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NV - Phase 3A > Psych > Flashcards

Psych Flashcards

1
Q

What are the core symptoms of depression?

A
  1. Low mood
  2. Loss of energy (anergia)
  3. Anhedonia - loss of enjoyment of formerly pleasurable activities
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2
Q

Name some other symptoms of depression.

A 
Early morning wakening 
change in appetitie
change in sex drive
diurnal variation of mood - lowest in morning 
agitation
loss of confidence 
loss of concentration
guilt
hopelessness
suicidal ideation
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3
Q

What is the ICD10 diagnostic criteria for clinical depression?

A

At least 2 of the 3 core symptoms
present every day
for at least 2 weeks

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4
Q

What are some risk factors for depression?

A 
Family hx 
hx of abuse
drug and alcohol abuse
low socioeconomic status 
having a chronic disease
traumatic life event
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5
Q

What are some medical causes for depression?

A

hypothyroidism
physical health problems/chronic disease
medications - isoretinoin (roccutane), beta blockers
childbirth

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6
Q

What are some non-medical treatments for depression?

A

self-help groups
guided self help
computerised CBT
individualised CBT or onterpersonal therapy
psycholoigcal therapy with antidepressants

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7
Q

What are some medical treatments for depression?

A

antidepressants - continue for at least 6 months after symptoms stop

resistant depression = antidepressants + lithium/atypical antipyschotic/another antidepressant

ECT

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8
Q

Name some classes of antidepressants, give examples of drugs within them.

A

SSRIs - sertraline, citalopram, fluoxetine

SNRIs - venlafaxin, duloxetine
inhibits 5HT reuptake pumps and NAd transporter

MAOIs - isocarboxazid, seligiline - can lead to hypertensive crisis and can cause migraine

TCAs - amitryptyline

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9
Q

What are some side effects of SSRIs?

A 
GI symptoms 
sexual impotence 
weight gain
increased bowel motility 
agitation
increased risk of GI bleed if taking NSAID so give PPI
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10
Q

Which drugs do SSRIs interact with?

A

NSAIDs - add PPI if giving SSRI
Warfarin/heparin - avoid SSRI, consider mirtazapine (SNRI)

Aspirin - give PPI

Triptans - avoid SSRI

NB: fluoxetine and paroxetine have higher risk of interaction

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11
Q

Which SSRI is given first line in children and adolescents?

A

Fluoxetine

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12
Q

Which SSRI is given first line for generalised anxiety disorder?

A

Setraline

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13
Q

What are some discontinuation symptoms of SSRIs?

A 
incresed mood change 
restlessness
difficulty sleeping
unsteadiness
sweating 
GI symptoms - pain, cramping, diarrhoes, vomiting 
paraesthesia
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14
Q

What are some side effecs of tricyclic antidepressants?

A

urinary retention - anticholinergic effects
Dry mouth
lethargy/drowsiness
constipation

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15
Q

Name some risk factors for suicide following self harm.

A

single
homeless
unemployed/stressful job
poor social support
type of self harm - superficial vs deep cuts
whether they regret the self harm or express the desire t do it again

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16
Q

Define bipolar affective disorder.

A

recurrent episodes of altered mood and activity

involving both upswings and downswings (hypomania/mania + depression)

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17
Q

What’s the difference between bipolar 1 and 2?

A

Bipolar 1 - mania + depression, sometimes more episodes of mania

Bipolar 2 - more episodes of depression and only mild hypomania

Cyclothymia - chronic mood fluctuations over at least 2 years. Episodes of depression and hypomania Rapid cycling, episodes only last a few days.

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18
Q

What are the risk factors for bipolar disorder?

A

strong genetic component
traumatic life event
hx of abuse
sleep deprivation can cause mania

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19
Q

What is the peak age of onset of bipolar disorder?

A

Early 20s

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20
Q

What are the symptoms of hypomania?

A

Lasting at least 4 days -

elevated mood
increased energy 
increased talktativeness
poor concentration 
mild reckless behaviour (overspending) 
overfamliarity 
increased libido/sexual disinhibition 
increased confidence 
decreased need to sleep 
change in appetitie
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21
Q

What are the symptoms of mania?

