Psych Flashcards

Question

Management of alcohol abuse

Answer 1

``` Bio Disulfuram (blocks alcohol) Naltrexone (opioid antagonist) Acamprostate (GABA) Psychosocial - self help, AA etc (see more in public health) ```

Answer 2

``` <18 Previous delirium tremens Failed home detox Concern for safety Wernick's Autonomic involvement ```

Answer 3

Thiamine (B1) deficiency in alcoholics ``` Presentation TRIAD Confusion Ophthalmoplegia (incl nystagmus) Wide based gait ataxia ``` Also decreased reflexes Peripheral neuropathy Investigations - Decreased red cell transketolase - MRI Management Pabrinex (B1 complex) Complications Development of WKS - confabulation and anterograde amnesia - this is permanent

Answer 4

Alcohol withdrawal Alcohol increases GABA - so sudden drop in alcohol --> not much GABA boppin around --> everything is really fast ``` 6-12 hours after withdrawal Sweating Tachycardia Tremor Anxiety Formication ``` 36 hours - peak seizures ``` 48hrs - delirium tremens - CASH COARSE tremor Ataxia Seizures Hallucinations ``` Tachycardia HTN Sweating Imbalances Hypoglycaemia Metabolic acidosis ``` Management ABC Treat hypoglycaemia Give benzos - chlordiazepoxide Give magnesium to protect against seizures/ arrhythmia Give carbamazepine if seizures occur ``` Thiamine

Answer 5

``` ABC Treat hypoglycaemia Give chlordiazepoxide (benzo) Give magnesium to protect against seizures/ arrhythmias Give carbemazapine for seizures Start thiamine ```

Answer 6

Due to the sudden stopping of an increase in GABA --> everything is UP ``` 6-12 hrs Tachycardia Sweating Fever Tremor Formication ``` 36 hrs - peak seizures ``` 48-72hrs delirium tremens: Tachy, fever, sweating, N, COARSE TREMOR Seizures Hallucinations Ataxia ``` Metabolic imbalances Hypoglycaemia Metabolic acidosis

Answer 7

Type I - MANIA - and depression Type II - hypomania and DEPRESSION Criteria At least 2 episodes of mood disorders - at least 1 mania or hypomania (eg there can be 2 episodes of hypomania and this then counts as a diagnosis)

Answer 8

Hypomania >4 days Mania >7 days ``` STARS MILC Sociability Talkativeness (PRESSURE in mania) Appetite Risk taking Sleep Mood Irritable Libido ^ Concentration decreased ``` Mania defining: Grandiose delusions Auditory hallucinations

Answer 9

Genetic Childhood Sleep deprivation Post-partum ``` Drugs Steroids Statins SSRIs Illicits and alcohol ``` Organic - Tumour - Infection - Hyperthyroidism

Answer 10

Remember organic causes Bloods - TFT - Tox screen - Infection screen (ESR CRP) CT - tumour etc EEG MSE

Answer 11

CBT ``` ACUTE (manic episode) SGA Olanzapine Clozapine Quetiapine TAKE THEM OFF THE SSRI ``` Mood stabiliser Lithium Valproate Other antipsychotics

Answer 12

SSRI AND a mood stabiliser

Answer 13

At least 1 first rank symptom for at least 1 month ``` 1st rank Delusions Hallucinations (auditory, 3rd person) Thought disorder Passivity ``` Other Hallucinations of other modalities Catatonia ``` Negative Thought poverty Speech poverty Anhedonia Self neglect Low motivation Social withdrawal Flattening of affect ```

Answer 14

``` Genetics Childhood trauma MIGRANTS Drugs Alcohol and illicits ``` Organic: Neuro - tumour, trauma, infection Endo - Hyperthyroidism - Cushings Metabolic - Hyper Na - Hypo Ca

Answer 15

``` MSE Bloods - TFT - OGTT (Cushing's) - Na - Ca - FBC, U+E, LFT, tox screen CT EEG - remember temporal lobe seizure can produce similar symptoms ```

Answer 16

1) SGA + CBT (TOGETHER) | 2) Switch antipsychotic

Answer 17

