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Management from lecs > Psych > Flashcards

Psych Flashcards

1
Q

To be diagnosed with schizophrenia, the symptoms must have lasted..

A

One month or more

* with at least 1st rank symptoms or 2/more other symptoms

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2
Q

Hypercalcaemia can present with …

A

Psychosis

** as well as VIT b12/folate deficiency

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3
Q

Both typical and atypical psychotics are

A

Dopamine D2 receptor antagonists

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4
Q

Management of schizophrenia

A
  1. patient choice

if unsuccessful: change drug

if still unsuccessful: give clozapine

** can offer CBT if still a bit of symptoms despite being on clozapine OR family psychotherapy

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5
Q

Size effects of clozapine include

A

Weight gain, sedation, hypersalivation + neutropenia - too much = epilepsy

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6
Q

Side effects of 1st generation drug haloperidol….

A

EPSE + has a direct effect on the heart

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7
Q

symptoms of neuroleptic malignant syndrome

A
  • pyrexia
  • raised CK
  • Tachy
  • Deranged LFTs + increase WBC/neutrophils
  • confusion

** potential if started new antipsychotic or rapid change in doses

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8
Q

Psychotic episode is diagnosed if it lasted

A

2 weeks or less

*symptom may vary over time

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9
Q

Schizoaffective disorder can be diagnosed if

A
  • presence of affective symptoms (e.g. low mood/irritability) with schizophrenic symptoms
  • Duration at least 2 weeks
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10
Q

Persistent delusion disorder is diagnosed if

A

Presence of delusional symptoms in the absence of hallucinations or thought disorder

** symptoms presents for either 1 or 3 months

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11
Q

To be diagnosed with depression you need to have

A

Core symptoms - low mood, lack of energy or anhedonia

Other symptoms - loss of libido, early morning awakening, loss of appetite, feelings of guilt or worthlessness

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12
Q

Classification of depression

A
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13
Q

Management of depression

A

For mild

  • 1st line: CBT
  • IPT (relationship problems)
  • psychoeducation/ ask about social side e.g. housing

For mod-severe

  • SSRI’s i.e. sertraline/citalopram
    • Can give ECT with severe depression that has not responded to other treatments
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14
Q

Recurrence after a first episode of severe depression

A

80%

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15
Q

Anti-depressant withdrawal symptoms

A
  • Restlessness/parathparaesthesiaing /insomnia dizziness
  • Duration: few weeks to a year
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16
Q

Diagnosing bipolar disorder

A

At least 2 episodes of significant mood disturbance

  • one of which must be mania or hypomania
  • and the other depression
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17
Q

Difference between mania and hypomania

A

same symptoms but different duration and impairment

e.g. grandiosity/decreased need for sleep/ pressured speech/distractibility/ flight of ideas/ increased activity

  • Hypomania lasts < 7 days + not cause functional impairment
  • mania >7 days + causes functionol impairment
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18
Q

Long-term management for bipolar disorder

A
  • 4 weeks after an acute episode has resolved: lithium (to prevent relapses)
  • if lithium ineffective consider: Valprate, olanzipine or quetiapine
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19
Q

Management of acute manic or mixed episode

A
  1. offer antipsychotic e.g. olanzapine/risperidone
  2. Mood stabilizers e.g. lithium (2nd line)
  3. can consider benzodiazepines to aid sleep
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20
Q

What to do before you start someone on lithium

A
  • U&E’s
  • TFT’ss
  • Pregnancy status
  • Baseline ECG

Monitored closely for SE

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21
Q

Management of specific phobia

A

1st line: self-help - CBT online/booklet or website

2nd line: CBT - graded exposure focus

3rd line: can consider antidepressants/benzodiazepines or b blockers

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22
Q

How to diagnose specific phobia

A
  • marked persistent fear/anxiety of a specific object/situation
  • should last 6 months
  • Avoids it but can tolerate it with pain
  • immediate reaction with same response each time
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23
Q

Social/ anxiety phobia , its symptoms

A

A fear of social situations due to humiliation/criticism or embarrassment - individuals are usually self critical

  • somatic symptoms e.g. blushing/trembling/palpitations
  • with excessive fear
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24
Q

ICD-10 diagnostic criteria of GAD

A
  • Anxiety symptoms lasting 6 months or more with at least one of autonomic arousal e.g. chest pain/discomfort
  • anxiety symptoms e.g. excessive worry, concentration difficulties, restlessness, sleep disturbance
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25
Q

Management of GAD

A
  1. Self help
  2. CBT (low intensity - if fails, high)
  3. antidepressants - SSRI (1st line)
  4. Consider benzodiazepine or anti-histmiane e.g. promethazine
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26
Q

