psych Flashcards

Question

reflex hallucination

Answer 1

stimulus in one sensory modality produces a sensory experience in another

Answer 2

hallucination that is outside the limits of the sensory field- e.g. hears voices talking in Paris when they are in Sydney

Answer 3

hallucinations as person is falling asleep

Answer 4

hallucinations as person is waking up

Answer 5

Too much unnecessary, convoluted detail before finally reaching the point can be seen in anxiety

Answer 6

migraine epilepsy delerium brain tumour

Answer 7

sudden interuption of thoughts, mind left blank schizophrenia

Answer 8

A certain thought is predominant despite lack of relevance, repeating this.

Answer 9

Thought insertion Thought broadcast Thought withdrawal

Answer 10

Primary - A new meaning arises in connection with some other psychological event - Eg thumbs up meaning distorted to mean a sign from reincarnated wartime friend to find gold (compared to illusions - thumbs up looks like holding a candle) Secondary - Arises from other morbid experiences - Eg depressed person feeling worthless/ responsible for terrible crime

Answer 11

Sudden amnesia that occurs during periods of extreme trauma and can last for hours or even days eg robbed at gunpoint

Answer 12

inability to experience joy

Answer 13

CONVERSION Physical symptoms as a result of psychological distress (without pathology) - weakened/ stopped body functions - Blindness - Mute (aphonia) - Paralysis - Headaches Histrionic personalities (A histrionic personality has a tendency for suggestibility, shallowness, emotional lability, dependency, and selfishness) are more susceptible to conversion disorder BELLE INDIFFERENCE Indifference about the disability/ symptoms (conversion) Emotional disconnect symptom of conversion disorder

Answer 14

a feeling of some change in the self, associated with a sense of detachment from one's own body. Perception fails to awaken a feeling of reality, actions seem mechanical and the patient feels like an apathetic spectator of his own activities.

Answer 15

a sense of one's surroundings lacking reality, often appearing dull, grey and lifeless

Answer 16

Somatic passivity - delusional belief that one is a passive recipient of bodily sensations from an external agency Made acts, feelings & drives - actions, feelings and impulses are not their own, but are carried out by the person - Eg X makes him hit himself when he doesnt want to

Answer 17

actions, feelings and impulses are not their own, but are carried out by the person - Eg X makes him hit himself when he doesnt want to

Answer 18

the patient's limbs when moved feel like wax or lead pipe, and remain in the position in which they are left. Found rarely in (catatonic) schizophrenia and structural brain disease.

Answer 19

automatic repetition of words heard. (can be present in catatonia)

Answer 20

an automatic repetition by the patient of movements made by the examiner (can be present in catatonia)

Answer 21

repetition of the last syllable of a word. (can be present in catatonia)

Answer 22

motiveless resistance to movement (can be present in catatonia)

Answer 23

repetition of a word over and again with increasing frequency. (can be present in catatonia)

Answer 24

repetition of one or several sentences or strings of fragmented words, often in a rather monotonous tone. (can be present in catatonia)

Answer 25

Believes their body/mind / loved ones don’t exhist Rare but more common in psychotic depression

Answer 26

Someone they know has been replaced by a replicate

Answer 27

Different people are actually the same person but able to change their appearance

Answer 28

Lithium = gold standard Narrow therapeutic window - so weekly blood tests -- 0.6-1.0mmol/L S/E = nausea, vomiting, Diarrhea

Answer 29

2nd line - when 2 other antipsychotics (at least one atypical) has been tried - then 66% success in these patients!