A

Lasting over 1 week and more extreme than hypomania -

extreme, uncontrollable elation 
overactivity 
pressured speech 
impaired judgement 
extreme risk taking behaviour 
social disinhibition 
inflated self-esteem, grandiosity 
mood congruent psychotic symptoms 
insight is often absent
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22
Q

What is the main feature that differentiates mania from hypomania?

A

presence of psychotic symptoms such as auditory hallucinations and grandiose delusions

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23
Q

What are some differential diagnoses for bipolar disorder?

A

substance abuse - amphetamines, cocaine
endocrine disease - Cushing’s, steorid-induced psychosis
schizophrenia
schizoaffective disorder
personality disorders - EUPD, histrionic
ADHD in younger people

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24
Q

How do you treat an episode of acute mania?

A

antipsychotics - haloperidol, olanzapine, quetipine, risperidone

lithium

Benzos for acute behavioural disturbance

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25
Q

What are the longer term treatments used for bipolar disorder?

A

mood stabilisers - lithium, valproate, carbamazepine

during pregnancy use antipsychotics

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26
Q

How are severe depressive episodes of bipolar disorder treated?

A

Quetiapine
olanzapine (+/- fluoxetine)
lamotrigine

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27
Q

Things to be aware of on lithium…

A 
L- leucocytosis 
I - insipidus diabetes (nephrogenic)
T - tremors (if coarse, think toxicity)
H - hydration
I - increased GI motility 
U - underactive thyroid 
M - metallic taste, mums beware - teratogenic

Lithium + diuretics = beware dehydration
Lithium + NSAIDs = beware kidney damage

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28
Q

Name some side effects of lithium.

A 
weigth gain
nephrotoxicity 
tremor 
diabetes insipidus 
hypothyroidism
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29
Q

What are the symptoms of lithium toxicity?

A 
dry mouth/extreme thirst 
strange movements
very sleepy 
nausea and vomiting 
diarrhoea
confusion

basically act like a drunk person

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30
Q

Define dysthymia.

A

chronic, mildly depressed mood and diminished enjoyment
not severe enough to be depression
at least 2 years
tx with SSRIs and CBT

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31
Q

What are some risk factors for post-partum depression?

A 
Past psychiatric hx 
conflicting feelings about the pregnancy 
hx of abuse as a child 
USS showing foetal abnormalities 
low socioeconomic status 
lack of supportive relationships
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32
Q

What is the first-line tx for post-partum depression?

A

psycholoigcal therapy

because if breastfeeding - antidepressants can have adverse effect on the baby

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33
Q

What are the causes/risk factors for schizophrenia?

A 
family hx/genetic link 
insult to brain development in early life 
smoking cannabis in adolescence 
severe childhood bullying 
socioeconomic depreivation 
adverse life events
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34
Q

What is the pathophysiology of schizophrenia?

A

dopamine excess - overactivity in mesolimbic and corticolimbic dopaminergic pathways

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35
Q

What is the typical age of onset of schizophrenia?

A

20-30s

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36
Q

How is a diagnosis of schizophrenia made?

A

at least 1 first-rank symptom

or at least 2 second rank symptoms

for a duration of at least 1 month

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37
Q

What are the first rank symptoms of schizophrenia?

A

3rd person auditory hallucinations (running comentary, hears people talking ABOUT them)

thought disorder/alienation - broadcast, withdrawal, insertion, deletion

passivity phenomenon - made to do or feel things against their will - as if someone is controlling their thoughts, feelings and actions

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38
Q

What are the second rank symptoms of schizophrenia?

A 
delusions
2nd person auditory hallucinations 
any other modality of hallucination
formal thought disorder (words come out wrong becasue thoughts are muddled)
catatonic behaviour
negative symptoms
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39
Q

What are the positive symptoms of schizophrenia?

A

delusions
hallucinations
formal thought disorder

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40
Q

What are the negative symptoms of schizophrenia?

A 
poverty of speech 
flat affect
poor motivation
social withdrawal 
lack of concerns for social conventions
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41
Q

What are the cognitive symptoms of schizophrenia?

A

poor attention and memory

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42
Q

What are the differential diagnoses for patients presenting with psychotic symptoms like hallucinations and delusions?

