Psych Beasts Flashcards
Schiz, Depression, Bipolar, Anxiety
1
Q
What is the risk of developing schizophrenia in the general population?
A
1%
This is the baseline risk for schizophrenia in the general population.
2
Q
What is the risk of developing schizophrenia for twins or individuals with both parents affected?
A
48%
This indicates a strong genetic component in the development of schizophrenia.
3
Q
List some antenatal factors that increase the risk of schizophrenia.
A
- Influenza infection
- Maternal measles infection
- Maternal rubella infection
- Preterm labour
- Premature rupture of membranes
- Low birth weight
- Foetal hypoxia during delivery
- Increased paternal age
4
Q
What are some biological factors associated with schizophrenia?
A
- Head injury
- Epilepsy
- Temporal lobe disease
- Protective factor: rheumatoid arthritis
5
Q
Which demographic factors influence the severity of schizophrenia?
A
- Male
- Urban living > rural living
6
Q
What gross changes are observed in the brains of individuals with schizophrenia?
A
- Atrophy of prefrontal cortex
- Atrophy of temporal lobe
- Increased ventricular size
7
Q
What neurochemical abnormality is associated with the mesolimbic pathway in schizophrenia?
A
Increased dopamine
8
Q
How does agonism of serotonin receptors in the nigrostriatal pathway affect dopamine?
A
Causes excessive serotonin and inhibits release of dopamine, leading to negative symptoms
9
Q
What are Schneider’s first rank symptoms of schizophrenia?
A
- Auditory hallucinations (3rd person)
- Delusions of thought (broadcasting, insertion, withdrawal)
- Delusion of control and passivity
- Delusional perception (persecutory)
10
Q
What is the DSM-V criteria for diagnosing schizophrenia?
A
Presence of ≥2 symptoms over a month (at least 1 must be from the first 3) affecting functioning in several major domains, with continuous impairment for at least 6 months.
first 3: delusions, hallucinations, speech abnormality
11
Q
List the types of symptoms that must be present for a schizophrenia diagnosis according to DSM-V.
A
- Delusions
- Hallucinations
- Speech abnormality
- Behaviour disorganization
- Negative symptoms (PLANT)
12
Q
What does the acronym PLANT stand for in relation to negative symptoms?
A
- Apathy
- Alogia
- Anhedonia
- Attention impairment
13
Q
What percentage of individuals with schizophrenia achieve sustained symptomatic and functional recovery after one episode?
A
9-38%
14
Q
What is the suicide risk percentage among patients with schizophrenia?
A
10%
15
Q
What are some poor prognostic factors for schizophrenia?
A
- Poor premorbid function
- Insidious onset
- Early onset
- Prominent and severe negative symptoms
- Prominent and severe cognitive symptoms
- Male gender
- High expressed emotion
16
Q
What are some environmental factors that negatively affect the prognosis of schizophrenia?
A
- Perinatal complications
- CNS viral infections
- Substance abuse
- Living in developed countries
- Longer duration of illness
- Lack of prominent mood symptoms
17
Q
What characterizes schizophreniform disorder?
A
≥2 symptoms for 1-6 months (at least 1 must be from the first 3 symptoms).
18
Q
What is the duration of symptoms for brief psychosis?
A
1 day to 1 month (at least 1 must be from the first 3 symptoms) without negative symptoms.
19
Q
In mood disorders with psychosis, when do the psychotic symptoms occur?
A
Only during diagnosable periods of mood disturbance.
20
Q
What distinguishes schizoaffective disorder from schizophrenia?
A
Prominent mood symptoms co-occur with symptoms of psychosis.
21
Q
List some organic causes that can lead to psychosis.
A
- Substance-induced (e.g., hallucinogens, cannabis, stimulants)
- Alcohol
- Medications (e.g., haloperidol, antibiotics)
22
Q
What are common investigations conducted for schizophrenia?
A
- FBC
- ESR
- LFT
- TFT
23
Q
What are the primary indications for antipsychotics?
A
Schizophrenia, Mania - mood stabilising effect
Antipsychotics are primarily used to manage symptoms of schizophrenia and mood stabilization in mania.
24
Q
What is the mechanism of action of first-generation antipsychotics?
A
Blockade of D2 receptors
This reduces the effects of excessive dopamine that causes first rank symptoms.
25
What is the mechanism of action of second-generation antipsychotics?
Blocks D2 receptors and 5HT2A receptors
## Footnote
This stops first rank symptoms and reduces the effects of excessive serotonin, inducing some dopamine release in the nigrostriatal pathway, thereby stopping negative symptoms.