Answer 30

hypersalivation -- potential medication constipation -- potential laxative neutropenia -- weekly bloods myocardiits -- ECG

Answer 31

weight gain sedation

Answer 32

their medication puts them at risk of increased QT syndrome (and olanzapine has risk of myocarditis) - seizures, palpitations, blackouts

Answer 33

Sedation Weight gain Extrapyramidal symptoms - Drooling - Parkinsonism - Rigidity - Tremor - Mask affect neuroleptic malignant syndrome

Answer 34

neuroleptic malignant syndrome Symptoms - Temperature drop - agitated/ restless - Muscle rigidity - Sweating - Tremor - Incontinence Test = raised CK Treatment = stop causing antipsychotic and get fluids

Answer 35

seizures, palpitations, blackouts

Answer 36

1 2 2 1 (cheaper and able to be in IM form) 1

Answer 37

both require 2 episodes for diagnosis: Bipolar 1 - 2 episodes including one mania or hypomania episode - Episodes of mania and depression equally or more mania - (+/- psychosis, +//- depressive episodes) Bipolar 2 - 2 episodes : one depressive and one hypomania (not full mania) - Many more episodes of depression, few of mania - Therefore easy to miss -- so ask about manic symptoms if suspect depression

Answer 38

Less extreme mania / depression (bipolar) episodes are shorter in duration (<4d, compared to about a week) 2y+ for diagnosis, no 2month period of stability in this 2y

Answer 39

Thought alienation Passivity phenomena 3rd person auditory hallucinations Delusional perception

Answer 40

Delusions 2nd person auditory hallucinations Hallucinations in any other modality (tactile, gustatory, olfactory) Thought disorder Catatonic behaviour Negative symptoms

Answer 41

depression

Answer 42

urine drug screen bloods - LFTs, U/Es, prothrombin time, paracetemol time, arterial pH, lactate level, salicylate levels physical examination

Answer 43

Counselling = shorter term, psychotherapy = more complex / long-standing Counselling = for big decision or past/current life event, interpersonal factors often present

Answer 44

lethargy low mood anhedonia

Answer 45

most of the day, everyday for 2 weeks or more

Answer 46

Electroconvulsive Therapy - electrical current through brain to cause a seizure Major depressive disorder (MDD - Severe) 1 it is rapid acting so suitable for those at imminent risk of suicide 2 antidepressant do not treat the psychotic side of psychotic depression so ECT may be appropriate when multiple classes of antidepressant have failed 3 comorbidities make medication less desirable (elderly, pregnant, physically debilitated ) bipolar (manic OR dep) schizophrenia -- if these are life threatening / severe / have had previous good response to ECT

Answer 47

hypothyroidism

Answer 48

sensation opposed upon their body by an external agent ?same as made feelings (maybe made feelings is made emotions)

Answer 49

delusional perception is when their is a delusional belief based on a interpretation of a stimus. normal perception and then a delusion is formed around that eg flatmates moved tv --> they are MI5 and plotting eg traffic lights go red --> bad thing about to happen eg thumbs up in street --> sign from god i need to complete a task

Answer 50

Mild = core symptoms +2-3 others / peer teach says <5 symptoms total + minor functional impairment (PHQ:1-9) Moderate = core +4 others + function affected / peer teach says >5 + variable functional impairment (PHQ:10-14) Severe = marked loss of function, suicidal - If any psychosomatic symptoms-- Delusions of guilt, Derogatory voices, Nihilistic delusions / peer teach says >5 + marked functional impairment (PHQ:15-27) mild - low-intensity psychological interventions, group CBT, avoid antidepressants moderate/severe- antidepressant + high intensity psychological interventions

Answer 51

childhood trauma/neglect self harm subconcious desire for attention impulsivity unstable mood, emotional dysregulation - small trigger intense unstable relationships onset as young adult/teen possible : hallucinations, paranoia

Answer 52

mood alteration (mania normally but can be depression or both) psychotic symptoms antipsycotic and mood stabliser

Answer 53

- mood stabliser - not suitable for any women child-bearing age due to baby birth defects... so highly effective contraception required (implant, coil, depot and NOT pill, condoms as these are temporarily reversible - depression +, mania ++

Answer 54

schizoaffective disorder has psychotic symptoms before mood symptoms (bipolar other way round) schizoaffective disorder has less of a depressive drop post manic episodes

