptom, often associated with grandiose ideas, disinhbition, loss of judgement

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35
Q

What is the definition of hypomania?

A

Lesser degree of mania with no psychosis
Mild elevation of mood for days on end
Increased energy and activity,
marked feeling of wellbeing
Increased sociability, talkativeness, overfamiliarity, increased sexual energy and decreased need for sleep
May be irritable
concentration reduced, new interests, overspending

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36
Q

What is mania?

A 
1 week, severe enough to disrupt ordinary work and social activites
Elevated mood, 
Increased energy and activity, 
marked feeling of wellbeing
Disinhbition
Grandiosity
Aleration of senses
Extravagant spending
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37
Q

What are the differentials of mania?

A 
Mixed affective state
Schizoaffective disorder
Schizophrenia
Cyclothymia
ADHD
Stroke
Tumour
Infections
Cushings
Hyperthyroidism
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38
Q

How do you treat mania?

A

Antipsychotics
Mood stabilisers
Lithium
ECT

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39
Q

How do you diagnose bipolar affective disorder?

A

2+ repeated episodes of depression and mania or hypomania
If only depression, than it is recurrent depression
If no depression then either hypomania or bipolar disorder

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40
Q

What is the epideminology of bipolar?

A

Male=female rate
Average age 21
Early onset usually related to family history
Prevelance increased with 1st relatives

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41
Q

What is the eipdemiology of depression?

A 
Females 2x more likely than males
Highest risk age 18-44
Mean age is 27
Associated with lower educational attainment
Increased risk in 1st degree relatives
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42
Q

What are the affective disorders that can be treated with pyschological therapies?

A

Major depressive disorder
Generalised anxiety disorder
Panic disorder and phobic anxiety disorders
Obessive compulsive disorders

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43
Q

What is cognitive behavioural therapy?

A

Explores how thoughts relate to feelings/behaviours
Particularly good for depression, anxiety, phobias, OCD and PTSD
Focuses on here an now
Short term
Problem focussed

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44
Q

What is behavioral activation avoidance in depression?

A 
Social withdrawl (avoiding friends/phone)
Non-social avoidance (not taking challenges)
Cognitive avoidance (not taking opportunities/thinking of future)
Emotional avoidance (alcohol/substance abuse)
Avoidance by distraction (games, comfort eating etc)
45
Q

What is the aim of behavioral activation theory?

A

Analyse how actions have unintended consequences
Has a non-judgmental approach
Small changes building towards long term goal
Structred adgenda with review process

46
Q

What is interpersonal psychotherapy?

A 
Treatment for depression/anxiety
12-16 weeks
Focused on present
Analyses how affect and interpersonal event are related
Given sick role
Work towards a goal using focus area
Non formal homework (unlike CBT)
47
Q

What is motivational interviewing?

A

Talking with patient encouraging them to take up changes they have already been thinking about
Why do they find it helpful?
What donā€™t they like?
Effectively talk through their thoughts, and then offer support
Help through stages of change

48
Q

How do you diagnose alcohol dependance?

A 
3 or more of following for more than 1 month
Cravings/compulsions to take
Difficulty controlling use
Primacy
Increased tolerance
Physiological widrawl on reduction
Persistence despite harmful consequences
49
Q

What is alcohol widrawl state?

A 
Tremor
Weakness
Nausea
Vomiting
Anxiety
Seizures
Confusion
Agitation
Death

Usually 48-72 hours after alcohol stopped

50
Q

What are the 4Ls of alcohol problems?

A

Liver
Love
Liveliehood
Legal

51
Q

What is korsakoffā€™s psychosis?

A 
Prominent impairment of recent/remote memory
Preservation of immediate recall
No general cognitive impairment
Impaired learning and disorientation
Due to thiamine deficency
52
Q

What are the screening tools for alcohol abuse?

A

CAGE
AUDIT
FAST
PAT

53
Q

What is the medicla management of a patient presenting with alcohol abuse?

A

Prevent wernicke/karsakoff syndrome with thiamine
Benzodiazepine (chlordiazepoxide) for alcohol widrawl
Aversion/deterrent medication
Anti-craving medication
>Acanprosate
>Naltrexone

54
Q

What is best practice in psychopharmacology?

A

Adjust dosage for optimum benefit and safety + compliance
Use adjunctive/combination therapies if needed
But strive for simplest regime

55
Q

What are the indications for antidepressants?

A 
Unipolar and bipolar depression
Organic mood disorders
Schizophrenic disorder
Anxiety disorders
>OCD
>Panic
>social phobia
56
Q

What are the classifcations of antidepressants?

A 
TCAs
Monoamine oxidase inhibtors - MAOIs
SSRIs
SNRIs - serotonin/noradrenaline reuptake inhibs
Novel antidepressants
57
Q

What are the potential side effects of TCAs?

A 
Antihisteminic
>Weight gain
>Sedation
Anticholinergic
>Dry mouth
>Constipation
Antiadrenergic
>orthostatic hypotension
>Sedation
>Sexual dysfunction
Very lethal in overdose
Can cause QT lengthening
58
Q

What are tertiary TCAs?