Diagnostic criteria for OCD

A
  • obsession/compulsion present on most days
  • originates from patients mind and carrying it out is not pleasureable but reduces anxiety levels
  • for a period of at least 2 weeks which causes distreess
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27
Q

Management of OCD

A
  • Guided self help or computerized CBT (mild)
  • SSRI (mod)
  • SSRI + CBT with ERP (severe)
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28
Q

symptoms of PTSD

A
  • reliving situation
  • avoidance
  • hyperarousal
  • emotional numbing e.g negative thoughts about oneself, feelings of detachment
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29
Q

diagnosis of ptsd

A

Note: if same symptoms lasts less than a month then consider acute stress reaction as diagnosis

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30
Q

Treatment of PTSD

A
  1. Trauma-focused CBT
  2. Eye-movement desensitization reprocessing (EMDR)
  3. narrative exposure therapy
  4. can consider antidepressants SSRI/SNRI or short term sleep treatment (zopiclone)
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31
Q

Difference between adjustment disorder and PTSD

A

PTSD usually catastrophic event and lasts >6 months but AD is non-catast. and last < 6months

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32
Q

What antidepressants can you offer pregnant women

A

1st line is Setraline (as it is only secreted in 10% of breast milk and so can be continued after birth)

* needs to be avoided in 1st trimester

*avoid benzidiazepines

* can give promethazine low dose to help with sleep

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33
Q

Abortion is legal upto

A

12 weeks

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34
Q

Post natal depression usually presents

A

8-12 weeks post delivery (at worse 4-6 weeks)

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35
Q

Body mass indes

A

weight/H2

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36
Q

Diagnosis of anorexia nervosa

A

FEED

  1. Fear of gaining weight
  2. Endocrine disorder e.g. amenorrhea/loss of sexual interest
  3. Emaciated (abnormally low body weight): >15% below expected weight (or BMI <17.5)
  4. Distorted body image

***symptoms must be present for a_t least 3 months_ + in the absence of recurrent episodes of binge eating or preoccupation with eating/craving to eat

Other symptoms include

  1. Physical (fatigue/hypothermia/bradycardia/hair loss/ palpitations)
  2. Dieting/ diet pills/ self-induced vomiting/ use of laxatives
  3. socially isolated + sexually feared
  4. Symptoms of depression and obsessions
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37
Q

Anorexia has the highest x rate out of all psych disorders

A

Death

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38
Q

Investigations to do if investigating eating disorders

A
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39
Q

Blood results of someone with refeeding syndrome

A

Low phosphate, magnesium and potassium - due to a surge in insulin

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40
Q

Management of AN

A
  1. if BMI <14 then consider hospitalization -
  • Correct electrolyte abnormality
  • Aim of treatment as an inpatient is for a weight gain of 0.5–1 kg/week and as an outpatient of 0.5 kg/week
  1. Psycho-education about nutrition
  2. CBT/ cognitive analytical therapy/ IPT
  3. Consider SSRI if depressed
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41
Q

Treatment of paracetamol over dose

A

Intravenous N-acetylcysteine (NAC)

42
Q

MHA

A
43
Q

2 types of bulimia nervosa - what are they

A
  1. Purging type - self induced vomiting + laxatives
  2. non-purging type - excessive exercise + fasting/dieting
44
Q

ICD-10 criteria for BN

A
  • Compensatory behaviours to prevent weight gain
  • pre-occupation with eating
  • fear of fattness
  • overeating
  • other features include: normal/overweight/depression/ signs of dehydration
45
Q

Management of BN

A
  1. Risk assess
  2. Guided self -help + nutritional advise
  3. if unsuccessful after 4 week: do CBT- ED
46
Q

Diagnostic criteria for binge eating disorder

A
  • Recurrent episodes of binge eating - associated with 3 (or more of the following)
  • Eating very fast during a binge
  • Eating until you feel uncomfortably full
  • Eating when not hungry
  • Eating alone or secretly because of feeling embaressed
  • Feeling depressed, guilty, ashamed or disgusted after binge eating
  • Binge eating occurs, at least once a week for 3 months
  • Other physical Features: Tiredness, Difficulty sleeping, Weight gain, Bloating, Constipation + Stomach pain
47
Q

Dementia diagnosis

A
48
Q

Methods of testing cognition in dementia

A
  • MMSE
  • Glasgow coma scale
  • 4AMT
49
Q

What investigation would you do if you suspect dementia/delirium

A
  1. urine - rule outUTI
  2. blood test - hypercalaemia/ anaemia/ hypoglycaemia/ vit b12or folate deficiency
50
Q

Managment of dementia

A
  1. non-pharmaco include: social support, info and communication, CBT for depression/anxiety
  2. Pharamco - Acetylcholinesterase inhibitors (AChE)

e.g. Donepezil, galantamine and rivastigmine. (alternative: memantine)

***cognitive enhancement and slows progression on MMSE per year and adds 6 months to placement in a home.

  1. Can consider antipsychotics if agitation is uncontrollable or anti-depressants for low mood
51
Q

Common features of Lewy body dementia?

