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Phase 3a > Psych > Flashcards

Psych Flashcards

1
Q

What is the term given to someone with a fear of outdoor spaces

A

Agoraphobia

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2
Q

What sleep disturbance do you classically see in depression

A

EMW

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3
Q

Give 4 types of bipolar

A

Type 1
Type 2
Rapid cycling
Cyclothemia

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4
Q

How many cycles would someone with rapid cycling bipolar have in a year

A

4+

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5
Q

First line tx for self harm

A

DBT

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6
Q

What are the 3 key features of mania

A

IHE

Irritability
Hyperactivity
Elated out of context

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7
Q

Definition of delusion

A

A fixed unshakeable belief, out of context of religious and cultural norms, that is held in the face of evidence

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8
Q

Name the two MHA police orders and when they are applied

A

S13– need a house warrant

S136-in community/ a&e, hold for 24hrs (+12)

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9
Q

What sleep disturbances do you see in GAD

A

Insomnia, struggle to get to sleep + wake lots in the night

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10
Q

How long do you ha e to have had depressive symptoms for to get a diagnosis

A

2weeks

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11
Q

How long do you have to have had manic symptoms for to get a diagnosis of mania

A

1week

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12
Q

How long do you have to have hypomanic symptoms for to get a diagnosis of hypomania?

A

4days+

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13
Q

What are the causes of lithium toxicity

A

Dehydration- any cause for this
Excessive intake
Decline in renal function
Drug interactions

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14
Q

Complications of lithium toxicity

A

Induction of Serotonin syndrome
Nephrogenic diabetes insipidus
Coma
Death

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15
Q

Before starting lithium what tests do you need to do:

A

Preg test
Renal function test
Thyroid function test

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16
Q

What advice would you give to someone starting lithium

A

Stay hydrated
Don’t restrict salt intake
Carry lithium card

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17
Q

Lithium toxicity symptoms

A 
Tremors
hyperreflexia 
Ataxia 
Nystagmus 
Inability to concentrate urine

Sign - hypothyroidism

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18
Q

Core features of PTSD

A

Reliving experiences
Hyper vigilance
Avoidance

Due to traumatic event - occurs w/in 6 months

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19
Q

Symptoms of anxiety

A

Sweating
Palms/tachyC
HyperV

May go on to vomit/ pass out

Sign- wringing hands

(Enhanced startle response, difficulty concentrating)

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20
Q

Treatment for anxiety

A

Propanalol / benzos for tachyC
SSRIs- paroxetine/ fluoxetine
SSNRI- venlaflaxine
Mirtazapine - more sedating antiD

Psychological- 
CBT exposure techniques (graded or flooding)
In PTSD - trauma focussed CBT
Breathing techniques 
Mm relaxation techniques
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21
Q

What are the characteristics of OCD

A

Obsessional thoughts and compulsive acts

They have insight but feel compelled

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22
Q

What is meant by blunted affect

A

Reduced emotional responsiveness

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23
Q

What is meant by flat affect

A

No emotional responsiveness

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24
Q

What is psychoanalysis

A

Opening the pt up to ideas about themself

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25
Q

What is the difference between OCD and OCPD?

A

OCPD- perfectionism, not aware their habits are detrimental, think others should function the same. Harsh super ego. Ego-syntonic

OCD - aware their actions are irrational and are distressed by it , ego dystonic

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26
Q

Define ego

A

Ones self that bridges between conscious and unconscious though

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27
Q

Define dystonic (such as ego-dystonic)

A

Responses and behaviours are against a persons beliefs and will

Inconsistent with ones self concept

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28
Q

What is meant by egosyntonic

A

Responses and behaviours are in keeping with the needs and goals of the ego, consistent with ones ideal self image

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29
Q

Treatment of lithium toxicity

A

Hydration.
Stop lithium
Hemodialysis

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30
Q

Symptoms of serotonin syndrome

A

Altered mental state - irritable, confused,manic

Autonomic dysfunction- bp, tachyC, hypothermia,diarrhoea

NM hyperactivity- tremor, hyperreflexia, (myo)clonus

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31
Q

What class of antidepressants give rise to anticholinergic SEs - name two

A

TCAs - amitriptylin, imipramide

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32
Q

What life threatening SEs does clozapine have. How are they monitored

A

Agranulocytosis- blood tests

Myocarditis - annual ecg

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33
Q

What is clozapine used to treat

A

Treatment resistant schizophrenia ( have to have tried 2APs at a reasonable dose prior)

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34
Q

SEs of olanzapine

A

Metabolic SEs

Increase cholesterol and glucose - diabetic risk

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35
Q

What syndrome are you at risk of when you take lamotragine ?