A

Have tertiary amine side chains
>These cross react with other receptors which gives the side effects (more than secondary)
Act on serotonin receptors
Also used for chornic pain

59
Q

How affective are antidepressants?

A

70% response rate

40% placebo response

60
Q

What are the examples of tertiary TCAs?

A

Imipramine
Amitrptyline
Doxepin
Clomipramine

61
Q

What are secondary TCAs?

A

Often metabolites of tertiary TCAs
Side effects same as tertiary, just more severe
Block noradrenaline

62
Q

What are the examples of secondary TCAs?

A

Desipramine

Notrtriptyline

63
Q

What is the MOA of monoamine oxidase inhibitors?

A

They bind to monoamine oxidase
Prevent inactivation of amines like noradrenaline, dopamine and serotonin
Leads to increased synaptic levels
Very effective for depression

64
Q

What are the side effects of monoamine oxidase?

A 
Orthostatic hypotension
Weight gain
Dry mouth
Sedation
Sleep disturbance
Sexual disfunction

!!! Hypertensive crisis if taken with tyramine-rich foods - like cheese or wine!!!
!!!serotonin syndrome!!!

65
Q

What is serotonin syndrome?

A 
If MAOI taken with meds that increase serotonin/sympathetic actions
Leads to
Abdominal pain
Diarrhoea
Sweats
Tachycardia
Hypertension
Myoclonus
Can lead to cardiovascular shock and death
66
Q

How do you prevent serotonin syndrome?

A

Wait 2 weeks before switching from SSRI to MAOI

>Fluoxetine needs 5 weeks

67
Q

How do SSRIs work?

A

Block presynaptic serotonin reuptake

Treat symptoms of both anxiety and depression

68
Q

What are the side effects of SSRIs?

A 
GI upset
Sexual dysfunction
Anxiety
Restlessness
Nervousness
Insomnia
Fatigue
Sedation
Dizziness
69
Q

What are the common SSRIs?

A

Paroxetine
>Short half life
>Significant CYP2D6

Sertraline
>very weak P450 interactions
>Short half life
>Needs full stomach

Flucoetine
>Long half life - less discontinuation syndrome
>But may build up
>Significant P450 interactions

Citalopram
>Low P450 inhibition with immediate half life
>Dose-dependant QT interval prolongation

Escitalopram
>Low inhibition of P450
>More effective than citalopram in acute response
>Dose dependant QT interval prolongation

Fluvoxamine
>Shortest half life
>Strong inhibitor of CYP1A2 and CYP2C19

70
Q

What are SNRIs?

A

Inhibit both serotonin and noradrenergic reuptake
Without antihistamine, antiadrenergic or anticholinergic side effects that TCAs have
Used for depression, anxiety and neuropathic pain

71
Q

What are teh different SNRIs?

A 
Venlafaxine
>Minimal drug interactions
>Short half life
>Can cause rise in BP
>QT prolongation

Duloxetine
>Less BP increase compared to venlafaxine
>CYP2D6 and CYP1A2 inhibitor
>Not stable in stomach, needs capsule

72
Q

What are teh novel antidepressants?

A

Mirtazapine 5HT2/3 receptors antagonist
>increaes cholesterol/triglycerides

Buporoprion

73
Q

How do you treat resistant depression?

A

Combination therapy
Adjunctive treatment with lithium
Adjunctive with atypical antipsychotics
ECT

74
Q

What is lithium useful for?

A

Long term prophylaxis of mania
And depressive episodes
Reduces suicide rate

75
Q

How should lithium be prescribed?

A

Before starting - baseline U&Es + TSH
>Pregnancy test

Monitor - steady state achieved after 5 days, check 12 hours after last dose
Check every 3 months for TSH + creatinine

Looking for blood level between 0.6-1.2

76
Q

What are the side effects of lithium?

A 
GI distress
Reduced appetite
Nausea/vomiting
Thyroid abnormalities
Nonsignificant leukocytosis
Polyuria/polydipsia secondary to ADH antagonism
Hair loss
Acne
Cognitive slowing
Intention tremor
77
Q

What are the symptoms of lithium toxicity?

A

Mild - moviting, diarrhoea, atacia, slurred speach, dizziness, nystagmus
Moderate - symptoms of mild + blurred vision, clonic limb movements delerium
Severe = convulsions, oliguria, renal failure

78
Q

What indicates a positive response for valproic acid?

A

Rapid cycling patients
Comorbid substance issues
Mixed patients
Patients with comorbid anxiety disorders

79
Q

What is valproic acid good for?

A

As goo as lithium for mania prophylaxis

Not as effective in depression prophylaxis

80
Q

What tests need to be done before starting valproic acid, what other consideration needs to be taken into account?

A

LFTs
Pregnancy test
FBC
>In women, need to start folic acid supplement

81
Q

How do you monitor valproic acid?

