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Psych Flashcards

1
Q

Definition of dementia

A

A global and progressive intellectual deterioration without impairment of consciousness

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2
Q

6 deficits of dementia (+ examples)

A 
Behaviour - restless/ repetitive
Thought - slow, memory impairment
Speech - mutism, dysphasia 
Mood - irritable, depression, emotionally incontinent 
Personality - blunt, sexual inhibition
Perception - illusions, hallucinations
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3
Q

Investigations for dementia

A 
1) Bloods 
FBC, U+E, LFT 
Glucose 
Ca 
Na 
Thiamine 
B12 
Tox 
ESR/CRP
2) ECG - heart block/ other arrhythmias 
3) CXR - chest infection
4) CT 
- enlarged ventricles 
- atrophy of: 
Cortex 
Hippocampus 
Medial temporal lobe 
5) Cognitive test 
MMSE 
ACE-R 
MOCA 
6-CIT 
GP-COG 
AMT
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4
Q

Cognitive tests

A

MMSE
ACE-R
MOCA

6-CIT
GP-COG
AMT

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5
Q

What are the components of ACE-R

A 
Attention
Memory 
Language 
Visuospatial 
Fluency
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6
Q

Management of dementia

A

Biological - Rx underlying cause, anticholinesterase inhibitor (only for alzheimers)
Social - clubs eg dementia cafe, keep social
Practical - big clock, routine, no naps, continuity of care, post-it notes

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7
Q

Dementia vs delirium (the table)

A

Delirium reversible
Delirium rapid onset
Delirium course is fluctuating, dementia is slow decline
Delirium is consciousness impaired
Delirium memory not typically affected
Delirium more common hallucinations
Delirium thought muddled, dementia impoverished

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8
Q

What 3 features points towards a diagnosis of VASCULAR dementia

A

Stepwise decline
RF present eg diabetes
FND

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9
Q

Management of vascular dementia

A

ACE-i
Statin
Aspirin
Rx others eg diabetes

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10
Q

Alzheimers pathophysiology

  • Micro ∆
  • Macro ∆
  • Neurotransmitter defects
A

Micro:
Beta amyloid plaques
Neurofibrilliary tangles (tau protein build up)

Macro: 
Increased sulcal widening 
Enlarged ventricles 
Cortical atrophy 
Hippocampal atrophy

Neurotransmitter defects
NA
5-HT
Ach

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11
Q

the 4 As of alzheimer’s

A

Amnesia
Apraxia
Agnosia
Aphasia

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12
Q

Aetiology of alzheimer’s

A 
Multifactorial 
Genetic 
- Presenilin - PS1/PS2 
- APP - amyloid precursor protein 
5% autosomal dominant
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13
Q

Management of alzheimer’s

A

Non pharma
Group therapies, reminiscing groups etc - keep active all that shite

Pharma 
AchE-i 
Rivastigmine 
Galantamine 
Donepezil

NMDA receptor antagonist
Memantine
(note: this is used if ACHEi not tolerated/ CI, not working or in conjunction with it. OR in severe alone)

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14
Q

Presentation of LBD

A

TRIAD

  • hallucinations
  • Parkinson’s
  • Fluctuating consciousness

REM sleep disorder (like in parkinsons)
Frequent falls

Hallucinations are small people and animals - lilliputian!

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15
Q

LBD vs parkinsons dementia onset

A

Movement then dementia - parkinsons

Dementia then movement - LBD

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16
Q

LBD pathophysiology

A

alpha synuclein cytoplasm inclusions in:

1) Substantia nigra
2) Paralimbic
3) Neocortical areas

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17
Q

LBD investigations

A 
Bloods - dementia bloods 
FBC, U+E, LFT, ESR/CRP 
Na 
Ca 
B12 
TFT 
Glucose 
Tox screen 
ECG - heart block etc 
CXR - if suspect infection as cause of delirium 
CT - organic cause 
EEG - for hallucinations ∆

SPECT - radioisotope (IMPORTANT!)

