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Big Reece's Little Specialties > Psych > Flashcards

Psych Flashcards

1
Q

Antidepressant used after MI/ Coronoary heart disease

A

Sertraline

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2
Q

Antidepressant causing Long QT

A

Citalopram

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3
Q

Antidepressant with long half life (so no withdrawal)

A

Fluxoetiene

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4
Q

Rapid tranquillisation drugs

A

IM Lorazepam, Haloperidol

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5
Q

Clozapine Use

A

Treatment resistant Schizophrenia

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6
Q

Definition of Treatment resistant depression

A

failure to respond to 2 or more antipsychotics (1 of which is atypical) @theraputic dose for more than 6 weeks

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7
Q

Emergency side effect with Clozapine and how to prevent

A

Angranulocytosis - occurs in 0.7%

Weekly blood test to look for neutropenia

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8
Q

What is dystonia? What causes it

A

Involuntary, painful, sustained muscle spasms
onset within hours
Neck twist - torticollis
eyes twist up and can’t look down - oculogyric crisis

Extra-pyrimidal side effects (EPSE)
with typical antipsychotics

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9
Q

How do you treat dystonia

A

IM Procylidine/Benztropine (Anti-CHolinergic

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10
Q

What is Akathsia

A

Unpleasant subjective restlessness e/g leg jiggling

EPSE

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11
Q

How do you treat akathisia

A

Propanolol

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12
Q

What is Tardive Dyskinesia

A

Rhythmic involuntary movements e.g grimacing –> often irreversible

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13
Q

How do you treat Tardive Dyskinesia

A

Stop antipsychotics or change to atypical
Tetrabenazine
DON”T USE ANTICHOLINERGICS

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14
Q

What drugs cause Hyperprolactianemia and what does that cause

A

Typical antipsychotics

Amenorrhoea, gynaecomastia, hypogonadism, sexual dysfunction, osteoporosis risk

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15
Q

Schizophrenia first rank symptoms

A

Delusional perceptions
Passivitiy –> believing that things are being controlled e/g movements
Thought interference - Withdrawal, insertion, broadcast
Auditory Hallucinations –> thought echo or 3rd person

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16
Q

What is Hebephrenic Schizophrenia

A

Disorganised and chaotic mood/behaviour/speech
Often Childish
Less delusions and hallucinations

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17
Q

What is posturing and what do you get it with

A

Maintain bizzarre positions

Catatonic schizo

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18
Q

What is waxy flexibility

A

Can put them in weird positions and they’ll hold

Catatonic schizo

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19
Q

What is perserveration

A

Inappropriate repetition of words/actions

Catatonic scizo

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20
Q

What is rigidity

A

They won’t move when you try to move them

Catatonic schizo

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21
Q

4 key features of PTSD

A

Intrusive symptoms/re-experiencing
Avoidance
Hyperarousal
Emotional deficits e.g detachment

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22
Q

4 treatments of PTSD

A

CBT
Eye movement desensitisation and reprocessing
SSRI/SNRI
Support groups

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23
Q

Adjustment disorder trigger and length

A

Prolonged severe abnormal response to a stressful life event (e.g divorce) beginning within. 1 month and lasting no more than 6m
Symptoms of anxiety

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24
Q

How long should a manic episode last

A

1 week

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25
Q

A patient is hyperaroused but is able to go to work - is this mania or hypomania

A

Hypomania –> mania requires disruption to day to day life

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26
Q

MZ% of depression

A

44%

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27
Q

DZ% of depression

A

20%

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28
Q

Lifetime risk of schizo

A

1%

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29
Q

How long does it take SSRIs to work

A

4-6w

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30
Q

Which class of antidepressants are cardiotoxic in overdose

A

TCAs

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31
Q

Name some side effects of SSRIs

A 
Initial suicidal ideation
Sexual dysfunction
Drowsiness (esp with ETOH)
Decreased seizure threshold
Hyponatraemia 
N&V
Blurred vision 
Anxiety
Sweating
tremor 
Persistent pulmonary hypertension in the newborn
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32
Q