``` REMEMBER THE DOPAMINE PATHWAYS Mesolimbic - hallucinations Mesocortical - blunted, apathetic Neocortical - movement, EPSE Tubuloinfundibulum - prolactin ``` Weight gain BM^ Decreased seizure threshold NMS Prolactin ^ EPSE Long QT ^ risk of stroke

Answer 18

Mesolimbic - hallucinations Mesocortical - blunted, apathetic Nigrostriatal- EPSE, Movement disorders Tubuloinfundibulum - Prolactin

Answer 19

FGA D2 - worse for EPSE - Haloperidol - Chlorprozamine - Flupenthixol SGA D2 and 5HT - Olanzapine (worst for weight gain) - Clozapine (agranulocytosis) - Quetiapine - Risperidone (prolactin bad) TGA D2 partial - Aripiprazole (prolactin good)

Answer 20

Flu like dreaming Shock sensations Irritability

Answer 21

Parkinsonism - Tremor, bradykinesia, rigidity, shuffling gait etc Tardive dyskinesia - Lip smacking - Tongue protruding - Chewing - Involuntary movements of extremities Acute dystonia - Back arching - Face grimacing - Oculogyrate crisis - Laryngeal spasms Akisthesia Restlessness Pacing

Answer 22

Stop cause Benztropine (anticholinergic) Tetrabenzene for tar dive dyskinesia Other Procyclidine

Answer 23

Starting or increasing an antipsychotic - basically its bc of a sudden drop in dopamine (so either ^^ antipsychotic or sudden withdrawal of levodopa in parkinson's patients) Triad - Tachycardia - Pyrexia - Muscle rigidity Sweating Seizures Coma Hyperreflexia ``` Investigations - KALE CK^ ABG - metabolic Acidosis Leukocytosis ECG - long QT ``` ``` Management ABC Fluids - renal protection Dantrolene (muscle relaxant)/ diazepam Bromocriptine (dopamine agonist) ```

Answer 24

``` Leucocytosis Insipidus Tremor (fine) T waves flattened Hypothyroidism Increased Urine Mom's beware - teratogenic ``` Take lithium levels at 12 hrs, 1 week and 3 weeks

Answer 25

0. 4 - 0.1 - therapeutic range 1. 1 - 1.5 - mild, asymptomatic 1.6 - 2.0 N+V fine tremor ``` 2.1 - 2.5 Hyperreflexia Confusion, slurred speech Flat T waves Coarse tremor ``` ``` >2.5 Chorea Incontinence, oligurea/ RF Parkinsonism Seizures Coma ```

Answer 26

The most important are: TFT, U+E, dose Bloods - TFT (hypo) - FBC (rememeber leucocytosis) - Ca - Renal - U+E, eGFR, Cr ECG Weight BP HR Height

Answer 27

Symptoms must 1) Represent a ∆ from their normal personality 2) Be present every day for 2 weeks 3) interfere with ADLs ``` Core + other Mild 2 + 2 Mod 2 + 3+ Severe 3 + 4+ Psychosis - Nihilistic delusions Hypochondriac delusions 2nd person auditory hallucinations ```

Answer 28

Core Depression Anhedonia Fatigue ``` Other Bio ∆ appetite ∆ libido ∆ sleep Psychomotor Concentration ``` Psych Worthlessness /Guilt Confidence decrease Thoughts of self harm/suicide

Answer 29

``` Genetics Childhood Life circumstances - work, homeless Drugs + alcohol Medical - hypothyroid/ chronic disease Drugs - BB - Isotretinoin ```

Answer 30

Bloods - check for organic cause - TFT, LFT MSE Questionnaire PHQ-9 HAD

Answer 31

5-HT Dopamine NA

Answer 32

Side effects 1) weight gain 2) GI bleed ^ risk 3) ∆ bowel habit 4) Anxiety 5) Sexual dysfunction 6) Hyponatraemia ``` CI MANIA Epilepsy MAOI Antipsychotics Hepatic impairment GI bleed risk eg warfarin ```

Answer 33

Review in 2 weeks of starting (or 1 if <30) Give 4 weeks before swapping 6 months continue after symptoms resolve Taper off over 4 weeks Give PPI if on NSAIDS - protect that tummy!