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18
Q

Management of LBD

A

AVOID HALOPERIDOL (and neuroleptics in general)

ACHE-i or
NMDA

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19
Q

Features of BPSD

A 
Agitation 
Depression 
Anxiety 
Disinhibition 
Psychoses
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20
Q

What features are indicative of frontotemporal lobe dementia

A

Onset <65
Insidious onset
Personality ∆
Intact memory and visuospatial awareness

Other features:
Blunted 
Takes things literally 
Apathy 
Sexual disinhibition 
Memory loss usually occurs LATE
Language ∆ (temporal lobe!)
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21
Q

Pick’s disease MRI

A

Knife blade atrophy

Pick’s bodies

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22
Q

Screening tools used in alcohol overview

A 
CAGE 
Cut down
Angry 
Guilty
Eye opener 
TWEAK 
Tolerance
Withdrawal
Eye opener 
Amnesia 
Kut down

FAST

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23
Q

Addiction criteria

A 
TRAM WC 
Tolerance ^
Repertoire - decreased
Abstinence is difficult 
Maintain intake is priority
Withdrawal symptoms 
Compulsion to drink/ use
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24
Q

Long term alcohol problems

A

Neuro - wernicke’s, memory etc
Cardiac - cardiomyopathy, arrhythmia, MI
MSK - osteoporosis
GI - GI bleed, varices, stomach cancer, pancreatitis
Malignancy - GI, breast
Liver - fatty liver, cirrhosis, ALD, hepatitis
Psychosocial - homelessness, relationship breakdown, depression, crime etc etc
Pregnancy - congenital defects (FAS, cardiac lesions etc)

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25
Q

Management of alcohol abuse

A 
Bio
Disulfuram (blocks alcohol)
Naltrexone (opioid antagonist) 
Acamprostate (GABA)
Psychosocial - self help, AA etc (see more in public health)
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26
Q

Alcohol abuse - when to admit

A 
<18 
Previous delirium tremens 
Failed home detox 
Concern for safety 
Wernick's 
Autonomic involvement
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27
Q 
Wernicke's encephalopathy 
What is it 
Presentation 
Investigations 
Management 
Complication
A

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

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28
Q

Delirium tremens
What is it
Presentation
Management

A

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

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29
Q

Rx delirium tremens

A 
ABC 
Treat hypoglycaemia 
Give chlordiazepoxide (benzo) 
Give magnesium to protect against seizures/ arrhythmias 
Give carbemazapine for seizures 
Start thiamine
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30
Q

Presentation of alcohol withdrawal

A

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

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31
Q

Bipolar

types and definition

A

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)

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32
Q

Hypomania and mania symptoms (+what defines/separates)

A

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

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33
Q

Aetiology of mania

A

Genetic
Childhood
Sleep deprivation
Post-partum

Drugs 
Steroids 
Statins 
SSRIs
Illicits and alcohol

Organic

  • Tumour
  • Infection
  • Hyperthyroidism
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34
Q

Bipolar investigations

A

Remember organic causes

Bloods

  • TFT
  • Tox screen
  • Infection screen (ESR CRP)

CT - tumour etc

EEG
MSE

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35
Q

Management of bipolar

A

CBT

ACUTE (manic episode) 
SGA 
Olanzapine 
Clozapine 
Quetiapine 
TAKE THEM OFF THE SSRI

Mood stabiliser
Lithium
Valproate
Other antipsychotics

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36
Q

Someone with bipolar disorder who is having a depressive episode - how do you treat

A

SSRI AND a mood stabiliser

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37
Q

Schizophrenia

criteria/symptoms

A

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
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38
Q

Aetiology of schizophrenia

A 
Genetics 
Childhood trauma 
MIGRANTS 
Drugs 
Alcohol and illicits

Organic:
Neuro
- tumour, trauma, infection

Endo

  • Hyperthyroidism
  • Cushings

Metabolic

  • Hyper Na
  • Hypo Ca
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39
Q

Investigations for schizophrenia

A 
MSE 
Bloods 
- TFT
- OGTT (Cushing's) 
- Na 
- Ca 
- FBC, U+E, LFT, tox screen
CT 
EEG - remember temporal lobe seizure can produce similar symptoms
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40
Q

Management of schizophrenia

A

1) SGA + CBT (TOGETHER)