A

Steven Johnson’s syndrome

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36
Q

Which APs require hepatic monitoring

A

Carbamazepine

Na valproate

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37
Q

MH illness+ fever + APs is a combination for what syndrome

A

Neuroepileptic syndrome

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38
Q

MH illness + fever + ssris are a combination for what syndrome

A

Serotonin syndrome

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39
Q

How to pharmacologically treat an acute depressive crisis

A

SSRI-citalopram
AP- olanzapine
Benzo- lorazepam

40
Q

What is the classic picture of vascular dementia

A

Vasculopath
Stepwise decline
Executive function is first to go

41
Q

What dementia is it likely to be in a younger person who has personality changes

A

Frontotemporal

42
Q

How would you investigate FT dementia

A

SPECT - see reduce bf to frontal and temporal areas

43
Q

Give the classic symptoms of Alzheimer’s

A 
Short term memory problems 
Losing things 
Forgetting names / appts/ convos
Getting lost
Pacing 
Word finding difficulties
44
Q

What area of the brain is damaged in Alzheimer’s

A

Hippocampus

45
Q

Name 3 ACEi drugs used to tx mild to mod Alzheimer’s

A

Rivistigmine
Galantamine
Donepezil

46
Q

Name a NMDA R antagonist used to tx severe Alzheimer’s

A

Memantine

47
Q

SE of ACEi Alzheimer’s meds’

A

N&V

48
Q

Classic symptoms of Lewy body Alzheimer’s

A 
Visual hallucinations 
(M symps come after)- stuffing gait (don’t confuse w/ Parkinson’s dementia
49
Q

Classic symptom of Parkinson’s dementia

A

Emotional liability

(1/3 of PD pts )

(Have to have had motor symps for a year before)

50
Q

What illness is pseudo-dementia commonly seen in

A

Severe depressive disorder

51
Q

Two key features of pseudo dementia

A

Are aware their memory is rubbish (insight)

Respond to ADs

52
Q

What medication must you not give in Alzheimer’s w/ Lewy bodies ?

A

APs - as can precipitate movement disorders

53
Q

How many points is the ACE out of and what is the cut off?

A

/100

Cut off 85

54
Q

How many points is the mini ACE out of and what’s the cut off score?

A

/30

Cut off 21

55
Q

How many points is the mmse out of and what are the cut offs?

A

/30

Severe dementia = <12
Moderate = 13-20
Severe = 21-24

56
Q

What is Capgras syndrome

A

That someone they know is being replaced by an imposter

57
Q

Fregoli syndrome

A

That a stranger is someone they know in disguise

58
Q

What is De clerabaults syndrome

A

That someone at a higher role in society is I love with them

59
Q

Cotards syndrome

A

A person believes they are dying/ dead/ putrefying I.e. have lost all their blood

60
Q

Charles bonnet syndrome

A

Complex visual hallucinations in pts with visual impairments - pt has insight

61
Q

3 differences between EUPD and BAD

A

High and low moods occur within a day in EUPD.

Impulsivity is in high and low moods in EUPD but only in high moods in BAD

EUPD doesn’t have manic episodes

Tx EUPD w/ DBT tx BAD w/ CBT

62
Q

What are the features of EUPD

A

Devo quick and strong attachments/ strong sense of abandonment

Self harm

Impulsivity

Mood swings

Inner subjective space voices

63
Q

Two types of EUPD

A

Boarderline

Impulsive

64
Q

What psychological interventions would be appropriate for someone with EUPD

A

DBT to teach coping mechanisms
Mentalisation based therapy (MBT)
Cognitive analytic therapy

65
Q

What psychological therapy would be appropriate for someone with dementia

A

CST

Cognitive stimulation therapy

66
Q

How does MBT work?