Answer 55

discomfort in close relationships - often due to something misinterpretted odd/eccentric delusions/hallucinations - but brief and intense

Answer 56

difficulty/apathy in forming relationships no delusions/ halucinations coherent reduced pleasure / indifference

Answer 57

Cluster A (‘odd/ eccentric’ - wierd) - Schizoid (reduced emotions inc libido, no close friends) - Paranoid (jealous, suspicous, percieve attack, unforgiving) - Schizotypal Cluster B (‘dramatic/ erratic’ - wild) - Emotionally unstable (=EUPD) (unstable relationships, fear of abandonment, suicidal, poor anger control) - Histrionic (vain, attention seeking, seductive inapprop) - Narcissistic - Dissociative (?) - Dissocial (deceitful, callous, violent, no guilt admission, no safety concern) Cluster C (‘anxious/fearful’ - worriers) - Obsessive compulsive - Dependant (low self confidence, needs reassurance and companionship) - Avoidant - Anxious (feels inadequate, social inhibitions, needs to be certain they are liked) - Anankastic (workaholic, perfectionist, stubborn, inflexible, meticulous)

Answer 58

delusional disorder no hallucinations no thought disorder no mood disorder no significant flattening of affect

Answer 59

Both increase the risk of the other (bidirectional relationship) - And more so than when younger , more delicately balanced - eg UTI/ hypothyroidism is more likely to result in mental illness - Eg depressed older person staying in bed will have a greater impact on their physical health - muscle loss, falls, dehydration Sensory impairment (common in older patients) increases risk of mental illness - depression, anxiety, dementia, visual/auditory hallucinations (in the area of their deficit)

Answer 60

Higher amount of cerebrovascular disease, the more likely you are to have treatment-resistant depression

Answer 61

increases risk of alzheimers

Answer 62

you or part of you are dead (nihilistic)

Answer 63

CAGE Have you ever felt you should Cut down on your drinking? Have people Annoyed you by criticising your drinking? Have you ever felt bad or Guilty about your drinking? Have you ever had a drink first thing in the morning to steady your nerves or to get rid of a hangover (Eye opener)?

Answer 64

Chlordiazepoxide (a benzodiazapine)

Answer 65

- Ammonia not cleared by the liver, builds up in the circulation and passes to the brain - Astrocytes try to clear ammonia by converting glutamate → glutamine. Excess glutamine causes imbalance in osmotic pressure so fluid into cells → cerebral oedema - Permanent brain damage as ammonia is neurotoxic (halts Krebs cycle, less ATP) wernicke's encephalopathy: - Thiamine reserves exhausted - malnutrition, alcoholism - Triad (most don’t have all 3) --- Ataxia --- Nystagmus (involuntary eye movements)/ ophthalmoplegia (paralysis / weakness of eye muscles) --- Confusion - Acute onset - Reversible : treat with IV thiamine

Answer 66

acomprosate - alleviates cravings disulfiram - makes you v ill (anaphylactic-like) every time you drink alcohol nalmefene - effect of alc still present but reduced feeling of pleasure/reward

Answer 67

ABCDE Naloxone hydrochloride IV fluids oxygen

Answer 68

Use of the substance is high priority, higher than other things which were previously higher Tolerance - increased doses required Persistence despite harmful consequences Withdrawal syndrome

Answer 69

POS delusions (esp persecutory) hallucinations (esp aud) formal thought disorder - disorganised thoughts NEG apathy flat affect self neglect reduced social interaction anhedonia avolition (less empathy) alogia and catatonia (speaking and moving less)

Answer 70

Hypomania is a milder version of mania that lasts for a short period (4d+) - less extreme symptoms, smaller effect on function Mania is a more severe form that lasts for a longer period (7d+).

Answer 71

4 or more depressive, manic, hypomanic episodes in a 12 month period.