26
What are the key extrapyramidal side effects (EPSEs) associated with antipsychotics?
* Acute dystonia
* Akathisia
* Tardive dyskinesia
* Pseudoparkinsonism
## Footnote
These side effects are often linked to the use of antipsychotics, particularly first-generation types.
27
What is the treatment for acute dystonia caused by antipsychotics?
* Prevention: low dose prophylactic anti-cholinergic
* Acute: IM congentin
* Maintenance: Benzhexol (anti-cholinergic drug)
## Footnote
Acute dystonia can be managed through various anti-cholinergic medications.
28
What is the preferred treatment for akathisia?
* Modify drugs
* Anticholinergics
* Beta blockers
* Benzodiazepines
## Footnote
Adjusting medication and using adjunctive therapies can alleviate akathisia.
29
True or False: Tardive dyskinesia is commonly seen with newer antipsychotics.
False
## Footnote
Tardive dyskinesia is not commonly seen with newer antipsychotics.
30
What are the side effects of first-generation antipsychotics compared to second-generation?
* 1st gen: More EPSE
* 2nd gen: Less EPSE, metabolic syndrome, more weight gain, prolonged QTc
## Footnote
First-generation antipsychotics are associated with more extrapyramidal side effects, while second-generation types have additional risks such as metabolic syndrome.
31
Which antipsychotic is associated with the highest risk of weight gain?
Olanzapine
## Footnote
Among second-generation antipsychotics, olanzapine is noted for significant weight gain.
32
What are the indications for Haloperidol?
* Acute psychosis
* Schizophrenia
* Bipolar/manic episodes
* Delirium
* Alcohol withdrawal states
## Footnote
Haloperidol is often used in acute situations and when second-generation antipsychotics are ineffective.
33
What is the primary use of Clozapine?
Treatment resistant schizophrenia
## Footnote
Clozapine is specifically indicated for patients who do not respond to at least two different antipsychotics.
34
Fill in the blank: All antipsychotics are excreted by the __
liver
## Footnote
This highlights the importance of monitoring liver function in patients on antipsychotics.
35
What is the dosing schedule for Paliperidone?
Depot injection - given once every 3 months
## Footnote
This formulation is designed for patients who may struggle with regular medication adherence.
36
What is a significant side effect of Clozapine that requires monitoring?
Agranulocytosis
## Footnote
Patients on Clozapine must have their full blood count monitored weekly for the first 18 weeks, then biweekly for one year, and monthly thereafter.
37
What are the side effects of Quetiapine?
Lower potency, suitable for neuroleptic sensitivity
## Footnote
Quetiapine is often chosen for patients who are sensitive to neuroleptics, although it has its own side effect profile.
38
What is Othello Syndrome?
Morbid jealousy with the belief that a partner is unfaithful, reached through delusional means
## Footnote
Often associated with alcohol dependence and erectile dysfunction.
39
What should be checked in a patient with Othello Syndrome?
Homicidal risk and violence
## Footnote
Important to assess safety in these cases.
40
What is De Clerambault syndrome also known as?
Erotomania
## Footnote
Involves the belief that someone powerful or a celebrity is in love with the patient.
41
What should be assessed in a patient with De Clerambault syndrome?
Danger to self, person of affection, partner of person of affection
## Footnote
Safety concerns are critical.
42
What is Capgras syndrome characterized by?
Belief that people in the patient's life have been replaced by exact doubles
## Footnote
Often requires checking for organic causes.
43
Which disorders can Capgras syndrome be seen in?
Schizophrenia, mood disorders
## Footnote
Important to consider when diagnosing.
44
What is Cotard’s syndrome?
Belief that one is dead or that the world has ended
## Footnote
Associated with nihilistic delusions and severe depression.
45
What should be checked in a patient with Cotard’s syndrome?
Organic cause, schizophrenia, mood disorders
## Footnote
Necessary to rule out other underlying issues.
46
What neurotransmitter levels are decreased in depressive disorder?
* Noradrenaline
* Dopamine
* Serotonin
47
Which brain structures are involved in depressive disorder?
* Amygdala
* Hippocampus
* Frontal lobe
48
What is a key feature of cortisol regulation in depressed patients?
High cortisol levels do not have an inhibitory effect on CRH production
49
What are the diagnostic criteria for a depressive episode according to DSM-V?
At least 5 symptoms for minimum 2 weeks, with marked impairments in premorbid functioning
50
What mood symptoms are indicative of depressive disorder?
* Low mood most days
* Feeling worthless or excessive guilt
* Recurrent ideations of self-harm or suicide
51
What are some biological symptoms of depressive disorder?