Answer 34

GI upset Sweating difficulty sleeping Paraesthesia

Answer 35

``` Mild Self help Sleep hygeine CBT Interpersonal therapy ``` Moderate 1st line SSRI Fluoxetine - long T1/2 - only lisc for <18 Sertraline - best for post MI - best in preg Citalopram - long QT Paroxetine - PTSD, PND Escitalopram 2nd line SSRI swap 3rd line NaSSA - mirtazapine (sleepy + weight gain) SNRI - venlafaxine/ duloxetine - BP and ECG - can have ^ BP SARI - trazodone NRI - reboxitine 4th line TCA - amytryptilline - DO ECG - HF and arrythmias MAOI - moclobemide/ phenelzine- Fatal HTN, SS, hyponatraemia SARI - trazodone Severe - CBT/ ECT/ consider inpatient

Answer 36

TCA - DO ECG Amytryptylline, noritryptylline, imipramine MAOI - DO BP and ECG - Moclobemide - Phenelzine SARI - trazodone - drowsiness/ constipation

Answer 37

Do ECG and BP | fatal HTN, SS, hyponatraemia

Answer 38

Neuro - seizures, hallucinations Cardio - long QT, long QRS Histamine - hypotension, dizziness Dopamine - EPSE, sexual dysfunction, breast ∆ Antimuscarinic - dry mouth, blurred vision, constipation, incontinence/ retention

Answer 39

Sertraline is generally best Paroxetine has most risks 1st trimester - congenital cardiac defects 3rd trimester - PP HTN of newborn

Answer 40

at least 3 of the following symptoms present for 6 months ``` Anxiety + 3 REDI MS Restless Easily fatigued Difficulty concentrating Irritable ``` Muscle tension Sleep decreased Others - Constant need of reassurance - Depends on others - Avoidance Bio - goosebumps, tachycardia etc ``` Aetiology Genetics/ childhood/ life circumstances Medical conditions - chronic illness/ hyperT Drugs and alcohol Medicines Salbutamol Theophylline Antidepressants Steroids Caffeine ``` Investigations - SCREEN THYROID Management 1) Educate and monitor 2) Self help CBT 3) Pharmacological - BB - Benzos - Pregabalin etc - SSRI - sertraline

Answer 41

1) Educate and monitor 2) Self help - sleep hygiene, meditate 3) CBT 4) Pharma - BB - Benzos - Pregabalin - SSRI - sertraline

Answer 42

at least 3 of the following symptoms for 6 months ``` REDI MS Restless Easily fatigued Difficulty concentrating Irritable ``` Muscle tension Sleep decreased Other Bio: - goosebumps etc Behaviour - Constant need for reassurance - Depend on someone - Avoidance

Answer 43

Criteria are: - Symptoms arising within 6 months of the event - Affect ADLs - At least 2 of TRIAD - Constant reliving the event - Avoiding circumstances - Cannot remember part or all of the event HYPER hypervigilance Hyperarousal exaggerated startle response Other Guilt, anger, depression, outbursts Decreased sleep and concentration

Answer 44

Genetics Trauma ``` Protective factors male caucasian ^ IQ ^ social class ``` Management 1) watchful waiting <3 month: CBT, medicate sleep >3 months: EMDP SSRI - paroxetine NaSSA - mirtazapine

Answer 45

1) Watchful waiting <3 months CBT and sleep medicate >3 months EMDP SSRI - Paroxetine NaSSA - mirtazapine

Answer 46

1) >2 weeks 2) interferes with ADLs 3) subject tries to resist 4) thoughts originate from own mind 5) carrying out is not pleasurable 6) repetitive unpleasant Aetiology B haem strep (lol) Genetics etc ``` Management Educate and monitor Esposure and response therapy Psychodynamic therapy SSRI ( sertraline) or TCA (clomipramine) ```

Answer 47