Answer 72

mania/hypomania and depression at the same time (eg sad and hopeless and restless and overreactive)

Answer 73

manic - 3-6m // >1w? other place depressive - 6-12m

Answer 74

can trigger / worsen a manic episode

Answer 75

Acute - Olanzapine - Haloperidol Long term - Lithium- Needs monitoring, is he going to be compliant with services - Sodium valproate - lamotrigine, antipsychotics, carbamezapine

Answer 76

needs to be tapered off slowly

Answer 77

depression, anxiety, OCD, PTSD, eating disorder, psychosis

Answer 78

SCOFF Do you make yourself Sick because you feel uncomfortably full? Do you worry you have lost Control over how much you eat? Have you recently lost more than One stone (14 lb or 7.7 kg) in a three month period? Do you believe yourself to be Fat when others say you are thin? Would you say that Food dominates your life?

Answer 79

restriction of energy intake relative to requirements restrictive or purge and binge Underweight (normally cut off around 17.5 BMI) - compared to bulimia Oral: dental caries CVS (most common cause of death): hypotension, long QT, arrhythmia, bradycardia, cardiomyopathy Endocrine: hypokalaemia, hyponatraemia, hypoglycaemia, hypothermia, altered TFTs, increased cortisol, increased growth hormone, amenorrhoea, decreased libido, delayed/arrested puberty, pregnancy poorer prognosis in future, osteoporosis and osteopenia Kidney issues MSK eh Dermatology: dry scaly skin, brittle hair, fine body hair Haematology: anaemia, leukopenia, thrombocytopenia Social withdrawal SCOFF

Answer 80

recurrent episodes of binge eating (lack of control, large amounts of food) + compensatory behaviour to prevent weight gain (diuretics, vomiting, exercise) Normal or overweight (normally cut off 17.5BMI )- compared to anorexia nervosa purge and binge type

Answer 81

recurrent episodes of binge eating (episodes of rapid, uncontrolled eating when not hungry until uncomfortably full, eating alone and feeling disgusted after) no purging/compensatory behaviours

Answer 82

restrictive behaviours to prevent weight gain + absence of binge eating

Answer 83

when asleep so not aware eat little in day

Answer 84

Eating disorders can affect all systems. However, a normal physical examination does not rule out eating disorders. Hair thinning/loss - Lanugo - fine hair all over body Oedema Skin dry Abdominal pain Sore throat Cold intolerance Thyroid Signs of self-harm Amenorrhea Rosvig’s? Sign -- indents/calluses from teeth on knuckles from dominant hand down throat Ulcers Poor oral hygiene Enlarged salivary glands Constipation Headaches Fainting, dizzy Faituge, lethargy Mood Appetite Palpitations GORD Polyuria, polydipsia

Answer 85

fine hair over body typical of long standing eating disorder / underweight people

Answer 86

Bloods - Electrolytes, TFTs, LFTs, CRP, vit D, glucose, CK, vit B12, folate, phosphate, calcium, iron, mg, copper, zinc, PTH, sex hormones ECG CT head Glucose (DM) Congestive heart failure DEXA (OA) SUSS test - sit up, squat and stand - assessing muscle wasting Psychological assessment after stabilised Urinalysis Salivary gland enlargement Cardiomegaly Dental enamel erosion

Answer 87

Cardiac - Arrhythmia - Low BP, HTN - Low HR - HF T2DM OA/ osteoporosis Sleep apnea Dyslipidaemia Anaemia Thyroid problems Low K Low WBC Suicide risk Seizures Kidney failure Cognitive impairment Muscle weakness Vitamin deficiencies (eg wernickes) Infection hypothermia