A 
schizophrenia 
schizoaffective disorder
delusional disorder
brief/acute psychotic episodes (if they last < 1 month, then not schizophrenia) 
drug induced psychosis 
SOL - brain tumour or abscess
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43
Q

What are the side effects of antipsychotics?

A

diabetes/insulin resistance and dyslipidaemia
QT segment changes on ECG
agranulocytosis - clozapine
extra-pyramidal side effects due to dopamine blockade
urinary retention
blurred vision
weight gain
hyperprolactinaemia (dopamine bloackade –> dopamine downregulates prolactin)

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44
Q

What are the 4 EPSEs of antipsychotics?

A

acute dystonia (hours) - muscle spasm, acute torticollis, eyes rolling back

parkinsonism (days) - tremor, bradykinesia

Akathisia (days to weeks) - inner restlessness, pacing and intolerable agitation

tradive dyskinesia (months t years) - grimacing, tongue protrusion, lipsmacking

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45
Q

How are the EPSEs from antipsychotics treated?

A

Procyclidine (anticholinergic)

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46
Q

Define generalised anxiety disorder.

A

general persistent, excessive worry
about a number of different events
individual finds the worry difficult to control
for at least 3 weeks (ICD) or 6 months (DSM)

no particular stimulus
often comorbid with depression, substance misuse etc

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47
Q

What are the risk factors for GAD?

A 
alcohol use 
benzo use 
stimulants - esp if withdrawing 
co-existing depression
family hx
childhood abuse, neglect
excessively pushy parents
life stresses/events
physical health problems
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48
Q

What medical conditions can cause GAD?

A 
hyperthyroidism
phaeochromocytoma 
lung disease - excessive use of salbutamol 
congestive heart failure - heart meds 
hypoglycaemia
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49
Q

What are the symptoms of GAD?

A 
unpleasant/fearful emotional state 
bodily discomfort 
physical symptoms - palpitations, tachycardia, sweating, tremor, chest pain, nausea, chills/hot flushes
apprehension
increased vigilance 
sleeping difficulties
50
Q

How do you treat GAD?

A

conservative - individual self-help/self-help groups, CBT, applied relaxation therapy

Medical - SSRIs or SNRIs, pregabalin, benzos, beta-blockers like propranolol for physical symptoms

51
Q

What are the symptoms of panic disorder?

A

physical - tachycardia, palpitations, sweating, dizziness, choking

psychological - feel like they’re going to die, impending doom, depersonalisation, derealisation, fear of losing control

52
Q

What are the risk factors for OCD?

A

genetics - FHx of OCD or tic disorder
parental over-protection
may occur after strep infection - PANDAS subtype - paediatric neuropsychiatric disorders associated with streptococci

53
Q

How does OCD present?

A 
time consuming (>1hr/day) bsessions and/or compulsions
present most days for at least 2 weeks
distressing and interfering with ADLs
avoidance of the stimuli that trigger the symptoms
54
Q

How is OCD treated?

A

psychoeducation
CBT - exposure followed by response prevention
meds - SSRIs

55
Q

What is a somatisation disorder?

A

Physical symptoms without physical explanation
persistent for at least 2 yrs
more common in women
usually GI and skin complaints
massive impact on daily functioning
often results in multiple needless operations as they refuse to believe that there is no organic cause
tx - excluding all organic illness

56
Q

What is a conversion disorder?

A

presents with neurological SIGNS (rather than symptoms) e.g. paralysis, weakness, amnesia
btu the examination is inconsistent
pt is not faking it consciously
no evidence of underlying pathology

57
Q

How much is a unit of alcohol?

A

10 ml or 8g

58
Q

What are the signs of alcohol dependence?

A

CAN’T STOP

Compulsion to drink alcohol 
Aware of harms but persists
Neglect of other activities
Tolerance to alcohol
Stopping causes withdrawal
Time preoccupied with alcohol
Out of control use
Persistence, futile wish to cut down
59
Q

How to treat alcohol dependence?

A
  1. acute detoxification
  2. motivational interviewing
  3. psychological therapies
  4. self-help groups
  5. medication
  6. relapse prevention measures
60
Q

What medical treatments can be used to treat alcohol dependence?

