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MRCP > Psych > Flashcards

Psych Flashcards

1
Q

Alzheimer’s Dx

A

Non pharm mx:

  • Well being
  • Group therapy

Pharm:

1) ACHEI - Donepezil/glanatamine/rivastigmine
2) Memantine = NMDA antag:
- Use as mono if ACHEI CI or v.sev alzheimers
- Use as +on in mod - sev

Ranking - MMSE score:
26 - 18 mild
17 - 10 = mode
<9 =- severe

Donepezi;:

  • S.e insomnia
  • relative CI = hypotension
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2
Q

Vascular dementia

A

Subtypes:

  • stroke - related
  • subcortical - SVD
  • mixed - VD + Alzheimers
RF: 
smoking 
lipids
AF
HTN
Past HX - stroke/TIA
DB 
CHD
FHx

NINDS-AIREN Criteria:

  • Cerberovascular dx
  • Intefernece of ADL not secondary effects of cerebrovasc event
  • Relationship between above 2

Mx - Non harm:

  • Mx CV risk factors
  • specific
  • Mx challenging behaviour

Pharm - mx

  • not typically used
  • only if assoc alzheimers.
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3
Q

F-T dementia

A

common ft:

  • <65 yrs
  • insidious onset
  • Preserved memory and visuospatial skills
  • Pernsonality change and social conduct

Pick’s dx = most common type:

  • Focal gyral atrophy –> KNIFE BLADE APPEARANCE

Macroscopic changes of Pick’s:
- Atrophy of F + T lobes

Microscopic:
= pcik boies - tau protein = SILVER STAINING 
- Gliosis 
- NFTs 
- Senile plaques.

Other types of f-t dementia:

  • CPA - non-fluent speech
  • Semantic - fluent speech with empty meaning - LT memeory affected (unlike Alzheimer’s)
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4
Q

Lewy body demenetia

A

Parkinson plus synbdrome

alpha-synuclein cytoplasmic inclusions (Lewy bodies) in the SUBSTANTIA NIGRA/PARALIMBIC/.NEOCORTICAL AREAS

Ft:

  • progressive CI
  • parkinsonism
  • Visual hallucination

Diagnosis

  • clinical
  • SPECT

Mx:

  • Alzheimer tx
  • DO NOT USE NEUROLEPTICS –> irreversible parkinsonism.

Q stem - may give someone with acute deterioration after starting antipsychotic –> LBD

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5
Q

Charles bonnet syndrome

A

Persistent or recurrent complex auditory or visual hallucinations.

Retajn insight

Rf

  • age
  • visual impairment
  • social isolation
  • sensory deprivation
  • early conginitive impairment
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6
Q

First rank symptoms of schizo

ATPD

Aim. To pass definitely

A

Auditory hallucinations:

  • 3rd person
  • running commentary
  • thought echo

Thought disorder +:

  • insertion
  • withdrawal
  • broadcast

Passivity:..

  • bodily sensations
  • actions, feelings, impulses

Delusional:
- sudden, intense, self referential delusion
- In response to common things.
-

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7
Q

RF for Schizo

A 
FHx 
Blac/carribean
migration
urban 
cannabis
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8
Q

Poor prognostic ft of schizo

A 
\+ FHx 
Gradual onset 
Low IQ
Premorbid social withdrawl 
no precipitant
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9
Q

MX of sschizo

A

PO Atypicl antipsychotics
CBT
CV risk

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10
Q

Atypical Antipsychotics

A

Adverse effects:

  • WG
  • Raised PRL
  • Clozapine –> Agranulocytosis.

In elderly pt:

  • Inc. stroke risk
  • Inc VTE

Examples:

  • Clozapine
  • Onlazapine –> raised obesity/WG
  • Quetiapine
  • Risperidone
  • Amisulpride
  • Risperidone
  • Aripiprazoel
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11
Q

Clozapine

A

S.e = agranulocytosis –> monitor FBC

Only use after fx >/= 2 antipsych for 6-8/52

other adverse affects:

  • Decrease seizure threshold
  • constipation
  • Myocarditis –> ECG prior
  • hypersalivations
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12
Q

Hypomania vs mania

A

Mania:

  • > /= 7/7
  • imoact fn/social/worj
  • hospitalition
  • psychotic sx

hypomania - <7/7 out of all the others.

