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My notes - med > Psych > Flashcards

Psych Flashcards

1
Q

Tool for ADHD children

A

Conners Comprehensive Behavioural Scale (CRBS)- academic, behavioural and social issues

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2
Q

Tool for ADHD adults

A

Adult ADHD Self-Report Scale (ASRS) - current sx

Wendler Utah Rating Scale (WURS) - retrospective rating of childhood

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3
Q

ADHD stats

A

m:f 3:1
heritable
8-12% worldwide, 20-50% first degree relative

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4
Q

ADHD pathophys

A

disregulation of dopamine and noradrenaline in prefrontal cortex
Frontal lobe hypoperfusion and lower frontal lobe metabolic rates
Enviro: mom smoker or substance use in preg, low birth weight, premature, getal hypoxia

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5
Q

ADHD MSE

A

Overfamiliar + impatient
Good eye contact
Rapport reasonable but redirection + reassurance needed
Speech normal rate/rhythm/tone, slight increased volume
Thought content ok
Self describe as happy, no self harm, no psychotic
Attention reduced
Insight ok, realises he has an issue

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6
Q

ADHD tx

A
  • Parental support/teaching
  • Psychoeducation, social skills training, impulse control interventions, neurofeedback, CBT, classroom SNAssistant
  • Diet: minimise additives, lots of protein and vitamin rich food.
  • Meds: stims –>methylphenidate , amphetamine, dextroamphetamine, dexmethylphenidate, non stims –>atomoxetine, guanfacine
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7
Q

Methylphenidate

A

ADHD stimulant
Increase dopamine and noradrenaline levels in prefrontal cortex
Increases fine and gross motor control + cog performance and executive function

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8
Q

Methylphenidate SE

A

ADHD
N, abdo pain, headache, anxiety, sleep troubles, appetite and weight reduction, growth retardation
Increase HR and BP, monitor this
Suicidal thoughts, dysphoria, mood lability, psychosis
Tics

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9
Q

Non stim ADHD meds

A

atomoxetine

guanfacine

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10
Q

Atomoxetine

A 
ADHD non stim
Noradrenlaine reup inhib
SE: N, dry mouth, anorexia, insomnia
Irritability, behavioural changes, suicide thoughts
Liver damage
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11
Q

Guanfacine

A

ADHD non stim
Stims alpha 2 adrenergic receptors to enhance noradren neurotransmission
SE: fatigue, headache, GI

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12
Q

Symptoms of depression

A 
SIG-E-CAPS
Sleep changes
Interest low
Guilt (worthlessness)
Energy down
Cognition/Concentration low
Appetite low
Psychomotor depression or agitation
Suicide/death preoccupation
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13
Q

Criteria for Mild Depression

A

2 of main 3 sx + 2 other for >2weeks

Distressed but continues working/social functioning

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14
Q

Criteria for moderate depression

A

2 of main 3 + 3 other, >2w

Difficulty continuing normal social/work

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15
Q

Criteria major depression

A

3 main sx + 4 other, >2w
Can have psychosis or severe dep
Severe distress/agitation

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16
Q

Tools for depression

A

HAD (hospital anxiety and depression)–> score out of 21, <7 norm, 8-10 borderline, >11 positive
PHQ-9 (patient health question) –> <4 norm, 5-9 mild, 10-14 mod, 15-19 mod sev, 20-27 sev

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17
Q

DSM depression criteria

A

*1 depressed most of day most days
*2 v. diminished interest or pleasure in most/all activities most days
*3 sig weigh loss/gain
4 insomnia/hypersomnia most days
5 psychomotor agit/retard most days
6 fatigue/loss of energy most days
7 worthless/guilt most d
8 low concentration most d
9 recurrent thoughts of death, suicidal ideation w/ plan or w attempt or plan

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18
Q

Duloxetine MOA

A

Depression, GAD, social anx, panic, menopause sx

SNRI

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19
Q

Venlafaxine MOA

A

Depression, GAD, social anx, panic, menopause sx

SNRI

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20
Q

Typical antipsychotic eg

A

Haloperidol

Chlorpromazine

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21
Q

Haloperidol MOA

A

Typical

D2 receptor antagonist, blocks dop transmission in mesolimbic pathways

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22
Q

Haloperidol SE

A

Extrapyramidal SE and hyperprolactinemia

Long QT

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23
Q

Chlorpromazine SE

A

Extrapyramidal SE and hyperprolactinemia

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24
Q

Chlorpromazine MOA

A

Typical

D2 receptor antagonist, blocks dop transmission in mesolimbic pathways

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25
Q

Extrapyramidal SE’s

A

Parkinsonism
Acute dystonia (sustained muscle contraction –> procyclidine)
Akathisia (restless)
Tardive dyskinesia