Which drugs are most often implicated in serotonin syndrome

A

MAO-I

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33
Q

Which drugs cause the cheese reaction with tyramine rich foods

A

MAOI- cheese reaction

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34
Q

When would you use ECT in depression

A

Psychotic or v severe irretractible depression (affecting things like eating and drinking

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35
Q

How long should depressive symptoms last

A

2w

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36
Q

3 key depressive symptoms

A

Anergia
Anhendonia
Low mood

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37
Q

MZ risk of BPAD

A

80%

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38
Q

DZ risk of BPAD

A

20%

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39
Q

Risk with first degree relative

A

8%

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40
Q

Type 2 BPAD

A

Mainly depression w/ hypomania

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41
Q

Type 1 BPAD

A

Mania w/ depression

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42
Q

Rapid cyclic BPAD

A

4 or more episodes a year

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43
Q

Treatment for Rapid Cyclic BPAD

A

Sodium Valproate

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44
Q

Lithium Overdose

A

GI disturbances, ataxia, tremor, fit, renal failure, slurred speech, arythmia

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45
Q

Can you use Sodium Valproate in pregnancy

A

NO - give folate and contraception advice

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46
Q

What anomaly does Lithium cause in pregnancy

A

Ebstein’s anomaly - Atrialisaiton of the right heart, tricuspid
valve moves down, right to left shunt thru ASD/PFO

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47
Q

Should you give antidepressants in BPAD

A

Only with a mood stabiliser as can trigger mania

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48
Q

MZ for schizo

A

Around 50%

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49
Q

DZ for schizo

A

4%

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50
Q

1º relative for schizo risk

A

10%

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51
Q

How long should anxiety symptoms last for diagnosis

A

6m

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52
Q

What is Wernicke’s encephalopathy + Cause

A

Thiamine deficiency

Causes Ataxia, confusion and eye problems (ophthalmoplegia & nystagmus)

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53
Q

What is Korsakoff’s syndrome

A

Irreversible anterograde amnesia - can’t remember new events

Will confabulate to fill in the gaps

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54
Q

Questionaire for alcohol

A

CAGE -
Have you ever felt you needed to Cut down on your drinking?
Have people Annoyed you by criticizing your drinking?
Have you ever felt Guilty about drinking?
Have you ever felt you needed a drink first thing in the morning (Eye-opener) to steady your nerves or to get rid of a hangover?

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55
Q

Delerium trememns onset and symptoms and treatment

A 
~48 hours into abstinence
Confusion
Hallucinations esp visual
Gross tremor
Autonomic disturbance
Affective changes - fear, hilarity
Delusions

Treat with reducing chlordiazepoxide regimene + thiamine (pabrinex)

56
Q

Dependcey features

Take 
Care
With
Problematic
Substances,
Really
Can 
Need
A 
Tolerance
Compulsion
Withdrawal 
problems controlling use 
Salience - become so imptortant to use other needs are neglected
Reinstatement after absitnance 
Continued use despite harm
Narrowing of repitoire
57
Q

What do you have to do in every fucking PACEs station

A

Risk assess - risk to self, to others, vulnerability, suicide etc

58
Q

Delirium Causes

A 
Trauma
Hypoxia
Infectioon
Metabolic - liver/renal failure, electrolyte imbalance
Endocrine - hypoglycaemia 
CNS pathology 
Drug withdrawal
59
Q

Delirium features

A 
Sudden onset (days-weeks)
Fluctuating consciousness
Short duration <6m
Impaired consiousness
Poor atention
Disorganised thinking 
Delusions - transient, muddled
Hallucinations - visual 
Treat underlying cause

LOOK OUT FOR HYPOACTIVE DELIRIUM - stupour, drowsiness, withdrawal

60
Q

Agorpaphobia Definitions

A

Fear of being unable to escape to safe place

61
Q

Key features of OCD

A

Obsessions - recurrent intrusive thoughts –> recognised as unpleasant, irrational, and the patients own
Compulsions - to try and reduce the anxiety