``` Panic attacks for 1 month intense fear that is - sudden onset - peak at 10 mins - situational or non situational ``` Other Bio - goosebumps, lump in throat etc ``` Psychological fear of impending doom fear of dying fear of losing control Depresonalisation Derealisation ``` ``` Management CBT SSRI if no response in 12 weeks TCA (clomipramine/ imipramine ```

Answer 48

PINCH ME VITAMIN D ``` Pain/ post operative Infection Nutrition Constipation Hypoxia/ ``` Metabolic/ medications Environment ``` Vascular - stroke Infection Trauma - fall Autoimmune Metabolic Iatrogenic Neoplasm ``` Degenerative ``` Expansion: Metabolic HypoN HyperC, Mg Hypoglycaemia Alcohol Liver failure Renal failure ``` ``` Medications SSAAALLAD Steroids Statins Antispasmodics Antihistamines Anticholinergic Lithium Levodopa Anticonvulsants Digoxin ```

Answer 49

Antipsycotic - Haloperidol Benzos - Do not give haloperidol in LBD!!! ``` Care Nutrition Hydration Pain relief big clock, newspaper for date appropriate lighting continuity of care take time to explain things Allow family visits decrease polypharmacy hearing aids/ glasses ```

Answer 50

Impaired consciousness Perceptual disturbance or cognitive disturbance Develops over short time + fluctuates Evidence it may be related to a physical cause

Answer 51

``` SSAAALLAD Statins Steroids Antispasmodics Anticholinergic Anti-epileptics Lithium Levodopa Antihistamine Digoxin ```

Answer 52

**NEW** Intense fear of gaining weight Reduced intake Body image distortion (/ denial of low body weight) Genetics OCD Depression Family stress

Answer 53

``` Lanugo hair Cold intolerance dental caries Swollen abdo - constipation Low body weight Amenorrhoea ∆ libido Calloused skin over joints Underweight Dizziness ``` Murmur

Answer 54

``` SCOFF (2 or more) Sick - ever made yourself sick Control - ever feel like you have lost control One stone loss in 3 months Fat - feel fat when you are not Food dominates your life ```

Answer 55

SCOFF + probs do a PHQ-9 too ``` Bloods FBC - pancytopenia U+E ^ dehydration or decreased due to water loading LFTs - derranged TFT for organic cause Amylase ^- starvation mode Hyponatraemia Hypocalcaemia Hypokalaemia Alkalosis ``` ``` Hormones Oestrogen decreased LH decreased FSH decreased GH increased Cortisol ^ ``` ECG - long QT, brady DEXA ``` General Weight Height BP HR Sit up test Squat test ```

Answer 56

``` Neuro - seizures, peripheral neuropathy, enlarged ventricles Cardio - long QT, brady, ST elevation, Twave ∆ GI - constipation Psych - depression etc MSK - osteoporosis Endocrine - amenorrhoea/ subfertility Metabolic - hypo Ca, Na, K, albumin Renal - AKI, stones ```

Answer 57

``` Admit if - rapid weight loss not responding - Severe electrolyte imbalance - Serious physiological imbalance temp <35 HR <45 Electrolyte imbalance Psychosis Serious risk of suicide Cardiac ∆ ```

Answer 58

``` Adults - CBT-ED - MANTRA - SSCM Children anorexia focused family therapy ``` SSRI - fluoxetine Antipsychotic - chlopromazine

Answer 59

when they become super sensitive to glucose --> massive spike in insulin --> Hypophosphataemia Hypokalaemia Hypomagnesium --> TDP How to avoid Increase calorie intake slowly Monitor U+Es Vitamin B complex + multivits

Answer 60

``` SOL Charles Bonnet Optic nerve palsy Migraines LBD/ parkinsons Infection epilepsy Alcohol withdrawal ```

Answer 61

SAD PERSONS Sex - male Age <19 or >45 Depression ``` Previous attempt Ethanol/ substance misuse Rational thinking loss - schiz Single/ unemployed Organised - planned attempt No social support Sickness - chronic medical condition ```

Answer 62

CAN Cognitive agitation/ irritation/ confusion/ euphoria/ mania/ hallucinations Autonomic HR ^, BP^, temp^, sweating, mydriasis ``` Neuro Reflexes increased Tremor Ataxia Clonus Seizures ```

Answer 63

``` SAME OA SSRI Amphetamines/cocaine MAOIs Ecstasy ``` ``` Opioids Antipsychotics - Olanzapine - Risperidone - Lithium ``` Investigations - ^CK!