A

Disulfram - blocks alcohol metabolism resulting in flushing, headaches, anxiety and nausea

Acamprosate - acts on GABA to reduce cravings and risk of relapse

Naltrexone - opioid receptor antagonist

61
Q

What are the stages of change steps?

A
  1. pre-contemplation
  2. contemplation
  3. planning/preparation
  4. action
  5. maintenance
  6. sustained maintenance or potential for relapse
62
Q

What is delirium tremens?

A

An acute confusional state secondary to alcohol withdrawal - medical emergency requiring inpatient care

63
Q

How quickly does DT occur after last drink?

A

1-7 days

peak incidence at 48-72 hours

64
Q

How does dellirirum tremens present?

A 
clouding of consciousness
disorientation 
amnesia for recent events
psychomotor agitation 
tremors 
visual, auditory and tactile hallucinations (characteristically of small people or animals) 
fluctuations in severity 
risk of cardiovascular collapse, paranoid delusions/fear, confabulation and heavy sweating
65
Q

How do you treat delirium tremens?

A

thiamine (pabrinex)
lorazepam
antipsychotics - haloperidol, olanzapine

66
Q

What is Korsakoff’s psychosis?

A

short term memory loss and confabulation
occurs in heavy drinkers due to thiamine deficiency

thiamine deficiency causes damage and haemorrhage to the mamillary bodies of the hypothalamus and the medial thalamus

67
Q

What else can Korsakoff’s (other than alcohol abuse)?

A 
head injury 
post-anaesthesia
basal/temporal lobe encephalitis 
carbon monoxide poisoning 
other causes of B1 deficiency - anorexia, starvation, hyperemesis
68
Q

What is Wernicke’s encepalopathy?

A

Triad of:

  1. confusion/intellectual impairment
  2. ataxia
  3. ophthalmoplegia (eye muscle paralysis) and nystagmus

due to thiamine deficiency

69
Q

How do you treat Wernicke’s?

A

IV pabrinex (high potency thiamine replacement)

70
Q

Name some endocrine disorders that can cause depression.

A 
hypothyroid
primary hypoparathyroidism 
hypercortisolaemia (iatrogenic - steroids)
hypocortisolaemia - Addison's
hypopituitarism
71
Q

What are the symptoms of anorexia nervosa?

A 
Preoccupation with food
self-conscious about eating in public
vigorous exercise
constipation
cold intolerance
depressive and compulsive symptoms
binging/purging or extreme restriction subtypes
72
Q

Name some physical signs seen in someone with anorexia nervosa.

A

BMI <17.5
emaciation
dry and yellow skin
peach fuzz hair on face and trunk (lanugo hair)
bradycardia and hypotension
anaemia
consequences of repeated vomiting - hypokalaemia, alkalosis, pitted teeth, parotid swelling, sarring of the dorsum of the hand (Russel’s sign)

73
Q

What medications can you use to treat insomnia?

A

Z drugs - zopiclone, zolpidem, zapeplon (first-line)

sedating antidepressants - mirtazapine
sedating antipsychotics - quetiapine
melatonin

74
Q

What is paraphrenia?

A

late-onset schizophrenia, after age 45

less emotional blunting and personality decline compared to younger onset

75
Q

What are the clinical features of paraphrenia?

A

delusions and hallucinations - esp about neighbours
paranoid - often about neighbours
partition delusion - patient believes that people or objects can go trough walls
less negative symptoms (blunting/apathy) and formal thought disorder compared to early onset

76
Q

What are the risk factors for late onset schizophrenia?

A

social isolation
sensory deficits - poor eyesight/hearing
reclusive and suspicious pre-morbid personality
more common in women

77
Q

What is Cottard’s syndrome?

A

a belief that everything inside them is rotting/they’re already dead inside

seen in spychotic depression

78
Q

What is Charles-Bonnet syndrome?

A

complex visual hallucinations in a person with partial or severe blindness - macular degeneration, diabetic retinopathy

patients understand that the hallucinations are not real and often have insight

79
Q

What are some signs to look out for in a person with Munchausen’s syndrome?

A

Already diagnosed with personality disorder
usually physical symptomology
multiple A&E presentations to several different hospitals
frequent admissions
often multiple surgical procedures
multiple aliases, no fixed address of regular GP
when discovered - discharge themselves against medical advice

80
Q

Name some examples of learning disabilities.