62
Q

What is an acute stress reaction

A 
Occurs after a traumatic event 
Happens within minutes and should resolve within hours 
Depresonalisation and derislisartion
Disorientation
Agitated, panicky
63
Q

Somatisitation

A 
Rare, disabling, chronic
Multiple medically unexplained symptoms 
Frequently changing symptoms 
Symptoms persist for more than 2y
Multiple investiagations 
Refusal to accept advice

Rx - don’t conduct further investagations, involve family, try to give them copping strategies

64
Q

Schzioaffective disorder

A

Both mood disorder (usually BPAD-like) and schizophrenia in the same episode

65
Q

Bulimia key features and Rx

A

Preoccupation with eating and body weight
Binginging food
Then purging - laxative, vomiting
Signs of vomiting - parotid swelling, dental erosion, Russell’s sign (calluses on dorsal of hand) & calluses on finger
Weight often normal
Have insight - often want help
can cause cardiac arrhythmia and renal failure

Rx - CBT, interpersonal psychotherapy, SSRIs e.g fluoxetine (help impulse control as well as depression)

66
Q

Examples of dissociative disorders

A

Dissociative Amneisa
Dissociative fugue - purposeful trip away from home, new identity
Dissociative stupor - motionless and mute but aware of surroundings

Rx - usually spontaneously resolves, can give supportive therapy to increase insight and help with stress management

67
Q

Anorexia Key symptoms

A

Weight loss by diet restriction and one of:

1) self induced vomiting
2) excessive exercise
3) appetite suppressants or diuretics
4) laxatives

BMI <17.5 
Morbid fear of fatness
Body image distortion 
Loss of libido 
Fatigue 
Amenorrhoea
68
Q

Anorexia signs

A 
Guant
Dehydrated
Proximal myopathy
cold extremities
bradycardia and hypotenison
Exhibit peripheral oedema 
Parotid gland enlaegmenet and erosion of tooth enamel if vomting 
Can cause - 
osteoporosis, 
cardiac arrhythmia (2º to hypokalaemia), 
pancreatitis, 
hepatitis (nuturiton - low serum protein, raised bilirubin, LDH, ALP)
seizures, 
peripheral neuropathy,
 pancytopenia, 
suicide
69
Q

Anorexia Blood tests

A 
Low:
Hb
U+E
Phsophate
Glucose
T3
FH/LH/E2
Ca
Mg
Cl
Raised:
ALp
Bilirubin
CK
Amylase
Cortisol
Growth Hormone
Cholesterol
70
Q

Rx for anorexia

A

Psycho-deucation
Treat comorbid psych issues
Nutritional management and weight restoration
Motivation interviewing - try to engage ambivalent patients
Family therapy
Interpersonal therapt
CBT
Medical treatment - esp if physical complications, rapid weight loss of BMI<13.5
Inpatient - BMI <13, extreme rapid wt loss, serious physical complications high suicide risk

71
Q

When to admit anorexia patients –> high risk

A

BMI <13
Weight loss >1kg a week
purpuric rash
cold peripheries
Core body temp less than 34.5
hypotensions (Systolic <80, diastolic <50)
bradycardia <40
Prolonged QT
Inability to stand from squatting wo/ using arms (squat test)
Electrolyte imbalance (K<2.5, Na <130, PO4 <0.5)

72
Q

what blood tests should be checked on lithium

A

U+E
TFTs
Lithium levels

73
Q

Criterial for learning disability

A

IQ <70

Mild - 50-69
Moderate - 35-49
Severe - 20-34
Profound <20

74
Q

Postnatal depression % and signs

A

10% of mothers
Insidious onset over weeks, ~3m (or progress from baby blues)
Obsessive recurrent intrusive thoughts about harming baby
Depressive cognitions –> guilty, failure of a mother
Rx - support, admission to mother and baby unit, consider antidepressants
90% respond to treatment within 1m

75
Q

baby blues

A

Begin within 10d
Tearful, weepy, muddled, liability of mood
NORMAL - occurs in up to 3/4
Reassure, family support, antenatal education