2) Switch antipsychotic

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41
Q

Side effects of antipsychotics (general list)

A 
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

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42
Q

Dopamine pathways

A

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

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43
Q

Examples of antipsychotics

A

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)

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44
Q

Discontinuing an antipsychotic - side effects

A

Flu like
dreaming
Shock sensations
Irritability

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45
Q

What are the EPSE (including synptoms)

A

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

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46
Q

Management of EPSE

A

Stop cause

Benztropine (anticholinergic)

Tetrabenzene for tar dive dyskinesia

Other
Procyclidine

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47
Q 
NMS 
Causes 
Symptoms 
Investigations 
Management
A

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)
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48
Q

Lithium side effects

A 
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

49
Q

Lithium toxicity - ranges and symptoms

A
  1. 4 - 0.1 - therapeutic range
  2. 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
50
Q

Lithium baseline investigations

A

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

51
Q

Depression criteria (whole shebang)

A

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
52
Q

Depression symptoms

A

Core
Depression
Anhedonia
Fatigue

Other 
Bio 
∆ appetite 
∆ libido 
∆ sleep 
Psychomotor 
Concentration

Psych
Worthlessness /Guilt
Confidence decrease
Thoughts of self harm/suicide

53
Q

Depression aetiology

A 
Genetics 
Childhood 
Life circumstances - work, homeless 
Drugs + alcohol 
Medical - hypothyroid/ chronic disease 
Drugs 
- BB 
- Isotretinoin
54
Q

Depression investigations

A

Bloods - check for organic cause
- TFT, LFT

MSE

Questionnaire
PHQ-9
HAD

55
Q

Neurotransmitters decreased in depression

A

5-HT
Dopamine
NA

56
Q

Side effects of SSRIs and CI

A

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
57
Q

SSRI housekeeping

A

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!

58
Q

SSRI - side effects of discontinuing

A

GI upset
Sweating
difficulty sleeping
Paraesthesia

59
Q

Management of depression (pharma and non pharma) (entire drug overview - class + example of each + what to monitor

A 
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

60
Q

4th line antidepressants

A

TCA - DO ECG
Amytryptylline, noritryptylline, imipramine

MAOI - DO BP and ECG

  • Moclobemide
  • Phenelzine

SARI - trazodone - drowsiness/ constipation

61
Q

Side effects of MAOI

A

Do ECG and BP

fatal HTN, SS, hyponatraemia

62
Q

Side effects of TCAs

A

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

63
Q

SSRIs in pregnancy
Risks
Which drugs

A

Sertraline is generally best
Paroxetine has most risks

1st trimester - congenital cardiac defects
3rd trimester - PP HTN of newborn

64
Q 
GAD 
Criteria 
Symptoms 
Aetiology 
Investigations
Management
A

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

65
Q

GAD management

A

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

66
Q

GAD definition and symptoms

A

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
67
Q

PTSD
Diagnosis
Criteria

A

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

68
Q

PTSD
aetiology
protective factors
management

A

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

69
Q

Management of PTSD

A

1) Watchful waiting

<3 months
CBT and sleep medicate

> 3 months
EMDP
SSRI - Paroxetine
NaSSA - mirtazapine

70
Q

OCD
Criteria
Aetiology
Management

A

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)
71
Q

Panic disorder
Criteria + symptoms
Aetiology
Management

A 
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
72
Q

Delirium

Causes

A

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
73
Q

Management and prevention of delirium

A

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
74
Q

Delirium ICD-10 definition

A

Impaired consciousness

Perceptual disturbance or cognitive disturbance

Develops over short time + fluctuates

Evidence it may be related to a physical cause

75
Q

Drugs causing delirium

A 
SSAAALLAD
Statins
Steroids
Antispasmodics
Anticholinergic 
Anti-epileptics
Lithium
Levodopa
Antihistamine 
Digoxin
76
Q

Anorexia
Criteria
Aetiology

A

NEW
Intense fear of gaining weight
Reduced intake
Body image distortion (/ denial of low body weight)