Answer 88

Short term = Marsipan guidance ((management really sick patients with anorexia nervosa) - national protocol for acute eating disorder presentation) refeed - Fine line between refeeding and underfeeding syndrome - Re feeding (dont go too fast) --- Low electrolytes (monitor!) --- Arrythmias (ECG monitored too) --- HF --- Seizure --- -Diarrhea/ GI upset --- Confusion, delerium --- Paralysis --- Respiratory depression, SOB --- Fluid excess --- Rapid weight gain --- Increased BP and HR --- Hyperglycaemia - May be NG tube, fortisip etc - Electrolyte replacement (inc thiamine) IV - Possible bathroom supervision Long term - Referral to eating disorder psychiatry service online self help CBT family therapy - explore underlying issue Focal Psychodynamic Therapy (FPT)

Answer 89

Explain early on the option that this is psychological Explain that this is common - 20% to ⅓ of GP - Around half of new referrals to secondary care Explain that this does not mean that what they are experiencing is not real. It is genuine. It is not imagined Explain that this is not their fault, they did not choose this Explain that there is hope - the good news is that these symptoms are potentially reversible. However, they need to collaborate and put in work in order to achieve this.

Answer 90

Physio Pain relief CBT Psychodynamic therapy Regular check-ups inc physical examination Take patient seriously, open minded, happy to reassess Increases patient satisfaction signs taken over symptoms Health beliefs - ICE about diagnosis Antidepressants Reassurance Behavioural advice Tracking symptoms - who with, doing what, feeling what, Ways to reduce stress, relaxation, manage concerns Medication review

Answer 91

delerium tremens - visual hallucinations of small animals, no insight sleep distrubance - circadian distruption - disorientation seizures naus/vom shakes wernickes delerium can fluctate - worse at night Change in HR, BP, temperature anxiety irritability sweaty

Answer 92

Do you wash or clean a lot? Do you check things a lot? Is there any thought that keeps bothering you that you would like to get rid of, but cannot? Do your daily activities take a long time to finish? Are you concerned about putting things in a special order, or are you upset by mess? Do these problems trouble you? know its unreasonable and active (not passive) (DD schiz),

Answer 93

SSRI different SSRI Metazapine Venlafaxine Combination (either venlafaxine and metazapjne or SSRI and metazapine )

Answer 94

Noradrenergic and specific serotonergic antidepressant (NaSSA) Increase in appetite Drowsiness (So good of patient also complains of difficulty sleeping or poor appetite!)

Answer 95

Stronger antidepressant Try after having tried 2 x SSRI Venlafaxine is an SNRI

Answer 96

Voice sounds inside your head Illusion rather than hallucination eg mirage Recognised as unreal by the patient Historically indicates not psychosis (but lines are blurring)

Answer 97

Haloperidol Lorazepam can aggregate

Answer 98

Antidepressant/mood stabiliser - 300-350mg per day Antipsychotic- 600-800mg per day

Answer 99

Anti craving alcohol dependence drug used post detox

Answer 100

Feel sick and get strong withdrawal type symptoms whenever you drink alcohol

Answer 101

Yale–Brown Obsessive-Compulsive Scale (Y-BOCS)

Answer 102

SSRI 1st line - Escitalopram - Fluoxetine - Fluvoxamine - Paroxetine - Sertraline - Citalopram (unlicensed) TCA - Clomipramine 2nd line (TCA) if SSRI contraindicated or previous good response to clomipramine Monitor for emergence of suicidal / psychotic symptoms No benzodiazapines (Addiction/dependance) or antipsychotics treat physcial injuries eg cream for excessive hand washing

Answer 103

the first line drug treatments are venlafaxine (a SNRI) or a SSRI Antidepressants Sertaline (licensed) Paroxetine (licensed) Amitriptyline Phenelzine

Answer 104

eye movement desensitization and reprocessing Reprocess the memory so that is is dealt with and stored in the brain better Eye movements → Triggers the difficult memories to come to the surface and learning techniques to deal with the effects - breathing, mindfulness, learning to process this in the right way for PTSD (joint first line with CBT?)