Answer 64

``` ABC remove causative agent Fluids Benzos cyproheptadine Chlorprozamine ``` Beware hyperthermia can --> metabolic acidosis + AKI/rhabdo

Answer 65

MAD, BAD SAD MAD Paranoid- world is a conspiracy, everyone hates me Schizoid - billy no mates, doesn't want to be with anyone Schizotypal - magical + eccentric, odd beliefs Antisocial - crimes, no idea what is wrong/unethical BAD Histrionic - grandiose, manipulative Narcissist - craves power BPD - always in intense relationship, impulsive, self harm, ashamed of themselves SAD OCPD - must have control Anxious - worries, Dependent - needs to be with someone

Answer 66

Intense irrational fear Management CBT BDZ

Answer 67

Making up symptoms for medical or personal gain | Eg picking at a cut to make it infected

Answer 68

Making up symptoms for financial or other gain

Answer 69

Loss of motor or sensory | Doesn't consciously fake it or seek gain

Answer 70

Thinks they have a DISEASE (Not symptoms) despite medical tests proving otherwise

Answer 71

Presence of physical symptoms Present for 2 years Multi-organ

Answer 72

``` Presentation Pin point pupils Track marks Drowsy Yawning Rhinorrhoea Lacrimation ``` ``` Complications VTE Social - crime, homeless Resp depression Infection - At site - Endocarditis - Hep B etc ``` Management (overdose + detox) Overdose - Naloxone Detox Methodone Buprenorphine Naltrexone

Answer 73

3 or more of the following ``` Tolerance ^ Withdrawal state Neglect other activities Persistent use despite harmful effects Strong desire to take substance Difficulty controlling use ```

Answer 74

``` Useful for: Catatonia Depression + psychosis Severe depression Prolonged manic episode ``` ``` Side effects Myalgia Arrhythmias Short term memory loss Headache ``` Contraindications SAH ^ICP Heart block

Answer 75

1) Unshakable 2) Illogical grounds 3) Out of keeping with someone’s culture

Answer 76

the traffic light changed red and that’s when I knew MI5 were tracking me

Answer 77

how long did you go on holiday for – we packed and then I took my dog to the vet, my dog is called fluffy etc etc etc, 2 weeks – finally get back to the point

Answer 78

how long ago did you go on holiday – 2 weeks, where to? 2 weeks, who with? 2 weeks

Answer 79

make up a story but without the insight – seen in alcohol – filled in the gaps of his memory with a random story They truly believe what they are saying is true even though its a lie Wernicke's encephalopathy

Answer 80

I can feel something brushing on my arm – it’s the devil | Delusional belief that something is being imposed by outside forces

Answer 81

Slowing of thoughts and movements

Answer 82

Loss of activity with no response to stimuli

Answer 83

Significantly excited or inhibited motor activity | +/- unusual posturing

Answer 84

volume of speech increase – (quantity) rapid skipping from one thought to distantly related ideas, the relation often being so tentative as for instance the sound (rhyming) of different utterances

Answer 85

Speed of speech

Answer 86

my dog died im really sad (and they really are sad but they are smiling)

Answer 87

Mannerism – purposeful movement – salute every time you start a conversation with someone Stereotype behaviour – waving of the arms – not goal orientated Waving of the arms when the kid is excited about seeing ants

Answer 88

Elastic bands Meditation Sleep hygiene

Answer 89

Agranulocytosis | Toxic megacolon

Answer 90

Bipolar 1 – mania and depression | Bipolar 2 – hypomania and depression

Answer 91

THINK _ always bio, psycho, social SGA then Mood stabiliser CBT Social - fam care support engagement with support

Answer 92

he should inform DVLA

Answer 93

MHDisorder Risk to self or others/health Naure or degree to warrant detention in hospital

Answer 94

responsible officer Nearest relative Consultant psychiatrist