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26
Q

Tx for acute dystonia

A

procyclidine

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27
Q

Atypical antispychotic eg

A

Clozapine
Risperidone
Olanzapine

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28
Q

Clozapine, Risperidone, Olanzapine MOA

A

D2, D3, D4, 5HT

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29
Q

Clozapine, Risperidone, Olanzapine SE

A

Metabolic effects

ESPS + Hyperprolactinemia less common

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30
Q

Antipsychotic rare side effect

A

neuroleptic malignant syndrome

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31
Q

Antipsychotics in elderly se:

A

stroke

VTE

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32
Q

Typical antipsychotic se

A 
Antimuscarinic (dry mouth, blurred vision, urinary retention, contipation
Sedation, weight gain
Raised prolactin (galactorrhea)
Impaired glucose tolerance
Neuroleptic malignant syndrome
Reduced seizure threshold
Prolonged QT (haloperidol)
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33
Q

Neuroleptic malignant syndrome

A

Antipsychotics
Pyrexia + muscle stiffness
altered mental state, rigidity, fluctuating BP, high temp

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34
Q

Alcohol withdrawal tx

A

decreasing doses chlordiazepoxide or diazepam
**lorazepam if acute liver failure
Carbamazepine can be effective

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35
Q

Chronic alcohol on brain

A

enhanced GABA mediated inhibition of CNS, inhibits NMDA glutamate receptors

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36
Q

Alcohol withdrawal on brain

A

decreased inhibition of GABA and increased NMDA glutamate transmission

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37
Q

Alcohol withdrawal 6-12hr

A

tremors, sweating, tachy, anxiety

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38
Q

Alcohol withdrawal 36h

A

seizures

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39
Q

Alcohol withdrawal 48-72h

A

DTs: coarse tremor, confusion, delusions, aud/vis hallucinations, fever, tachy

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40
Q

Schneider’s 1st rank sx

A 
Auditory hallucinations (2+ voices discussing patient, thought echo, voices commending on pt behav)
Thought disorders (insertion, withdrawal, broadcasting)
Passivity (body sensations being controlled by external, actions/impulses/feelings imposed on pt by others)
Delusional perceptions (normal object perceived then sudden intense delusional insight into its meaning for pt.)
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41
Q

Auditory hallucinations - Schneider’s

A

2+ voices discussing patient in 3rd person
thought echo
voices commending on pt behaviour

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42
Q

Thought disorder - Schneider’s

A

Insertion, withdrawal, broadcasting

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43
Q

Passivity phenomenon - Schneider’s

A

Bodily sensations controlled by external influence

Actions/impulses/feelings imposed on patient or influenced by others

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44
Q

Delusions -Schneider’s

A

first a normal object is percieved, then there is sudden intense delusional insight into objects meaning for patient

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45
Q

Ft of schizophrenia

A

Schneider’s: auditory hallucination, thought disorder, passivity, delusions
Other: impaired insight
blunt affect/incongruous
Decreased speech
neologisms - made up words
Catatonia
Negative sx: blunting of affect, anhedonia, alogia, avolition

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46
Q

Negative sx schizo

A

Incongruity/blunting of affects
Anhedonia (no pleasure)
Alogia (poverty of speech)
Avolition (low motivation)

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47
Q

Anxiety ddx

A

hyperthyroid
cardiac disease
medication-induced anx (salbutamol theophylline, steroids, antidepressant, caffeine)

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48
Q

GAD mgmt

A

1: education + active monitor
2: psychoeducation groupts, self-help
3: CBT, meds
4: highly specialist input

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49
Q

GAD drugs

A

1st: Sertraline (SSRI)
2nd: another SSRI or SNRI (duloxetine, venlafaxine)
3rd: pregabalin
* * <30y warn of suicidal thinking and self harm

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50
Q

Panic disorder mgmt:

A

1: recognise + dx
2: primary care tx
3: review + alternative tx
4: refer to specialist
5: admit

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51
Q

Panic disorder tx

A

CBT
SSRI x 12 w
no resp: imipramine or clomipramie (TCA)

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52
Q

Weight gain antipsychotics

A

atypical antipsychotics

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53
Q

Clozapine risk

A 
agranulocytosis - monitor FBC
neutropenia
reduced seizure threshold
constipation
myocarditis
hypersalivation
Only use after failure of 2 other drugs
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54
Q

Olanzapine

A

atypical

Obesity, dyslipidemia

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55
Q

Clozapine

A

atypical
not first line
agranulocytosis

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56
Q

Risperidone

A

atypical

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57
Q

Quetiapine

A

atypical

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58
Q

Amisulpride

A

atypical

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59
Q

Aripiprazole

A

Atypical

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60
Q

Erotomania

A

delusion of famous person being in love with them
Absence of other psychotic sx
De Clerambeault’s

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61
Q

Schizotypal PD

A

odd beliefs
bizarre behaviours
No delusional convistions

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62
Q

Narcissistic PD

A

long term pattern of inflated self importance, excessive need for admiration, lack of empathy

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63
Q

Histrionic PD

A

excessively attention seeking

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64
Q

Lithium checks

A

1w after dose change/initiation and weekly until stable
check 12h post dose
Once stable - 3 monthly, 6monthly after 1 y
***thyroid, renal tests 6 monthly

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65
Q

Lithium therapeutic range

A

0.4-1.0

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66
Q

Lithium uses

A

bipolar

adjunct in refractory depression

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67
Q

Lithium SE

A 
N/V/D
Fine tremor
Nephrotoxic: polyuria from nephrogenic diabetes insipidus
Thyroid enlargement - hypothyroid
ECG: t wave flatten/inversion
Weight gain
Idiopathic intracranial HTN
Leucocytosis
Hyperparathyroid + hypercalcemia
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68
Q

ECT side effects

A

Short term: headache, nausea, ST memory, memory loss of events prior to tx, cardiac arrythmia.
LT: impaired memory

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69
Q

Unexplained symptoms:

A

Somatisation – Symptoms

hypoCondria – Cancer

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70
Q

Pt concerned about persistent (>2y), unexplained sx, no accepting reassurance of negative tests

A

somatisation

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71
Q

pt concerneed about an underlying diagnosis

A

hypocondria

72
Q

intentional production of sx

A

muchausen/factitious

73
Q

Somatisation

A

Pt concerned about persistent (>2y), unexplained sx,

no accepting reassurance of negative tests

74
Q

Illness anxiety disorder/hypocondria

A

belief in underlying serious disease

refusal to accept negative test results

75
Q

Conversion disorder

A

loss of motor/sensory function (amnesia, fugue, stupor)

not conscious of them not being real

76
Q

seeking material/financial gain from simulation or exaggeration of symptoms

A

malingering

77
Q

Dissociative disorder

A

separating certain memories from normal consciousness

78
Q

Anorexia Criteria

A

1) restriction of energy intake relative to requirements leading to sig low body weight in context of age/sex/development/health
2) intense fear of gaining weight or becoming fat, even through underweight
3) disturbance in exeperience of won body weight/shape, undue influence of body weight or shape on self eval, denial of seriousness of current low body weight

79
Q

Anorexia mgmt

A

CBT

Family focused therapy

80
Q

Paroxetine

A

SSRI

81
Q

Paroxetine in preg

A

avoid - risk of congenital malformations (1st tri and heart defects)
3rd tri: pulm HTN baby

82
Q

SSRIs

A

Citalopram
Dluoxetine
Sertraline

83
Q

First line depression

A

Citalopram or Fluoxetine (SSRI)

84
Q

Depression meds post MI

A

Sertraline (SSRI)

85
Q

Antidepressant for children/ado

A

Fluoxetine (SSRI)

86
Q

SSRI SE

A

GI
Hyponatremia in elderly
increased risk GI bleed, give PPI if giving NSAID
Can cause increased anxiety/agitation at frst

87
Q

Citalopram

A

SSRI

Dose dependent QT prolongation - dont use in those w congenital QT, pre existing QT, or in combo with other QT drugs