Mx - short term:

  • BZD
  • Onloanzapine
  • Li
  • ECT - prolonged + resistant

Mx - Long term:

  • Li –> fx/rapid cycling –> Carbemezapan
  • depressive sx +++ - Valproc acid/lamotrigine.
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13
Q

SSRIs

A

Cause hyponatraemia
GI effects
Increased vigillant

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14
Q

Lithium

A

Mood stabiliser –> narrow therapeutic indec = 0.4 -1.0

Excreted by KIDNEYS

S.e. - L.I.T.H.I.U.M.S:
Levels + leucocytosis/inc urine (DI) + inc wt/tremor + thirst/Hypothyroid + hair thin/interaction/upset stomac/Muscle weakness/ Skin - Acne + psoriasis

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15
Q

Li - Toxicity

A

Symptoms:

  • Tremor
  • Hyperreflexia
  • Acute confusion
  • Seizure
  • Coma

Mx:

  • IVI
  • HAemodialysis - (if severe Li >2.0)
  • +/- NaHCO3-
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16
Q

Depression

A

DSM IV grading

> /= 2 weeks

PHQ - 9:

  • 0-7 = normal
  • 8-10 = borderline
  • > 11 = +ve

Biological - important as predictor of response to Tx:

  • Diurnal variation
  • loss of libido
  • loss of appetite
  • Loss of energy
  • WL
  • psychomotor retardation

OTher sx:

  • low mood
  • annehedonia
  • low energy
  • insomnia

Psychotic symptoms

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17
Q

Depression grading

A

Subthreshold - <5 sx

Mild - 5 sx - mild impairment of fn

Mod: Mild – > Sev sx/fn’al impairment

Sev = Fnal impairmenet sev +/- psychotic sx

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18
Q

Depression Mx

A

SSRI –> try 2nd –> try ALT

ECT

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19
Q

Depression vs dementia

A

Dementia:

  • LT
  • Recent memory loss
  • Makes stuff up
  • consistent
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20
Q

Generalised anxiety disorder

A

Alway rule out physical cause first - Thyroid/hear/meds (theophylline, salbutamol, steroid, antidepressant, caffeine)

Mx:

1) Educate/active monitoring
2) low intensity psychology - self help/group
3) high intensity psychology (CBT) +/- drug therapy
4) specialist inout

Drugs:
- SSRI –> sertraline (if <30 will have initialsuicidal rxn)

21
Q

Panic disorder

A

Mx:

1) Recog + diagnose
2) TX in primary care
3) R/v + consider alt
4) R/V + Referral to specialist
5) care in specialist MH service

1st line SSRI for 12 weeks –> imipramine + clomipramine

22
Q

Phobias

A

Mx - Behavioural therapy = graded eposure

SSRI/beta block/BZD

23
Q

PTSD

A

> 1/12 - an event that a patient fines stresful.

HARE = Hypervigillant, avoidance, re-exposure, emotional numbing

Mild =- <4/52 –> W/W
Sev - Trauma focused CBT or EMDR

2nd line:
BEnlafexine or Sertraline
–> Fx/ severe –> Risperidone

24
Q

OCD

A

Obsession:

  • recurrent
  • persistent and intrusice
  • Occurs vs pt’s will
  • Regarded as absurd - INSIGHT
  • Pt own thoughts
  • resisting –> anx

Compulsions = irresistable

Assoc:

  • Depression
  • schixophrenia
  • Anorexia nervosa
  • organic brain disorder.

Mx:
1) Psychological –> EXPOSURE RESPONSE PREVENTION

2) SSRI or clomipramine +/- CBT

25
Q

Somatoform disorder

A

Somatisation:

  • > 2 physical SYMPTOMS w/o medical eplamatio/
  • Fn’al impairment

Hypochondrial dx:
- Persistenet belief that they have specific DISEASE(S)

Mx:

  • psychological
  • anti-depressants.
26
Q

Conversion disorder

A

Loss of MOTOR or SENSORY fn

NOT CONSCIOUSLY

27
Q

Dissociative disorder

A

typically involves psychiatric sx = Seperating off certain memories

28
Q

Fatcious disorder

A

MUNCHAUSEN = Intentional

29
Q

Malingering

A

seek material gain = FRADULENT

30
Q

Anorexi anervosa

A

Diagnostic criteria:

  • WL >15% or BMI <17.5
  • specific psychology - fear of fatness/low threshold for fatness
  • Spec endocrine ft:
  • delayed puberty, loss of libid, amennorhea

OTher ft:

  • Low BP
  • brady
  • Enlarged salivary glands
  • low K
  • Low FSH/LH
  • High GH /Cortisol
  • High cholessterol
31
Q

Bulimia nervosa

A

> once/week for 3/12

Recurrent episodes of binge
Lack of control whilst bingi g
recurrent compensatory
self evaluation by BW/Shape/

Mx:
- Refer all

32
Q

Suicide Risk factors

A

SAD PERSONS

sex/age/depressive/psych hx/excess drug use/rationale loss/seperated/organised plan/no support/sickness

33
Q

Delirium causes

I WATCH DEATH

A

Infection

Withdrawl = EtOH/BZD/sedatives
Acute metabolic 
Toxins - Opiates/steroids/anticholinergic/osychotropics
CNS 
Hypoxia 
Deficiencies - B12/Thiamine 
Endocrine - thyroid/BGL/low adrenal
Acute vascular 
Trauma
Hearing
34
Q

Delirium/Dementia

A

Delerium:

Low consciousness
Fluctuation
Perceptual changes
Drlusions

35
Q

Alcohol withdrawl

A

Chronic –> increased GABA –| CNS/NMBDA glutamate receptors.

Ft:

  • 6-12 hr - remor/sweatinf/anxietu
  • 36 hr - Seizure
  • 48-72 hr - DT

Mx - any pt with complex withddrawl hx (seizure/withdrawl) –> Admit

1) BZD = chlordiazepoxide

if liver fx - loazepam

36
Q

Alcohol withdrawl syndroem

A

CAGE
- thought of cut down/annoyance at others for asking to/ guilt/ eye opener

Mx:

  • Acute withdrawl - bzd
  • Disulifram - inhibits Acetylaldehyde dehydrogenase -CI = IHD/PSYCHOSIS
  • Acomprostate - weak NMDA receptor antag –> decrease craving
37
Q

Wernickes - Korsakoffss

“thin thigh Gym mnemonic”

A

Thalamus + mamillary body
Wernickes - Ataxia/confusion/opthalmoplegia-nystagmus

Korsakoffs - confabulation

Dry and wet beri beri (wet –> Cariomyopathhy)

38
Q

Mx of hepaticc encephalopathy

A

LActulose

Rifaximin

39
Q

Sleep disorders:

A

Stages of sleep:
Awake –> REM –> 1 - 2- 3- 4= non-rem

REM sleep:

  • EEG = ASYNHRONOUS beta waves
  • bursts of conjugate eye movement
  • high HR/BP/penile tumerscence
  • low musc tone
NON-REM:
- EEG = SYNCHRONOUS 
- stage 1 =  theta waves
2 = sleep spindles/K complexes
3 = delta waves

= The Sleep Doctors BRain = theta/spindle/delta/beta

40
Q

Sleep paralysis

A

TRansient = on waking and falling asleep = assox w/ REM

Ft = paralysis + hallucination

Mx if troubled –> clozapine

41
Q

Typical antispyschoics

A

Chlorpromazine, haloperidole, flupentixol, zuuclopenthixol

S.E:

  • EPSE
  • antucholinergic
  • anti-adrenergic
  • anti-histamines
  • hgih PRL
  • prolonged QTc
  • Reduced seizure threshold.
42
Q

SSRIs

A

Fluoxetie, duloxetine, paroxetine, citalopram, setraline

S.e:
- Seretonin syndrome 
nausea
SEXUAL DYSFN 
inc anx 
initial inc suicide risk
43
Q

TCA

A

Amtryptilline
imipramine
clomipramine

S.e:
- ANticholinergic
- anti-adrenergic
anti-histamine

44
Q

antidepressant - SNRI

A

Venlafexine

s.e - NAusea/HTN

45
Q

antidepressant - MAOI

A

Phenelezine

Anticholinergic
antiadrenergic

46
Q

Mirtazapine

A

presynaptic alpha-2 receptor antag

Agranulocytosis

47
Q

ECT

A

Catatonia
refractory sev depression
psychotic sx

CI = ICP raised

S.e
headache/nausea/ ST memory loss/cardiac arrythmia

LT - poor memory

48
Q

Serotonin syndrome mx

A

IVI
BZD

if more sev - use seretonine antag - CRYOHEPTADINE and CHLORPROMAZIEN

49
Q

Management of bipolar

A

1st line Lithium

2nd kine - Valproate

MRCP (20 decks)

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