* Appetite decrease
* Sleep difficulties - insomnia or hypersomnia
* Loss of libido
* Generalized low energy
52
What cognitive symptoms are associated with depressive disorder?
Attention and concentration difficulties
53
What are the psychomotor changes observed in depressive disorder?
Agitation or retardation
54
What characterizes psychotic depression?
Psychotic symptoms occurring after depressive symptoms
55
What are the symptoms of atypical depression (RAILS)?
* Reactive mood
* Appetite increased
* Interpersonal rejection sensitivity
* Leaden paralysis
* Sleep increases
56
What symptoms are associated with melancholic depression (MAD GRADS)?
* Motor retardation/agitation
* Anorexia, weight loss
* Diurnal variation
* Excessive guilt
* Absent reactivity
* Anhedonia
* Distinctively low mood
* Early morning awakening
57
What defines recurrent depressive disorder?
At least 2 major depressive episodes with an interval of at least 2 consecutive months
58
What is cyclothymia?
Numerous episodes over at least 2 years with hypomanic and depressive symptoms, but not meeting full criteria for either
59
How long must dysthymia (persistent depressive disorder) last?
Depressed most days for at least 2 years (1 year for children/adolescents)
60
What is a key feature of disruptive mood dysregulation disorder?
Persistently irritable mood in between outbursts
61
What is the symptom onset pattern for premenstrual dysphoric disorder?
Symptoms start at least in the week prior to menstruation and improve within a few days after onset
62
What are some organic causes that can lead to depressive symptoms?
* Hypothyroid
* Cushing’s disease
* Parathyroid dysfunction
63
What are the common investigations for depressive disorders?
* FBC
* ESR
* B12/folate
* Renal function tests
* Liver function tests
* Thyroid function tests
* Calcium panel
* PTH
64
What is the Beck Depression Inventory?
A 21 item self-rated questionnaire measuring symptoms over the past 2 weeks
65
What is the aim of management for depressive disorders?
Achieve symptomatic remission of all signs and symptoms and restore psychosocial functioning
66
What is the first-line pharmacological treatment for depressive disorders?
SSRIs
67
What should be monitored closely when starting SSRIs?
Increased agitation and suicidal behavior, especially in those <25
68
How long does it typically take for SSRIs to achieve an effect?
4 to 6 weeks
69
What is the recommended duration for the stabilisation phase of treatment?
At least 6 months after the acute phase
70
What is the process for discontinuing antidepressants?
Gradually over a 4 week period to avoid withdrawal symptoms
71
What is a common side effect associated with all antidepressants?
Hyponatraemia
72
What percentage of patients will not respond to antidepressants due to complicated psychosocial factors?
33%
73
List some factors that make patients unsuitable to stop taking antidepressants.
* Family history of depression
* Past hospitalization for suicide or severe depression
* History of relapse after stopping
* Unresolved life stressors
74
What are the indications for Selective Serotonin Re-uptake Inhibitors (SSRIs)?
* Depressive disorders
* Anxiety
* OCD
* Bulimia nervosa
* Premature ejaculation
75
What are common side effects of SSRIs?
* Nausea
* Abdominal pain
* Diarrhea
* Constipation
* Tremors
* Agitation
* Insomnia
* Sexual dysfunction
76
What is the recommended starting dose titration for SSRIs?
Start with half dose for few days, titrated up every two weeks if well tolerated
77
Which SSRIs are contraindicated in breast cancer patients receiving tamoxifen?
Sertraline, paroxetine
78
What is the dosage range for Fluoxetine (Prozac)?
20mg to 60mg
79
What is the special indication for Duloxetine?
Chronic pain
80
True or False: Venlafaxine can cause dose-dependent hypertension.
True
81
What condition is Bupropion primarily indicated for?
Poor motivation, ADHD symptoms, Smoking cessation
82
What are contraindications for Tricyclic Antidepressants (TCAs)?
* Cardiac disease
* Epilepsy
* Severe liver disease
* Prostate hypertrophy
* Mania
83
What are potential side effects of Tricyclic Antidepressants?
* Anticholinergic effects
* Nausea/Vomiting
* Weight gain
* Sedation
* Sexual dysfunction
* Hyponatraemia
* Cardiac arrhythmias
84
What is the most potent anticholinergic effect TCA?
Amitriptyline
85
What is the primary indication for Electroconvulsive Therapy (ECT)?
Major depressive episode that is refractory to medication
Severely suicidal
Depression with severe motor sx - catatonia, agitated
86
List some contraindications for Electroconvulsive Therapy.