88
Q

Citalopram max dose

A

40mg/d adults

20mg/d over 65 or hepatic impair

89
Q

SSRI interactions

A 
NSAID (give PPI)
Warfarin/heparin (mirtazapine instead)
Aspirin
Triptans (serotonin syndrome)
MAOis (serotonin syndrome)
90
Q

SSRI discontinuation sx

A 
Continue 6mo after remission, reduce over 4 weeks
Increased mood change
restlessness
difficulty sleeping
unsteadiness
sweating
GI
paresthesia
91
Q

SSRI + Preg

A

1st tri: congenital heart
3rd tri: pulm HTN
Paroxetine bad

92
Q

Stones, bones abdo moans and psychic groans

A

hypercalcemia

93
Q

Schizoid

A

Doesnt want or enjoy close relationships (fam included)
Chooses colitary activities
Little interest in sex
Pleasure in v few activities
Lacks close friends/confidants
Indifferent to praise or criticism
Emotional coldness/detachment, flattened affect

94
Q

Emotionally labile, severe sudden mood swings, rages, self harm, jealousy

A

borderline PD

95
Q

rely on reassurance of others, others to make decisions

A

dependent PD

96
Q

dont trust anyone, including partner, fear of people lying or harming them

A

paranoid PD

97
Q

PD tx

A

dialectical behavioural therapy

98
Q

Antisocial ft

A

Failure to conform to social norms - repeatedly performing acts that are grounds for arrest
Men>women
Deception, lying, use of alias, conning for profit or pleasure
Impulsive or failure to plan
Irritable, aggressive, fights/assaults
Reckless disregard for others safety
Consistent irresponsibility
Lack of remorse/indifferent to hurting/stealing/mistreating

99
Q

Avoidant PD

A

Avoid occupational activities involving significant interpersonal contact due to fear of criticism or rejection
Unwilling to be involved unless certain of being liked
Preoccupied w ideas of being criticized/rejected in social situations
Restraint in intimate relationships for fear of ridicule
Reluctance to take risks for fear of embarrassment
Views self as inept/inferior
Social isolation but craves social contact

100
Q

Borderline PD

A 
Avoid real/imagined abandonment
Unstable interpersonal relationships that alternate between idealization and evaluation
Unstable self image
Impulsive in self damaging areas (sex, $, substances)
Recurrent suicidal behaviour
Affective instability
Chronic feeling of empty
Hard to control temper
Quasi psychotic thoughts
101
Q

Dependent PD

A

Can’t make decisions without excessive reassurance from others
Need for others to assume responsibility for major areas of life
Hard to express disagreement with others cuz scared to lose support
Lack of initiative
Unrealistic fears of being left to care for self
Urgent search for another relationship after one ends
Need to obtain support from others
Unrealistic feelings that they cant care for themselves

102
Q

Histrionic PD

A

Inappropriately sexual
Need to be centre of attention
Rapidly shifting and shallow expression of emotion
Suggestibility
Dresses for attention
Self dramatization
Considers relationships more intimate than they are

103
Q

Narcissistic PD

A 
Grandise sense of self importance
Preocc w fantasies of unlimited success, power, beaty
Sense of entitlement
Lack of empathy
Take advantage of others for own needs
Excessive need for admiration
Chronic envy
Arrogant/hauty
104
Q

Obsessive compulsive PD

A

Occupied with details, rules lists, order, organization or agenda to the point that they key part of activity is gone
Perfectionism that hampers completion of tasks
Dedicated to work and efficiency with eliinationof spare time activities
Meticulous, scrupulous, rigis re etiquette of morality, ethics, values
Not capable of getting rif of indignificant things even when they dont have meaning
Unwilling to pass on tasts or work unless done their way
Stingy spending towards self and others, stiff, stubborn

105
Q

Paranoid PD

A

Hypersensitivity and unforgiving attitude when insulted
Unwarranted tendency to question loyalty of friends
Reluctant to confide in others
Preocc with conspirational beliefs and hidden meanings
Parceiev attacks on their character

106
Q

Schizoid PD

A 
Indifference to praise/criticism
Prefers solitary activities
Lack of interest in sex
Lack of interest in companion
Emotional coldness
Few interetss
Few friends/confidants
107
Q

Schizotypal PD

A 
Ideas of reference
Odd beliefs, magical thinking
Unusual perceptual distubances
Paranoid ideation, suspiscious
Odd, eccentric behaviour
Lack of close friends other than fam
Inappropriate affect
Odd speech but not incoherent
108
Q

SE after LT use of antipsychotics

A

tardive dyskinesia

109
Q

SE shortly after starting antipsychotics

A

neuroleptic malignant syndrome

Acute dystonia

110
Q

Serotonin syndrome

A 
Agitation
Hyperthermia
Hyperreflexia
Sweating
Dilated pupils
111
Q

repeating the same words/answers.