Answer 105

Citrolapram (SSRI) or SertraLine (SSRI) Beta blockers for heart symptoms Not benzodiazepines (dependence and addiction)

Answer 106

difficult to interrupt, annoyed when interrupt

Answer 107

flight of thought is more extreme on the scale than looseing associations

Answer 108

circumstantiality- long answer but will answer it, but tangential - will go off topic and not answer original q)

Answer 109

rhyming links (name, game), punning (soul, sole

Answer 110

1. increase in activity 2. elevated mood , euphoria 3. irritable - heightened sensitivity risk taking /reckless disinhibition anger, irritability sociable appetite and sleep change increased libido pressured speech flight of thought

Answer 111

poor concentraion overactivity inattention 6

Answer 112

difficulties in social understanding preoccupations language difference

Answer 113

ocd is ego dystonic (person knows its not right) whereas ocpd lacks insight ocd has more variation over time ocd's actions result from preventing catastrophe, whereas ocpd's action result from attempt to be perfection ocpd may have other personality disorder symtpoms eg intense unstable relationships etc ocpd experiences intrusive thoughts (obsessions) less often and their compulsions are less to do with relieving the anxiety from their intrustive thoughts and more to do with controlling the desired outcome. ocpd may have resulted from overstrict/ overprotective parents and so this behaviour is an attempt to avoid punishment both have rigidity

Answer 114

tantrums, irritability, refusion to go to school, clingy to parents, unable to express emotions

Answer 115

1. Secure – ‘I’m ok, you’re there for me’ 2. (Insecure) avoidant – ‘It’s not ok to be emotional’ 3. (Insecure) ambivalent – ‘I want comfort but it doesn’t help me’ 4. (Insecure) disorganized – ‘I’m frightened’

Answer 116

- typical - both - typical - both

Answer 117

fewer side effects so good for starting off with but takes longer to have an effect so less appropriate for acute presentation

Answer 118

To have capacity a person must be able to: •UNDERSTAND the information that is relevant to the decision they want to make •RETAIN the information long enough to be able to make the decision •WEIGH UP the information available to make the decision •COMMUNICATE their decision by any possible means, (including talking, using sign language, or through simple muscle movements such as blinking an eye or squeezing a hand.)

Answer 119

korsakoff (vit b1 thiamine deficinecy - commonly alcoholism)

Answer 120

anti craving for alcohol dependance

Answer 121

makes feel v sick (like withdrawal) when alcohol is drank

Answer 122

acomprosate (ac = anti-cravind) disulfiride (sulf= toxic, makes very sick when you drink alcohol)

Answer 123

300-350 = antidep/ mood stabiliser 600-800 = antipsychotic

Answer 124

- SSRI - different SSRI - metazapine (NaSSA) - increase appetite and drowsiness so good if these are problem areas - venlafaxine (SNRI) - stronger - combination- metazapine and SSRI or metazapine and venlafaxine - citrolapram and sertraline good if anxiety element

Answer 125

- teach life skills eg toilet, social skills, problem solving - alter behaviour eg sexual disinhibition - treat comorbidity - psychosis, depression, OCD, anxiety, epilepsy, bipolar - CBT if mild - psychodynamic therapies for emotional development, relationships, bereavement..

Answer 126

Anticholinergic - Amitriptyline - Oxybutin - promethazine, chlorpheniramine Opiates affect cognitive function alcohol withdrawal acute

Answer 127

Learning difficulty - -Psychological term to describe impairment in usually one domain - Disorders of speech/ language, motor function, - Eg dyslexia Learning disability - Global impairment affecting functioning and intelligence - Less than 70 IQ

Answer 128

Prenatal - Genetic (Downs syndrome, Fragile X syndrome ) - Infection (HIV, herpes, measles, rubella, chlamydia, syphilis, CMV, toxoplasmosis ) - Toxic (Smoking, alcohol, drugs, Lithium, sodium valproate, phenytoin , Lead) - Metabolic (HTN, Hypothyroidism , Anemia , Rh incompatibility , Folic acid deficiency) Perinatal - Infections (Encephalitis, Meningitis ) - Trauma (Forceps , Bleeding , Hypoxia , Premature, Low birth weight) - Malnutrition Post natal - Trauma (Head injury , Hypoxia , Physical abuse )