* Unstable/severe cardiovascular disease
* Space occupying lesions
* Recent CVA
* Severe pulmonary conditions
* ASA Class 4 or 5
87
What are common side effects of ECT?
* Headache
* Fatigue
* Increased falls
* Myalgias
* Memory impairment
88
What is the mechanism of action for Repetitive Transcranial Magnetic Stimulation (RTMS)?
Delivers magnetic pulse to stimulate nerve cells in the brain
89
True or False: RTMS requires general anesthesia.
False
90
What are the two phases of bipolar disorder?
Manic and depressive
91
What is the median age of onset for the first manic episode?
Mid-20s
92
What can trigger a manic episode in bipolar disorder?
Life events, high expressed emotions, sleep deprivation
93
What is the increased risk factor for children of parents with bipolar disorder?
9x increased risk
94
What neurotransmitter levels are increased in mania?
Noradrenaline, serotonin, dopamine, glutamate
95
What can precipitate a manic episode in predisposed patients?
Antidepressant monotherapy
96
What are some organic causes of mania?
- illicit substance use (meth, cannabis)
- CVA, head injury
- endocrine (thyrotoxicosis, cushing's)
97
What is the duration for a manic episode according to DSM V?
Persistent irritable/elevated mood for at least 1 week
98
List three symptoms of mania.
* Increased self-confidence
* Reduced need for sleep
* Racing thoughts (flight of ideas), chatty
* risky activities (dangerous driving, buying sprees, sexual indiscretion)
99
What distinguishes hypomania from mania?
Level of functioning is NOT markedly impaired
100
Define Bipolar I disorder.
Individual with at least 1 manic episode
101
Define Bipolar II disorder.
Individual with past/current hypomanic episode + past/current major depressive episode
102
What characterizes a mixed episode in bipolar disorder?
Both manic and depressive symptoms for at least one week
103
What is rapid cycling in bipolar disorder?
At least four episodes of mood disturbance in one year
104
What is the recommended treatment for severe manic symptoms?
Hospitalisation - pts with severe manic sx/serious risk
105
What medications are commonly used for acute mania?
* Mood stabilisers
* Antipsychotics
* Benzodiazepines
106
What medications should be avoided as monotherapy for acute bipolar depression?
Sodium valproate/carbamazepine
107
What non-pharmacological treatment can be effective for bipolar depression?
Psychotherapy (CBT)
108
What is a common mood stabiliser used for maintenance treatment?
Lithium
109
What are two antipsychotics used for maintenance in bipolar disorder?
* Aripiprazole
* Olanzapine
110
What should be considered for the treatment of pregnant women with bipolar disorder?
Switch to antipsychotics
## Footnote
Typical antipsychotics may be better as there are less metabolic complications
111
What fetal complication is associated with lithium use in the 2nd and 3rd trimester?
Ebstein’s abnormality
## Footnote
abnormal tricuspid valve + ASD
112
What fetal defect is associated with valproate in the first trimester?
Neural tube defects
113
What is the starting dose of Lithium?
400mg
## Footnote
Maximum dose is 1200mg
114
What are the monitoring requirements for Lithium?
• Lithium level every 3 months
• U/E/Cr every 6 months
• TFT every year
115
What is the first-line indication for Lithium?
Bipolar disorder
## Footnote
Also has some antidepressant and anti-manic effects
116
What are common side effects of Lithium?
• Metallic taste
• Nausea
• Polydipsia
• Polyuria
• Weight gain
• Fine tremor
117
What long-term side effects can Lithium cause?
• Hypothyroidism
• Renal failure
118
What is the starting dose of Sodium Valproate (Epilim)?
500mg
## Footnote
Maximum dose is 1300mg
119
What monitoring is required before starting Sodium Valproate?
LFT before starting
120
What is an indication for Sodium Valproate?
Can be combined with antipsychotics to treat mania
## Footnote
Can also be used for rapid cycling
121
What are the contraindications for Sodium Valproate?
* Liver disease
* AVOID in young women
## Footnote
can cause PCOS, decreased fertility, fetal malformations
122
What are common side effects of Sodium Valproate?
* Weight gain
PCOS
* Nausea
* Gastric irritation
* Hair loss
* Thrombocytopenia
123
What test is required before starting Carbamazepine?
HLA-B*1502
124
What is an indication for Lamotrigine?
Bipolar depression in bipolar I patients
125
What is a primary use for Topiramate?
Borderline personality disorder with mood swings
126
What are the symptoms of Lithium toxicity?