76
Q

Puerperal pscyhosis signs

A 
1 in 500-1000
~2w after birth 
Marked restlessness and fear
perplexity - can't deal with it 
Then psychotic symptoms:
    affective disorder, 
    delusions e.g baby is possed/evil
    Command hallucination to hurt baby

Symptoms can fluctuate quickly
Antipsychotics, mood stabilisers, antidepressants (Avoid lithium if breast feeding if possible)
most settle in 6w and fully recovered by 6m

77
Q

What condition is linked with OCD

A

Tourrettes

78
Q

Signs of foetal alcohol syndrome

A

A smooth philtrum: The divot or groove between the nose and upper lip flattens
Thin vermilion: The upper lip thins
Small palpebral fissures (opening of eyelid): Eye width decreases
Skin folds at corner of eye
short nose
small head
Foetal growth retardation/short stature
Behaviuoural difficulties
learning disabilities
neurological problems - epilepsy, hearing loss

79
Q

3 key features of ASD

A
  1. Lack of reciprocal social interaction –> not interested in people, poor attachment, weird eye contact, can’t read emotions
  2. Restricted behaviours and routine - repetitive, stereotype behaviour
  3. Communication abnormalities - concrete thinking, absent gestures, absent expressive speech, delayed comprehension, speech disorders (monologues, formal pedantic language, pronoun reversal)

hypo or hyperactivity to sensory input
¡present in early childhood!
Impair everyday functioning

80
Q

Enuresis 1º and 2º - causes and management

A

1º - toilet training never mastered - usually delayed bladder innervation or developmental delay (but stress and relaxed or strict toilet training can cause)
2º - dry for a year but lost –> usually stress related

Rx - refer to paediatrics, reassure child and family, restrict fluids, start charts, Bell and Pad (underpants alarm), TCA or desmopressin

81
Q

Encopresis - causes and management

A

Inappropriate defecation after age 4
Boys more commonly affected

Mostly relate to constipation - due to dehydration, painful defecation (e.g fissure), fear of punishment, toilet fears, Hirschsprung disease
Also due to diarrhoea, learning difficulties , occasionally hostile, stress

Rx - Laxitives for constipation, reassure, review toilet training, star charts

82
Q

What test does every child with suspected ASD need

A

HEARING TEST

83
Q

Asperger’s syndrome

A

Poor social skills and restricted interest w/ normal language and IQ

84
Q

Rx for ASD

What other conditions are associated w/ ASD

A

Support, behaviour therapy, speech and language therapy, special education

75% have learning disabilites
25% have epilepsy

85
Q

Ertonomania

A

delusion that the individual is loved by someone famous

86
Q

Knight’s move

A

Odd tangential association between ideas lead to disruption of speech
Can’t follow connection between topics unlike flight of ideas

87
Q

Flight of ideas

A

Stream of accelerated thought with abrupt changes, but can usually follow associations (e.g alliteration, homonoyms)
is a form of pressure of speech

88
Q

Neologism

A

Invent a new word

89
Q

Loosening of assocations

A

Connections between patients thoughts are difficult to follow

90
Q

Dysthymia

A

Chronic low mood not meeting depression standards

91
Q

Hypochondirasis

A

Fear of having a specific severe illness, in the absence of real organic pathology

92
Q

Formication

A

Feel insects under skin

93
Q

word salad

A

Inchoherent mess of words and phrases

94
Q

Section 2

A

Lasts 28 days
For assessment
Needs AMHP, and 2 doctors (1 S12)

95
Q

Section3.