Answer 129

Physical - Low muscle tone - Long narrow flat face - Large ears - High forehead Poor feeding Autism Cognitive disability Learning disability - maths and abstract concepts Anxiety - social, avoidance of eye gaze, withdrawal from social interaction Attention issues, distractible, hyperactive, impulsive Can be a carrier - milder symptoms

Answer 130

- intellecutal impairment (weschler) - functioning assessments - assess handicaps - quality of life - determine cause

Answer 131

mania +++ depression ++ lithium is 1st line for bipolar /mania Narrow therapeutic window - so weekly blood tests -- 0.6-1.0mmol/L dehydration (diuretics, diar/vom, water/salt intake, heat wave), reduced renal function, NSAIDs may cause toxicity - Naus /vomit/ diarrhea - Confusion - Excessive sleeping - Seizures - Coarse tremor - Myoclonic jerks tx: Stop lithium Rehydrate Consider haemodialysis if v high level Consider restarting lithium once stabilised - was this due to poor education, non compliance or is this due to renal function change and they should not be on this anymore

Answer 132

mania - depression ++ (opposite to antipsychotics!-- except olanzapine can be used a bit in depression)

Answer 133

mood stabilser not NICE recommended lihtium, then other one, then carbamezapine (3rd line)

Answer 134

form of sodium valporate

Answer 135

- acute, self limiting, few weeks - GI disturbance Parasthesia - Electric shock Headache Anxiety Dizzy Fatigue Sleep disturbance Sweating Tinnitus Flu-like symptoms - Paroxetine and venlafaxine are especially difficult for this due to short half lifes! - slow tapering off of antidepressants

Answer 136

SSRI - sertraline, citalopram, fluoxetine, paroxetine, zimeldine SNRI - venlafaxine, duloxetine, mitrazapine MAOi - phenelzine, isocarboxazid, iproniazid (MAOi used not so much due to foreign importing costs) TCA - amitryptiline, clompipramine, nortriptyline, dosulepin, lofepramine, imipramine other - mirtazapine

Answer 137

Often short term - GI side effects - nausea/ vomit/ diarrhea, weight loss/ anorexia (give PPI to elderly maybe) - Increase in anxiety /suicidality - Sexual dysfunction (not short term) - insomnia takes 2-4w to work

Answer 138

- Less appropriate for older adult ---- Postural hypotension, blurred vision, constipation, drowsy, confused - Less appropriate for overdose risk - weight gain - cardiac s/e -agitation

Answer 139

Cheese reactions → dietary restrictions - foods High in tyrosine (cheese, bovril, red wine, beer, banana …) causing big throbbing headache at bottom of head + tachycardia, arrythmias, nausea .... 'hypertensive crisis' Antidote = prazosin, phentolamine postural hypotension, constipation

Answer 140

sexual dysfunction, nausea, headache, anxiety, insomnia, sweating, increased BP

Answer 141

depression = lack of neurotransmitters in brain (serotonin/ noradrenaline) antidepressants keep neurotransmitters in cleft for longer / prevent breakdown ...

Answer 142

- overdose - dual antidepressant usage - drugs such as tramadol effects serotonin levels - neuromuscular hyperactivity - rigid, tremor, myoclonus, hyperreflexia - autonomic dysfunction - tachycardia, BP changes, hyperthermia, sweating, shivering, diarrhea - altered mental state - confusion, mania, agitation - Supportive - Cyproheptadine (5-HT2 antagonist)

Answer 143

hyponatraemia -- may be contributed to by PPI usage GI bleed

Answer 144

eg for tca ?? cant see cant pee cant sit cant shit

Answer 145

Psychosis is caused by excess dopamine Schizophrenia patients have relative underactivity in meso-cortical pathway, and relative overactivity in mesolimbic pathway Antipsychotics are dopamine D2 antagonists However this causes extra pyramidal side effects (EPSE) (parkinsonism symptoms) Atypicals: occupy 5HT2a --- less extra pyramidal side effects