A

perseveration

112
Q

repeating exactly what someone has said

A

echolalia

113
Q

making up new words

A

neologism

114
Q

disorganised speech, sentences that do not make sense

A

word salad

115
Q

difficulty putting together words. Often develops following a stroke

A

expressive dysphagia

116
Q

Alogia

A

little info in speech

117
Q

tangentiality

A

diverge from topic and dont return

118
Q

clanging

A

linking words by sound/rhyme not meaning

119
Q

Benzos MOA

A

enhance effect of GABA (main inhibitory NT) by increasing freq of chloride channels
“FRENdodiazepines increase FREquency”

120
Q

How to stop Benzos

A

Steps of 1/8 daily dose every 14d

If having trouble, switch them to equiv dose diazepam, reduce this every 2-3w by 2 or 2.5mg

121
Q

Benzo withdrawal

A 
Up to 3 weeks after stopping
Insomnia
Irritability
Anxiety
Tremor
Loss of appetite
Tinnitus
Perspiration
Perceptual disturbances
Seizures
122
Q

Barbituates

A

Increase DURATION of chloride channel

“barbiDURATes increase DURATion”

123
Q

Zoplicone SE

A 
Agitation
Bitter taste in mouth
Constipation
Decreased muscle tone
Dizziness
Dry mouth
Increased risk of falls
124
Q

LT SE of ECT

A 
apathy
anhedonia
difficulty concentrating
loss of emotional responses
difficulty learning new info
125
Q

OCD

A

either obsessions or compulsions causing significant impairment and/or distress

126
Q

Obsession

A

unwanted intrusive through, image or urge that repeatedly enters mind

127
Q

Compulsion

A

repetitive behaviours or mental acts that you feel driven to perform

128
Q

OCD mgmt

A

mild: CBT/ERP +/- SSRI
Mod: SSRI or intensive CBT
Sev: SSRI + CBT
*if SSRI works, keep for at least 12mo

129
Q

body dysmorphic disorder tx

A

fluoxetine

130
Q

Oculogyric crisis

A

Sustained upward deviation of eyes
Clenched jaw
Hyperextension of back/neck with torticollis

131
Q

Othello syndrome

A

delusional/pathological jealousy

Can be isolated or secondary to schizophrenia or a PD

132
Q

Psych Conditions with psychotic sx

A 
Schizophrenia
Depression
Bipolar
Peuperal psychosis
Brief psychotic disorder
133
Q

Non psych conditions with psychotic sx

A

Neuro conditions (Parkinsons, Huntingtons)
Corticosteroids
Cannabis, phencyclidine

134
Q

Schizophrenia poor prognosis

A 
Pre morbid social withdrawal
Low IQ
Fam Hx schizo
Gradual onset of sx
Lack of obvious precipitant
135
Q

PTSD features

A 
>1 month
re experiencing (flashback, nightmare)
avoidance (people/situations)
hyperarousal (hypervigilance, sleep problems)
emotional numbing
136
Q

PTSD mgmt

A

<4 w - watchful wait
CBT, Eye movement desensitization and reprocessing
Venlafaxine or SSRI (sertraline)
Severe - risperidone

137
Q

Commonest electrolyte abnormality in anorexia

A

hypokalemia

138
Q

Anorexia ft

A

reduced BMI
Bradycardia
Hypotension
Enlarges salivary glands

139
Q

Anorexia physiological abnormalities

A 
Hypokalemia
Low FSH, LH, estrogen, testos
Raised cortisol, GH
Impaired glucose tolerance
Hypercholesterolemia
Hypercarotenemia
Low T3
140
Q