Genetics
OCD
Depression
Family stress

77
Q

Anorexia signs and symptoms

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

Murmur

78
Q

Anorexia questionnaire

A 
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
79
Q

Anorexia investigations

A

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
80
Q

Anorexia complications

A 
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
81
Q

Anorexia risk assessment

A 
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 ∆
82
Q

Anorexia management

A 
Adults 
- CBT-ED 
- MANTRA
- SSCM
Children 
anorexia focused family therapy

SSRI - fluoxetine
Antipsychotic - chlopromazine

83
Q

Refeeding syndrome

A

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

84
Q

Organic causes of visual hallucinations

A 
SOL 
Charles Bonnet 
Optic nerve palsy 
Migraines 
LBD/ parkinsons 
Infection 
epilepsy 
Alcohol withdrawal
85
Q

how to assess someones suicide risk

A

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
86
Q

Serotonin syndrome

Symptoms

A

CAN
Cognitive
agitation/ irritation/ confusion/
euphoria/ mania/ hallucinations

Autonomic
HR ^, BP^, temp^, sweating, mydriasis

Neuro 
Reflexes increased 
Tremor 
Ataxia 
Clonus 
Seizures
87
Q

Serotonin syndrome

Aetiology and investigations

A 
SAME OA 
SSRI
Amphetamines/cocaine 
MAOIs
Ecstasy
Opioids
Antipsychotics
- Olanzapine 
- Risperidone 
- Lithium

Investigations - ^CK!

88
Q

Serotonin syndrome - management

A 
ABC 
remove causative agent 
Fluids 
Benzos 
cyproheptadine 
Chlorprozamine

Beware hyperthermia can –> metabolic acidosis + AKI/rhabdo

89
Q

Personality disorders

overview

A

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

90
Q

Phobias

A

Intense irrational fear

Management
CBT
BDZ

91
Q

Factitious disorder

A

Making up symptoms for medical or personal gain

Eg picking at a cut to make it infected

92
Q

Malingering disorder

A

Making up symptoms for financial or other gain

93
Q

Conversion disorder

A

Loss of motor or sensory

Doesn’t consciously fake it or seek gain

94
Q

Hypochondriasis

A

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

95
Q

Somatisation disorder

A

Presence of physical symptoms
Present for 2 years
Multi-organ

96
Q

Opioid misuse
Presentation
Complications
Management (overdose + detox)

A 
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

97
Q

Criteria for dependence syndrome

A

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
98
Q

ECT
Who is it suitable for
Side effects
Contraindications

A 
Useful for: 
Catatonia 
Depression + psychosis 
Severe depression 
Prolonged manic episode 
Side effects 
Myalgia 
Arrhythmias  
Short term memory loss 
Headache

Contraindications
SAH
^ICP
Heart block

99
Q

Delusion criteria

A

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

100
Q

Delusional perception example

A

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

101
Q

Circumstantiality

A

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

102
Q

Preservation

A

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

103
Q

Confabulation

A

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

104
Q

Somatic passivity

A

I can feel something brushing on my arm – it’s the devil

Delusional belief that something is being imposed by outside forces

105
Q

Psychomotor retardation

A

Slowing of thoughts and movements

106
Q

Stupor

A

Loss of activity with no response to stimuli

107
Q

Catatonia

A

Significantly excited or inhibited motor activity

+/- unusual posturing

108
Q

Flight of ideas

A

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

109
Q

Pressure of speech

A

Speed of speech

110
Q

Incongruent affect

A

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

111
Q

Stereotypism vs mannerism

A

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

112
Q

Coping mechanisms for self harm

A

Elastic bands
Meditation
Sleep hygiene

113
Q

Clozapine SE

A

Agranulocytosis

Toxic megacolon

114
Q

Bipolar 1 vs 2

A

Bipolar 1 – mania and depression

Bipolar 2 – hypomania and depression

115
Q

Bipolar management

A

THINK _ always bio, psycho, social

SGA
then
Mood stabiliser

CBT
Social - fam care support
engagement with support

116
Q

DVLA and mania

A

he should inform DVLA

117
Q

Section 3 criteria

A

MHDisorder

Risk to self or others/health

Naure or degree to warrant detention in hospital

118
Q

Who can release from section 3

A

responsible officer
Nearest relative
Consultant psychiatrist

3a (6 decks)

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