A

encourages pt to think what other people feel and think so they feel less persecuted by others

67
Q

How does cognitive analytic therapy work in EUPD

A

It teaches pt about helpful and unhelpful relationships

68
Q

What is attachment theory

A

It is a psychological theory regarding relationships between humans. Young children need to develop a relationship with at least one primary care giver for normal social and emotional devo

69
Q

What are the three types of attachment someone can develop

A

Secure
Insecure
Disorganised

70
Q

Name two chemicals in the brain that are altered during trauma

A

Cortisol

Adrenaline

71
Q

How does repeated trauma cause illness

A

High cortisol levels lower the immune system

72
Q

Why is memory altered in repeated trauma

A

Stress can inhibit neurogenasis

73
Q

What areas of the brain are affected by repeated trauma

A

Hippocampus, medial prefrontal cortex, HPA axis, amygdala

74
Q

Differentials for bipolar

A

Cyclothemia
Schizoaffective disorder
EUPD

75
Q

What is the DSM-IV criteria for T1 bipolar

A

Hx of 1+ manic episodes, 4+ symps of mania lasting over 1 week giving marked functional impairment/ hospitalisation

76
Q

What is the DSM-IV criteria for T2 bipolar

A

1+ depressive episode (lasts for 2w and occurs most days) 1+ hypomanic episode

Symptoms are not attributed to a physical illness or induced by a drug

77
Q

How does CBT work

A

Helps identify harmful thought patterns and behaviours

78
Q

What is the term for when a person places too much importance on a normal stimulus

A

Delusions of reference

79
Q

Mr X has heard his neighbours talking about him inside their house between themselves

A

3rd person auditory hallucinations

80
Q

What is a delusional perception

A

A two stage process where you first perceive a stimulus then a delusion develops around it

81
Q

What is passivity phenomena and what illness is it commonly seen in

A

Where a persons thoughts or actions are influenced or controlled by an external agent

Schizophrenia

82
Q

What are the schneiderian first rank symptoms of schizophrenia

A

3rd person auditory hallucinations
Thought alienation - I, W, B
Delusion of control-Passivity phenomena (inc somatic passivity)

Thought disordered

83
Q

Why do an ECG when someone is on APs

A

APs can cause long QT syndrome

84
Q

Psychiatric Differentials for schizophrenia

A

Acute/transient psychotic episode
BPD+ psychotic symps
Delirium
Dementia

Mood disorders :
BAD+ psychotic symps
Depression + psychotic symps
Schizoaffective disorder

85
Q

How long do schizo fist rank symptoms have to be present for for ICD10 diagnosis

A

1month

86
Q

Organic differentials for schizo

A 
V
I- Steroids, l-dopa, anticholinergics 
T- trauma
A- SLE
M-b12 deficiency, heavy metal poisoning, thyrotoxic storm
I- encephalitis, HIV, neuro syphilis 
N- Brain tumour/ mets
C

+ drugs (cannabis) and alcohol

87
Q

Treatment for first acute manic episode

A

Antipsychotic

88
Q

Core symptoms of mania

A

Elated
Irritability
Hyperactivity

89
Q

How long do you have to have symps of depression for a diagnosis

A

2w

90
Q

How long do you have had to have had manic symptoms for for a diagnosis of mania

A

1w

91
Q

What comorbidities might you have with depression

A

Anxiety
Bipolar
Addictive disorder

92
Q

What are the most common causes of lithium toxicity

A

Dehydration
Decline in renal function
Drug interactions

93
Q

What should you check before starting someone on lithium

A

Thyroid function
Pregnancy
Renal function

94
Q

What is the cause of wernickes encephalopathy

A

Thiamine / B12 deficiency

95
Q

What is the triad of wernickes encephalopathy

A

Ataxia
Confusion
Opthalamoplegia

96
Q

What could be an organic cause for mania

A

Hyperthyroidism

Phase 3a (7 decks)

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