A 
Down's syndrome
Autism specturm disorder and Asperger's syndrome 
Williams syndrome
Fragile X syndrome 
Global developmental delay 
cerebral palsy
81
Q

What is the triad of symptoms for autism spectrum disorder?

A
  1. impaired social interaction
  2. speech and language disorder
  3. imposition of routines - ritualistic and repeptitive behaviour
82
Q

What are the main symptoms of ADHD?

A

inattention
hyperactivity
impulsiveness

restlessness
poor concentration

83
Q

How do you treat ADHD?

A

methylphenidate (Ritalin) - monitor growth

psychotherapy

84
Q

What are the cluster A personality disorders? (mad)

A

paranoid
schizoid
schizotypal

85
Q

What are the cluster B personality disorders? (bad)

A

Emotionally unstable
Histrionic
Narcissistic
Antisocial

86
Q

What are the cluster C personality disorders? (sad)

A

avoidant anxious
dependent
obsessive compulsive/anankastic

87
Q

Define paranoid PD and list some of its features.

A

Definition = pervasive and unwarranted tendency to interpret the actions of others as demeaning or threatening

  • think the world is a conspiracy
  • thinks people are devious
  • acts as if always on guard, suspicious
  • commonest behaviour - watchfulness
  • least likely to be trusting
  • emotional hot-spot - being discirminated against

THINK MAD-EYE MOODY

88
Q

Define schizoid PD and list some of its features.

A

Definition = pervasive pattern of indifference to social relationships and a restricted range of emotional expereince and expression

  • thinks the world is uncaring
  • thinks poeple are pointless, replaceable
  • thinks they are the only person they can depend on
  • commonest behaviour - withdrawal
  • least likely to be emotionally available and close
  • emotional hotspot - being over-cared for and smothered by others

THINK SEVERUS SNAPE

89
Q

Define schizotypal PD.

A

pervasive pattern of deficits in interpersonal relatedness and pecularities of ideation, experience, appearance and behaviour.

THINK LUNA LOVEGOOD

90
Q

Define emotionally unstable/borderline PD and list some of its features.

A

Definition = pervasive pattern of instability of mood, interpersonal relationships and self-image.

  • thinks the world is contradictory
  • thinks people are untrustworthy
  • ashamed of themselves
    commonest behaviour - self-harm
  • least likely to be able to show self-compassion
  • emotional hotspot - abandonnment
91
Q

Define histrionic PD and list some of its features.

A

Definition = pervasive pattern of excessive emotionality and attention seeking.

  • thinks the world is their audience
  • thinks people are in competition for attention
  • thinks they are vivacious (attractively lively and animated)
  • commonest behaviour - exhibitionism
  • least likely to be able to listen to others
  • emotional hotspot - being actively or passively side-lined
92
Q

Define narcissistic PD an list some of its features.

A

Definition = pervasive pattern of grandiosity, lack of empathy and hypersensitivity to the evaluation of others

  • thinks the world is a competition
  • thinks people are inferior
  • thinks they are special
  • commonest behaviour - competitveness
  • least likely to be humble
  • emotional hotspot - loss of face/social rank/social status/being embarrassed
93
Q

Define antisocial PD and list some of its features.

A

psychopath - when they get into trouble with the law. Sociopath - same features without problems with the law

Definition = childhood conduct disorder before the age of 15 and a pattern of irresponsible and antisocial behaviour post 15 years

  • thinks the wolr dis predatory
  • thinks people are weak
  • thinks of themselves as autonomous and alone
  • commonest behavioural approach - crushing
  • least likely to be gentle and sensitive
  • emotional hotspot - perceiving exploitation
94
Q

Define avoidant/anxious PD and list some of its features.

A

Definition = pervasive pattern of social discomfort, fear of negative evaluation and timidity

  • thinks the world is evaluative
  • thinks people are judgemental
  • thinks they are inept
  • commonest behaviour - inhibition
  • least likely to be assertive
  • emotional hotspot - exposed ridicule or rejection
95
Q

Define dependent PD and list some of its features.