Answer 146

Emotional symptoms – fear, worry, nervous Physical Symptoms – sweating, tremor, palpitations, nausea, breathless, tired, light-headed/dizzy, tingly, chest pain, sleep worse, trembling, GI upset (lots..) Behavioural - avoidance of feared object, irritable ‘mood swings’, poor conc

Answer 147

- alcohol withdrawal. 48h on (but hallucincations from 12h on) - visual hallucinations - small animals - no insight - admit. Chlordiazepoxide or diazepam (long-acting benzos). carbamezapine - and thiamine/ vit B / pabrinex (all same thing) - if psychotic :haloperidol

Answer 148

Becks Depression Inventory 2 (a bit like PHQ9) 21 depression symptoms- ranked 1-3/4(?) over 2w

Answer 149

takes 2-4 w to work, wait at least this long before switch can have s/e in first few weeks take min 6m after recovered (prevent relapse)

Answer 150

- most 3-4w post-birth but in 1y - CBT, SSRI (if breastfeeding--> sertraline or paroextenie , not citalopram) few days after birth, resolves within several weeks

Answer 151

persistent depressive disorder 2+y, subthreshold ? (minor not major depression) CBT and SSRI

Answer 152

pyschotherapy - CBT, interpersonal therapy support mood stabiliser - lithium, sodium valp, carbamez SSRI antipsychotics - olanzapine, risperidone NB: lithium needs monitoring! - before start, get U/E, ECG, TFT, FBC, BMI (and measure these every 6m) - serum lithium levels recorded 1 w after dose change until stable within 0.6-0.8 (and every 3m for first year)

Answer 153

Quetiapine + Lithium +- benzodiazepines

Answer 154

female, 35-64y, Hx of trauma, Hx of anxiety disorders, FHx of anxiety, physical/ emotional stress, chronic conditions, substance abuse, single parents, divorced/widowed, live alone

Answer 155

anxiety diagnosis (7 symptoms, frequency over 2w (even though diagnosis needs 6m)) mild = 5-9 moderate = 10-14 severe = 15+

Answer 156

HEAR Hyperarousal Emotional Numbing Avoidance Reliving the Situation 1-6m after event (acute distress disorder presents within 1m, give them short-term CBT and SSRI rather than EDMR) 4w+ (acute distress disorder lasts <4w)

Answer 157

exposure and response therapy for OCD (+phobias/anxiety?) do activity and don't do compulsion

Answer 158

Anhedonia Affect blunted Asocial Alogia Attention deficit Avolition Catatonia Delusions Hallucinations Formal Thought disorder Thought interference Passivity

Answer 159

Hypercalcaemia B12 def Folate deficiency --> psychosis

Answer 160

“Paranoid Psychotic Humans Can’t Supply Understandable Reasoning” Paranoid: just +ve sx Post-schizophrenic Depression: depression with schiz hx in last 12months + some schiz sx still present Hebephrenic: thought disorganisation (mainly young onset, poor prognosis) Catatonic: 1 or more -ve sx Simple: no psychotic sx, with -ve sx Undifferentiated: meet Dx criteria but doesnt fit other types Residual: -ve sx lasting one year following a psychotic episode

Answer 161

3 or more Acute intoxication Harmful use Dependence Withdrawal sx Psychotic disorder Amnesia Residual disorder

Answer 162

Perseveration - repeating the same words/answers. Echolalia - repeating exactly what someone has said. Neologism - making up new words. Word salad - disorganised speech, sentences that do not make sense. Expressive dysphasia - difficulty putting together words. Often develops following a stroke. clanging - words strung together by sound/ rhyme rather than by meaning alogia: little information conveyed by speech palolagia : compulsive repetitions of utterances (saying same word lots in a paragraph)