***& Fronto-temporal lobe

A
  1. Visual Hallucinations
  2. Parkinsonism

**personality changes

52
Q

Delerium/confusion screening test

A
  1. Sqid
  2. 4AT
  3. CAM
53
Q

Test used in the detection of mild cognitive impairment and Alzheimer’s disease

A

MOCA (Montreal cognitive assessment)

*other Addenbrookes (ACE-II)

54
Q

there are 2 types of EUPD

A
  1. Impulsive type - lack of impulse control/anger control + outbursts of violence and threatening behaviour
  2. Borderline type -
  • Unclear identity
  • Series of suicidal threats or acts of self harm
  • Unclear identity, intense and unstable relationships including sexuality
55
Q

Treatment for EUPD

A
  1. Dialectical behavioural therapy
  2. CBT

* can consider short-term management of insomnia e.g. zopiclone

56
Q

Diagnosis of EUPD - what to remember

A

NICE emphasises that ‘borderline personality disorder’ should not be diagnosed under the age of 18, although characteristic personality traits can be detected at an earlier age.

57
Q

Diagnostic criteria for antisocial PD

A

At least 3 of the following

  • Callous unconcern for the feelings of others.
  • Frequent encounter with police
  • Gross and persistent attitude of irresponsibility and disregard for social norms, rules and obligations.
  • Incapacity to maintain enduring relationships, although having no difficulty to establish them.
  • Very low tolerance to frustration and a low threshold for discharge of aggression, including violence.
  • Incapacity to experience guilt, or to profit from adverse experience, particularly punishment.
  • Marked proneness to blame others, or to offer plausible rationalizations for the behavior bringing the subject into conflict with
58
Q

Treatment of antisocial PD

A
  • non-pharmacological
  • psychotherapy e.g. group psychotherapy or CBT
59
Q

ICD-10 definition of LD

A

ICD- 10 definition: Life long condition of arrested or incomplete development of the mind.

It is characterized by

  • A significant global impairment of intelligence
  • A significant impairment of social or adaptive functioning
  • Originating in the developmental period (or before age of 18)
60
Q

People with Ld are more prone to

A
  • psychiatric illnessess e.g. schizophrenia, anxiety, depression
  • Physical illnessess e.g. cancer , CVD, epilepsy
  • hearing and speech difficulties
  • more sensitive to side effects of drugs
61
Q

Name the IQ test

A

WAIS

62
Q

test to check for behaviour

A

Adaptive Behaviour Assessment System (ABAS-II)

Vineland Adaptive Behaviour Scales, (Vineland-II)

63
Q

IQ ranges

A
64
Q

Most common cause of LD

A
  1. Downs syndrome - chromosome 21 trisomy
  2. Fragile X syndrome - X linked dominant condition
65
Q

Autism diagnostic criteria

A
  • Carry Autism spectrum coefficient AQ-10 - 6 or more = possible autism
  • others: DISCO, AAA
66
Q

Features of autism

A
67
Q

Management of autism

A
  1. Treat any co-morbodities
  2. non-pharma
  3. psychological e.g.
  • CBT
  • Early intensive behavioral intervention (EIBI) programs
  • Communication intervention e.g. speech and language therapy
  • Occupational therapy/ music therapy
  • Other: Routines are helpful, Visual aids can facilitate communication, Look at changes to their environment to help (e.g. reduction in noise)
68
Q

How to tell if someone is dependent on recreational drugs

A

DRUG PROBLEMS WILL CONTINUE TO HARM - 3 or more of

  1. strong desire to consume substance
  2. pre-occupation with substance use
  3. withdrawal state when substance withdrawn
  4. impaired ability to control substance-taking behaviour
  5. persisting of use with use, despite clear evidence of harmful effects
69
Q

Side effects of opioids e.g. morphine/codeine

A

respiratory depression, hypoxia, pupillary constriction

70
Q

Management of substance abuse

A
  1. motivational interviewing
  2. Methadone (first line) or buprenorphine for detox and maintenance
71
Q

Anti-dote opioid overdose

A

IV naloxone

72
Q

One unit of alcohol is defined as

A

10ml (8g) of pure ethanol

  • can be worked out % x ml
  • divided by 1000
73
Q

Clinical features of alcohol intoxication

A
  • slurred speech
  • impaired judgement
  • labile affect (excessive display of emotion)
  • poor coordination
74
Q

Features of alcohol dependence

A
  • Subjective awareness of compulsion to drink.
  • Avoidance or relief of withdrawal symptoms by further drinking (also known as relief drinking).
  • Withdrawal symptoms
  • Drink-seeking behaviour predominates
  • Reinstatement of drinking after attempted abstinence.
  • Increased tolerance to alcohol.
  • Narrowing of drinking repertoire i.e. fixed time for drinking
75
Q

An alcoholic patient presenting with delirium, nystagmus, ophthalmoplegia, and ataxia. What is this?