A

Steady state after 4-5 days
12 hrs after last dose check LFTs
Target between 50-125

82
Q

What are the side effects of valproic acid?

A 
Thrombocytopenia = platelet dysfunction
Nausea, vomiting, weight gain
Sedation
Tremor
Hair loss
Increased risk of neural tube defects due to reduced folic acid
83
Q

When is Carbamazepine indicated?

A

Acute mania

Prophylaxis of mania that is resistant to lithium

84
Q

What tests need to be carried out before carbamazepine is started?

A

LFTs
FBC
ECG

85
Q

How do you monitor carbamazepine?

A

Steady state after 5 days
12 hours after last dose check levels + lfts
Target is 4-12 mcg/ml
Recheck after a month and adjust due to inducing own metabolism

86
Q

What are the side effects of carbamazepine?

A 
Rash
Nausea, vomiting, diarrhoea
Sedation, dizziness, ataxia, confusion
AV conduction delays
Aplastic anaemia
Water retention
Lots of drug-drug interactions
87
Q

What are the side effects of lamotrigine?

A 
Nausea/vomiting
Sedation, dizziness, ataxia, confusion
TEN/SJS
>If any tash develops discontinue!
Blood dyscrasias
88
Q

What is the mesocortical dopamine pathway#?

A

Projects from brain stem (ventral tegmentum) to cerebral cortex
Where negative symptoms /cognitive disorders are thought to arise
Too little dopamine

89
Q

What is the mesolimbic dopamine pathway?

A

Projects from dopaminergic cell bodies in brain stem (ventral tegmentum) to limbic system
Pathway for positive symptoms
Too much dopamine

90
Q

What is the nigrostriatal dopamine pathway?

A

Projects from dopaminergic cell bodies in substantia nigra to basal ganglia
Movement regulation
Too little dopamine can cause parkinsonian movements due to suppression of ACh

91
Q

What is the Tuberoinfundibular dopamine pathway?

A

From hypothalamus to anterior pituitary
Dopamine inhibits prolactin release
Hyperprolactinaemia in low dopamine

92
Q

What are D2 dopamine receptor antagonists?

A

High potency antipsychotic
High affinity for Dā€ dopamine receptors
>HIgh risk of extrapyramidal side effects

93
Q

What are some examples of D2 dopamine receptor antagonists?

A

Fluphenazine,
Haloperidol,
Pimozide.

94
Q

What are the effects of low potency typical anti-psychotics?

A

Less affinity for D2 receptors
Tend to interact with non-dopaminergic receptors
>Results in cardiotoxic and anticholinergic adverse effects

> Includes sedation and hypotension

95
Q

What are the examples of low potency typical anti-psychotics?

A

chlorpromazine

Thioridazine

96
Q

What are atypical antipsychotics?

A

Serotonin-dopamine 2 antagonists

Atypical because affect both dopamine and serotonin in the 4 dopamine pathways

97
Q

What is risperidone?

A

Atypical antipsychotic that can act like a typical at higher doses
Increased extrapyramidial side effects
Weight gain
Sedation
Very likely to induce hyperprolactinaemia

98
Q

What are the side effects of olazapine?

A 
Weight gain
Hypertriglyceridemia
Hyperglycaemia
Abnormal LFTs
Hyperprolactaemia
99
Q

What are the side effects of quetiapine?

A

Same as olazapine although lesser extent

Although causes orthostatic hypotension

100
Q

What is Aripiprazole + side effects?

A

D2 partial agonist
No weight gain
No QT prolongation, low sedation
However, CYP2D6 interactions

101
Q

When is clozapine indicated?

A

Treatment resistant patients

>Due to side effects. However high effiacy

102
Q

What are the side effects of clozapine?

A 
Agranylocytosis
>Requires weekly bloods for a month
Increased risk of seizures
Sedation weight gain + abnormal LFTs
Increased hypertrigylcerideaemia, hypercholesterolaemia and hyperglycaemia
103
Q

What are the adverse effects of antiphyschotics in general?

A

Tardive dyskinesia
>involuntary muscle movements
Neuroleptic malignant syndrome
Extrapyramisial side effects

104
Q

What is neuroleptic syndrome?

A 
severe muscle rigidity, 
fever, 
altered mental status, 
autonomic instability, elevated WBC, CPK and lfts. 
Potentially fatal
105
Q

What drugs can help with extrapyramidial symptoms?

A

Anticholinergics
Dopamine facilitators
Betablockers

106
Q

What are the common anxiolytics?

A

Buspirone

Benzodiazipines

107
Q

What is buspirone?

A

No sedation
Works independant of endogenous serotonin
Takes 2 weeks to kick in
Will not help if benzos have been used before

108
Q

When are benzodiazapines used?

A

Insommnia
Parasomnias
Anxiety disorders

Also CNS depressant withdrawal protocols (eg alcohol)

109
Q

What are the side effects of benzodiazipines?

A 
Somnolence
Cognitive deficits
Amnesia
Disinhibition
Tolerance
Dependence

Conditions + definitions (68 decks)

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