Catatonia

A

stopping of voluntary movement

Staying in unusual position

141
Q

Abnormal grief response

A

> 6mo

142
Q

RF for schizophrenia

A 
Fam w schizo = strongest (RR7.5)
Twin (50%)
Parent (10-15%)
Sibling (10%)
No relatives (1%)
Black caribbean (5.4)
Migration (2.9)
Urban enviro (2.4)
Cannabis (1.4)
143
Q

Meds + ECT

A

reduce dose but dont stop

144
Q

Clozapine bad SE

A 
agranulocytosis
neutropenia
reduced seizure threshold
myocarditis
constipation/intestinal obs
145
Q

Olanzapine SE

A

Weight gain
dyslipidemia
Diabetes
Sedation

146
Q

Quetiapine SE

A

postural hypotension
weight gain
dyslipidemia

147
Q

Risperidone SE

A

EPSPs
Postural hypotension
ED

148
Q

GAD tx, first SSRI doesnt work

A

If first SSRI doesnt work, try a different one

149
Q

Clomipramine

A

TCA

Depression , OCD

150
Q

Benzos SE

A

anterograde amnesia - recall and creation of new memories impaired

151
Q

Anorexia: raised

A 
MOST thing low but
G's and C's raised:
Growth hormone
Glucose
salivary Glands
Cortisol
Cholesterol
Carotenemia
152
Q

Grief rxn stages

A 
Denial - numb, pseudohallucinations, make meals for them
Anger - against family and docs
Bargaining
Depression
Acceptance
153
Q

Atypical grief rxn ft

A

Delayed - when 2+ weeks have passed

Prolonged - hard to define…>12m?

154
Q

SSRI discontinuation

A

Gradual over 4 w

except fluoxetine

155
Q

Things that change clozapine blood levels

A

Smoking: lowers levels, cessation will increase levels
Alcohol: low alcohol will reduce levels, binges will increase

156
Q

Suicide risk factors

A 
SAD PERSONS
Sex (M>F)
Age (35-49)
Depression/mental illness
Prev attempts
Ethanol/Drugs
Rational thinking
Social support (loss of job, friends/support)
Organized plan
No spouse (single/div/widdow)
Sickness (pain, chronic illness)
157
Q

Increased risk of future successful suicide after this attempt

A 
Efforts to avoid discovery
Planning
Leaving a note
Final acts
Violent method
158
Q

Protective factors for suicide

A

Family support
Children
Religion

159
Q

Mirtazapine

A

Noradrenergic and Specific Serotonergic Antidepressant (NaSSA)
SE: sedation + increased appetite

160
Q

TCA side effects

A 
dry mouth, blurred vision, urinary retention, drowsiness
weight gain
Constipation
mydriasis
Long QT
161
Q

TCA eg

A 
Amitriptyline
Clomipramine
Trazodone
Dosulepin
Imipramine
162
Q

Most dangerous TCA for OD

A

amitriptyline

Dosulepin

163
Q

Least dangerous TCA for OD

A

Lofepramine

164
Q

TCA for headache/migrain

A

low dose amitriptyline

165
Q

ECT indications

A

catatonia
prolonged severe mania
severe life threatening depression

166
Q

Circumstantiality

A

inability to answer question without giving excessive, unnecessary detail, eventually returns to the point

167
Q

Knight’s move thinking

A

loosening of associations, unexpected and illogical leaps from one idea to another - schizophrenia.

168
Q

Flight of ideas

A

leaps from one topic to another with links between them

169
Q

Mania

A

> 1w
severe functional impairment in social/work
can require hospitalization for risk of harm to self or others
Can have psychotic sx

170
Q

Hypomania

A

<7days - usually 3-4
Can be high functioning, doesnt impair functional capacity in society
No hospitalization
no psychotic sx

171
Q

Mania/Hyponaia ft

A

Mood: elevated, irritable
Speech/thought: pressured, flight of ideas, poor attn
Behaviour: insomnia, loss of inhibitions, increased appetite

172
Q

Acute stress disorder

A

<4w after trauma

Intrusive thoughts, dissociation, negative mood, avoidance, arousal

173
Q

Acute stress disorder tx

A

CBT

Benzos for acute sx (agitation, sleep disturbance)

174
Q

Agoraphobia

A

situations where escape is difficult or help unavailable

175
Q

Panic disorder

A

random panic attacks on a background OF NO ANXIETY

My notes - med (14 decks)

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