A

Lasts. 6 m
for treatment
Need 2 doctor (1 s12) and AMHP

96
Q

Section 5(2)

A

Holding power for patient on ward
Need 1 docto
Last 72 hours

97
Q

Section 136 -

A

Police remove from public to safe place

Last 72 hours

98
Q

Section 135

A

Police remove from house to save place

99
Q

Section 5(4)

A

Nurses holding power for someone on ward

last 6 hours

100
Q

CTO

A

Have to take treatment while living in community, and can be recalled to hospital
for someone who was under a section 3

101
Q

Section 4

A

Emergency section for 72 hours, require one doctor and AMHP

102
Q

Abnormal grief reaction time scale

A

Lasts more than 2 years or delayed onset

self neglect

103
Q

Indicators of serious self harm attempt

A

Planned and premeditated
Final acts in anticipation - closing accounts, writing notes
Violent/dangerous methods
Trying not to be found
People who think the act would be irreversible
Didn’t seek help/angry someone helped them
Regrets surviving
Numerous previous attempts
Still hopeless for future

104
Q

Anti-ETOH drugs

A

Acamprostate - anti-craving drugs
Disulfram - causes build up of acetaldhyde, which is unpleasant
Naltrexone - opioid antagonist, reduces pleasure of alcohol

105
Q

Buprenorphine

A

Partial agonist of µopioid receptor
Blocks euphoric effects wo/ withdrawal
Sublingal tablet

106
Q

Methadone

A

Liquid
Long half life
Full agonist at opiate receptors

107
Q

Neonatal abstinence syndrome

A 
Babies born to heroin addicted mothers
Suffer with withdrawal symptoms --< start within hours, can last weeks 
High pitched cry
restlessness
tremor
hypertonia
convulsions
diarrhoea
vomiting 
sweats
fever
tachypnoea

Rx - neonatal opiate preparations, anti-convulsants, supportive measures

(opiates can also cause IUGR, low birth wt, prematurity, and risk of SIDS increased)

108
Q

Conduct disorder

A

10% of 10 year olds
4x more common in boys
RF - urban, parental criminality, harsh/inconsistent parenting, maternal depression, deprivation

Persistantly bullying, sterling, fighting
Socialised - have friends who they are antisocial with
Unsocilaised - rejected by other children

109
Q

Oppositional defiant disorder

A

Milder form of CD
In children under 10
provocative, disobidient behaviour towards adult
No extreme antisocial behaviour

110
Q

what age does ADHD present

A

~6

111
Q

What are the main features of ADHD

A

Inattention - chaotically flit between tasks, distractible
Hyperactive - excess energy, loud
Impulsivity and disinhibition - can’t share, social disinhibited (butt in) disorganised

These are worse in unfamiliar envorinments 
Short tempered 
Poor social relationships
Do poorly at school
Low self esteem
112
Q

Rating scale for ADHD

A

Conners rating scale

113
Q

Ix for ADHD

A

Questionaires,
Classroom observation
Child psych + paeds assessment
Educations psychologist assessment

114
Q

Rx for ADHD

A

Educate parents and teachers
Active promotion of behaviour and education process with kid - advice on behaviour modification, building concentration, self esteem
Behaviour intervention - clear rules and expectations, clear rewards and consequences
Advice that dietary restriction doesn’t help

Try behaviour and education therapy first + family therapy, before giving drugs
But if really severe can give at same time
Methylphenidate or dexamphetamine reduce motor activity (can cause growth retardation so drug holidays)
Non-stimulant - atomoxetine (increase attention and decreases unwanted motor activity)

115
Q

What other conditions are associated w/ ASD

A

up to 75% have learning difficulties

25% have seizures/epilepsy

116
Q

Paranoid personality disorder

A 
Group A  - paranoid bois 
SUSPECT
Sensitive
Unforgiving --> grudges
Suspicious 
Possessive and jealous 
Excessive self-importance
Conspiracy theories 
Tenacious sense of rights
117
Q

Schizoid Personality disorder

A 
Group A - socially withdrawn and flat 
ALL ALONE
Anhedonic
Limited emotional range
Little sexual interest
Apparent indifference to praised/citicism 
Lacks close relationships
One player activity 
Normal social convention ignored 
Excerssive fantasy world
118
Q

Histironinc Personality disorder

A

Group B
ACTORS

Attention seeking 
Concerned with own appearance 
Theatrical 
Open to suggestion
Racy and seductive  
Shallow affect
119
Q

Emotional Unstable PD - general

A 
Group B
AEIOU
Affective Instability
Explosive Behaviour
Impulsive
Outbursts of anger
Unable to plan or consider consequences
120
Q