• Coarse tremor
• Vomiting
• Diarrhea
• Slurred speech
• Ataxia
• Confusion
• Death
127
What are common causes of Lithium toxicity?
• Drugs - thiazides, ACEI, NSAIDs
• Dehydration
128
What is the treatment for Lithium toxicity?
• Cessation of lithium
• Haemodialysis (serum levels > 3mmol/L)
129
How is Lithium cleared from the body?
By the kidney
130
What is General Anxiety Disorder (GAD)?
Sensation of persistent worry and apprehension about common day problems and events
## Footnote
Associated with autonomic arousal, chest symptoms, mental symptoms, general symptoms, and others.
131
List some symptoms associated with GAD.
* Autonomic arousal: palpitations, tachycardia, diaphoresis
* Chest: dyspnoea, chest pain, nausea
* Mental: giddiness, derealisation/depersonalisation, fear of losing control, fear of dying
* General: hot flushes, muscle tension/aches, restlessness, feelings of being keyed up/on edge, lump in throat
* Others: exaggerated response to minor symptoms, easily startled, persistent irritability, poor sleep, poor concentration
132
What are the diagnostic criteria for GAD according to DSM-V?
Excessive anxiety and worry for almost every day for at least 6 months, causing significant impairment in functioning, and associated with at least 3 symptoms
## Footnote
Symptoms include restlessness, easily tired, attention & concentration difficulties, feeling irritable, muscle tension, sleep difficulties.
133
What are some differential diagnoses for GAD?
* Panic disorder
* Phobia
* Mixed anxiety and depression
* Medical conditions: arrhythmia, IHD, asthma, COPD, hyperthyroidism, hypoglycemia, pheochromocytoma
* Medications: anti-HTN, antiarrhythmics, bronchodilators, anticholinergics, NSAIDs
134
What is the first-line pharmacological treatment for GAD?
SSRIs
## Footnote
Venlafaxine is used for GAD not responding to at least 2 types of intervention.
135
Describe the characteristics of Panic Disorder.
Episodic with sudden onset of intense fear and physical and mental symptoms
at least one panic attack + anticipatory anxiety and/or avoidance (at least 1 month)
## Footnote
Symptoms include autonomic arousal, chest symptoms, mental symptoms, and more.
136
What is a panic attack?
A sudden onset of intense fear with physical and mental symptoms
## Footnote
One panic attack does not equal panic disorder.
137
What is Agoraphobia?
Significant anxiety and fear in a crowd, enclosed/open spaces, using public transport
fears escape might be difficult or help may not be available
## Footnote
Affects functioning for at least 6 months and can occur with or without panic disorder.
138
What are some differential diagnoses for Panic Disorder?
* Social anxiety
* Substance use: caffeine, alcohol
* General medical conditions: hyperthyroidism, hypoglycemia, pheochromocytoma, arrhythmias
139
What is the management approach for Panic Disorder?
* Counsel patients about panic attacks being uncomfortable but not life-threatening
* Pharmacology: Antidepressants, benzodiazepines, CBT
140
Define obsessions in OCD.
Persistent, intrusive thoughts recognized as the patient's own, causing significant distress
## Footnote
Not excessive worries about real-life problems.
141
What are compulsions in OCD?
Repetitive behaviors aimed at reducing distress caused by obsessive thoughts
## Footnote
Examples include cleaning, checking, counting, ordering, and praying.
142
What is the non-pharmacological management for OCD?
CBT, specifically exposure and response prevention
## Footnote
This involves exposing the patient to obsession while preventing the compulsive response.
143
What is the pharmacological treatment for OCD?
* SSRIs: 2-3x higher dose for OCD than for depression
* TCA: Clomipramine when SSRIs are ineffective
144
What are OCD-spectrum disorders?
* Hoarding
* Body dysmorphic disorder
* Trichotillomania
145
What is Post-Traumatic Stress Disorder (PTSD)?
Prolonged response to a traumatic event such as abuse, serious RTA, diseases, violent crime, torture, terrorism
## Footnote
Symptoms usually develop within 6 months after the traumatic event.
146
What are the clinical features of PTSD?
RAHE
* Re-experiencing: flashbacks, nightmares
* Avoidance: avoiding reminders, loss of interest in normal activities
* Hyperarousal: irritability, poor concentration, exaggerated startle response
* Emotional numbing: detachment, lack of interest
147
What is the management approach for PTSD?
* Psychotherapy: CBT, exposure therapy, anxiety management, cognitive therapies
* Pharmacology: SSRIs
148
Differentials for PTSD
Acute stress reaction
adjustment disorder