A

Definition = pervasive pattern of dependent and submissive behaviour

  • thinks the world is overwhelming
  • thinks people are stronger and more competent than themselves
  • they are needy
  • commonest behaviour - clinging
  • least likely to be self-sufficient
    emotional hotspot - making a decision
96
Q

Define anankastic/obsessive compulsive PD and list some of its features.

A

Definition = pervasive pattern of perfectionism and inflexibility

  • thinks the world is sloppy
  • thinsk people are irresponsible
  • thinks they are responsible
  • commonest behaviour - control
  • least likely to be flexible
  • emotional hotspot - making a mistake
97
Q

What is adjustment disorder?

A

An abnormal and excessive reaction to an identifiable life stressor.

98
Q

What are the main symptoms of PTSD?

A
  1. re-experiencing - flashbacks, nightmares
  2. avoidance - avoiding people, situations or circumstances resembling the traumatic event
  3. hyperarousal - hypervigilance for threat, startles easily, struggles to sleep
  4. emotional numbing
99
Q

What signs would you see in someone intoxicated with heroin?

A 
euphoria 
pinpoint pupils
drowsiness
constipation 
respiratory depression
100
Q

What signs would you see in someone withdrawing from heroin?

A 
goose flesh (piloerection)
pupil dilation 
yawning 
sweating
abdo cramps
insomnia
101
Q

What is the role of section 2 of the MHA?

A

compulsory admission to hospital for assessment

102
Q

What is the duration for a section 2?

A

28 days

103
Q

What is the purpose of section 3 of the MHA?

A

compulsory admission to hospital for treatment

104
Q

What is the duration of section 3?

A

6 months

105
Q

Can section 2 be renewed?

A

no

106
Q

Can section 3 be renewed?

A

yes

107
Q

What is the purpose of section 4 of the MHA?

A

emergency order

when waiting for a second doctor would lead to undesirable delay

108
Q

What is the duration of a section 4?

A

72 hours

109
Q

What is the purpose of a section 5(4)?

A

for a patient ALREADY admitted but wanting to leave

110
Q

Who can hold a patient on a section 5(4)?

A

nurses

this is their holding power until a doctor can attend

111
Q

How long does a section 5(4) last?

A

6 hours

112
Q

What is a section 5(2)?

A

For a patient ALREADY admitted to hospital but wanting to leave

113
Q

Who can implement a section 5(2) and how long does it last?

A

Doctors

72 hours

doctor’s holding power - gives time for section 2 or 3 to be put in place. Has to be a doctor on that specific ward, cannot be done in A&E

114
Q

Which sections can be put in place by the police?

A

Section 135 and 136

136 - suspicion of having a mental disorder in a public place

135 - needs court order to acccess patient’s home and remove them

115
Q

What is neuroleptic malignant syndrome and what are some of its features?

A

Psychiatric emergency caused by excess of enuroleptic medicaion or acute wthdrawal from Parkinson’s medication.

onset over hours or days 
hyperpyrexia 
hyporeflexia 
sweating 
normal pupils 
tachycardia 
rigidity 
rasied CK
116
Q

How to manage NMS?

A 
stop the offending agent or give L-dopa in dopamine withdrawal 
IV fluids
Benzos 
bromocriptine 
dantrolene

dantrolene is also used to prevent and treat malignant hyperthermia

117
Q

What is serotonin syndrome?

A

Caused by SSRIs, MAOIs, Ecstacy, Amphetamines (cocaine, mcat), antiemetics (metoclopramide), St John’s Wort

118
Q

What are the features of serotonin syndrome?

A 
onset over minutes/hours
hyperthermia/hyperpyrexia
sweating
hyperreflexia 
clonus
rigidity 
altered mental state 
dilated pupils
119
Q

How to manage serotonin syndrome?

A

IV fluids
Benzos
stop the offending agent

120
Q

What is the revised dopamine hypothesis for schizophrenia?

A

positive symptoms are caused by dopamine overactivity in the mesolimbic system.

negative symptoms are cuased by dopamine underactivity in the mesocortical system.

121
Q

What is Clerambault’s syndrome?

A

erotomania

young woman believes man of higher status is secretly in love with her and is sending her secret messages

122
Q

What is Othello syndrome?

A

pthological jealousy - high risk of abuse and violence

NV - Phase 3A (7 decks)

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