EUPD - Borderline

A 
Group B
SCARS
Self image unclear
Chronic empty feelings
Abandoment fears
Relationships are intense and unstable 
Suicide attempts and self harm
121
Q

EUPD - impulsive

A 
Group B
LOSE IT 
Lacks impulse control
Outbursts or threats of violent 
Sesntivity to being thwarted or criticised 
Emotional instability 
Inability to plan ahead
Thoughtless of consequences
122
Q

Dissocial PD

A 
Type B - angry bois 
FIGHTS 
Forms but can't maintain relationship
Irresponsive
Guiltless
Heartless
Temper easily lost
Someone else thought
123
Q

Anakastic PD

A

Type C - perfectionists
DEFLATED

Doubtful
Excessive detail
Tasks not completed 
Adheres to rules
Inflexible
Likes own way
Excludes pleasure and relationships 
Dominated by intrusive thoughts
124
Q

Anxious/Avoidant personality disorder

A

Group C - anxious bois
AFRAID

Avoids social contact
Fears rejection/criticism 
Restricted lifestyle
Apprehensive
Inferiority
Doesn't get involved unless sure of acceptance
125
Q

Dependent personality disorder

A

Type C
SUFFERS

Subordinate
Undemanding
Feels helpless when alone
Fears abandomnet
Encourages others to make decisions
Reassurance needed
126
Q

Personality disorder defintion

A

3Ps
Pervasive - occurs in all/most areas of life
Persistent - evident in adolescence and continues throughout adulthood
Pathological - causes distress to self and others and impairs function

ICD 10 require following (REPORTD):
Relationship affected
Enduring
Pervasive
Onset in childhood adolescence
Results in distress
Trouble in occupational/social performance 
Don't have brain damage or another psych disorder
127
Q

What is Derailment

A

Derailment is a type of formal thought disorder in which there are disjointed thoughts with no meaningful connections. It is commonly seen in schizophrenia, but also presents sometimes in other disorders.

128
Q

What is Circumstantial thinking

A

Circumstantial thinking is somewhat difficult to describe but occurs when the person talks around a subject exhaustively with only loosely relevant associations. They will usually return to the point but only after many detours of almost irrelevant (or certainly over-inclusive)
information

129
Q

what is Cyclothymia

A

Cyclothymia

is diagnosed where there is persistent instability of mood with a cycle of low grade elevated and depressed mood

130
Q

What is Logoclonia

A

Logoclonia describes the symptom of repeating the last syllable of a word repeatedly and is often seen in Parkinson’s disease

131
Q

What is Echolalia

A

Echolalia is the phenomenon whereby
words or sentences that the patient hears are repeated back, sometimes continuously and incessantly. It often has an organic cause such as dementia or brain injury but may also be seen in functional disorders such as schizophrenia

132
Q

What is alogia

A

Alogia is the phenomenon of ‘not having any words’ and refers to extreme poverty of speech. It is commonly seen in severe negative schizophrenia
or dementia

133
Q

What is negativisim

A

Negativism is the symptom whereby catatonic patients
will appear to automatically do the opposite of what they are asked to do. This is not just resisting instructions or movement but actually attempting to perform the opposite instruction or movement.

134
Q

What is clanging

A

Clanging is a form of thought disorder whereby words are used based on their similar sounds or rhyming and the meaning becomes unimportant. For example, ‘A cat pat on my hat sack, ate the bait and skated’. It is seen in schizophrenia

135
Q

Anorexia hormonal abnormalities

A 
hypokalaemia
low FSH, LH, oestrogens and testosterone
raised cortisol and growth hormone
impaired glucose tolerance
hypercholesterolaemia
hypercarotinaemia
low T3
136
Q

electroylte abnormalities in refeeding sydrome and what causes it

A

low phosphate
Low K
Low magnesium

Swtich from fat to carb metabolism causes increased secretion of insulin, moving these electrolytes intracellularly

137
Q

rating scale for depression

A

PHQ9

Big Reece's Little Specialties (4 decks)

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