A

Wernickes encephalopathy and is due to thiamine deficiency

76
Q

Treatment fo alcohol abuse

A
  1. Thiamine if patient deficient
  2. For dependence long term: Disulfiram, Acamprosate (reduces craving) and Naltrexone (opioid antagonist that reduce pleasurable effects of alcohol)
  3. Psychological

CBT, Motivational interviewing

  1. Social e.g. alcoholics anonymous
77
Q

What to give somone for alcohol withdrawal ?

A

BDZ e.g. chlordiazepoxide

78
Q

Delirum tremens

A
  • Occurs within 3 days of abstinence or decreased drinking
  • global confusion with hallucinations, seizures
79
Q

Amitriptyline is a tricyclic antidepressant that should be avoided in

A

patients with suicidal ideation

  • MOA: inhibits reuptake of serotonin and NA and act on cholinergic receptors and histamine
  • SE: dry mouth, constipation, thirst
80
Q

SSRI is prescribed for

And when should it be avoided

A
  • Moderate to severe depression
  • Avoided in those taking blood-thinning meds
81
Q

Most common side effects of SSRI

A

Gi symptoms, csn also give tremor, rashes, sweating

82
Q

SSRI MOA

A

Prevents the reuptake of serotonin from the synaptic cleft therefore increasing their concentration

83
Q

Examples of SNRI’s

A

Venlafexine (second or third line in treatment of anxiety/depression)

MOA: prevents reuptake of NA and serotonin but do not block cholinergic receptors

SE: nausea/dry mouth and headaches

84
Q

NASSA (noradrenaline serotonin specific antidepressants) example + MOA

A

Mirtazapine (often 2nd line in depression)

MOA: alpha 1 and 2 blocker

SE: increases appetite and is sedative

85
Q

Prolonged QT is a particular concern in which antipsychotic

A

Haleperidol

86
Q

Typical

Atypical antipsychotics

A
  • Haleperidol and chlorpromazine
  • Olanzepine, clonazepine
87
Q

EPSE is most common in

A

Typical antipsychotics

  • Examples include Parkinsonism, akathisia (unpleasant feeling of restlessness), dystonia (painful spasms), tardive dyskinesia
88
Q

Mood stabilizers

A

Lithium (1st line) , sodium valproate and lamotrigine

89
Q

Sodium valproate

MOA?

Avoid in?

A
  • inhibit catabolism of GABA
  • Pregnancy
  • SE: GI disturbance, weight gain, ataxia, increase in agression
90
Q

Lithium is first line in

A

Bipolar affective disorder

91
Q

Side effects of lithium

Presentation of lithium toxicity

A

LITHIUM

  1. leucocytosis, impaired renal function, fine tremor, hypothyroidism, metallic taste
  2. Course tremor, renal failure, ataxia, convulsions/seizures and increased reflexes
92
Q

Management of lithium toxicity

A

If signs of toxicity are identified,

  1. lithium should be stopped immediately
  2. give a high intake of fluid should be given
  3. IV sodium chloride therapy, to stimulate osmotic diuresis.
  4. In the most severe cases, renal dialysis may be needed.
93
Q

Anxiolytics e.g. BDZ, busiprone or B-blockers are used as

A

Sedatives

  • BDZ (first line)
  • Can be used in anxiety, insomnia, delirium tremens and alcohol detox or violent behaviour
94
Q

Examples of long-acting and short acting BDZ

A
  • Long acting >24 hrs: Diazepam/chlordiazepoxide/clonazepam
  • Short-acting <24hr: Lorazepam
95
Q

BDZ MOA

A
  • increases the inhibitory effect of GABA
96
Q

What is promethazine

A
  • antihistamine sometimes used as a sleeping pill.
  • Can be given to pregnant women but for shortest period of time
97
Q

Side effects of BDZ

A

Lighti headedness, drowsiness, confusion

98
Q

Features of BDZ overdose

+ management

A

ataxia, nystagmus, coma, resp depression

  • IV flumazenil
99
Q

When to expect a lack of capactiy

A

CARD

  1. cognitive impairment
  2. abnormal behaviour
  3. refusing treatment
  4. delirium
100
Q
A

CAMHS

MHA

HTT

PICU

EIP

CRT

101
Q
A

Management from lecs (7 decks)

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