psych cards Flashcards
ED screening questionnaire?
SCOFF
sick, controll, one, fat, full. 2+ = ED
Shizophrenia 1st rank?
positive
negative sx?
1st rank: thought insertion/ withdrawal/ echo/broadcasting
delusions of control/ passivity/ delusions of perseption, auditory hallucinations talking about person in 3rd perosn
positive:hallucinations, disrupted speech, delusions
negativie: social withdrawal, self neglect, flat affect, demotivation
Munchausen vs malingering?
somatisation vs hypochondria?
conversion disorder?
dissociation disorder?
munhausen - for attention, malingering - for external gain,
somatisation - multiple sx, conscious, no gain, hypochondria - belief that there is serious underlying condition. both refuse to accept reassurance or negative result
conversion: loss of sensory/ motor function result of psychological conflict. not conscious. keep conflict internal
dissociation - involves psychiatric sx eg amnesia, depersonalisation
CAGE qs?
cut down, annoyed, guilty, eye opener (first thing in day)
Medical emergency ED red flag?
WL 1kg/ week for 2weeks, BMI <14/ <70 in <18YO, dehydrated, U+Es altered, daily self harm/ laxitive abuse, <30.5kg (M), <17.5 (F), QTC 450+ )F/430+M. BP postural sx SBP 20 drop.
BPD, increased reflexes, ataxia, tremour, flat t waves,
lithium
mild sx: GCS low, diarrhoea, low co-ordination, muscle weak at Li <2
severe: T wave flat, ataxia, tinnitus, blurred vision, large UO dilute at levels 3+
normal: 0.5-1.2 perform 12 hrs after dose. 5 days after started tx
aripiprazole tox?
lethargy, HTN, N+V, tachycardia, somnolence,diarrhoea
vaporate toxicity?
low Ca, Low BM, high Na, lactic acidosis , tahcycardia, hypotension,
CI lithium therapy?
renal imp, cardiac, untreated hypothyroid, addisions with low Na
pregnancy - CI 1st, only use with nec with 2nd and 3rd
risk renal/ low Na with acei, diruetics (thiazides), SSRI, NSAID
Monitoring lithium therapy?
levels 5 days after starting, then weekly until stable then 3 monthly and during any illness.
TFTs, U+Es, urine dip, Ca, creatiine (6 monthsly and initial)check goitre, ECg, weight pulse, BP
common lithium SE?
metallic taste, thirst, polyuria, weight gain, oedema, abdo pain, nausea,
less commonL hypothyroid, diabetes insipidus (nephro), high PTH, high Ca, acne, cognitive impairment, high MG,m
monitoring clozapine?
tx resistant shizophrenia.
weekly FBC for 18 weeks then fortnightly 34 weeks then monthly. risk reduces the longer the therapy
8YO boy staring into space/ daydreaming?
abscent seizurr
60YO F, derranged LFTs, acutely confused, ataxic gait, B/Lhorizontal nystagmus. CTH petechial haemorrhages
Glucose infusion with chronic thiamine deficiency precipitating wernickes
Features of borderline personality disorder?
emotional instability, intense and unstable relationships, impulsive behaviour, disturbed patterns of thinking/perception
risk of suicide?
most concerning intent?
male, self harm, physical health issues, express suicidal intent
most concerning: detailed planning of event
3 month HX low mood, suicide, hallucinating dead mother, 21YO
depression.
bereavement usually within 2-3 weeks. psychotic sx unlikely in uncomplicated bereavement
Breastfeeding safe SSRI?
paroxitine/ sertraline
When is mirtazipine/ trazadone/ reboxetine best to start in depression with chronic illness?
if patient is on NSAID/ warfarin/ aspirin, triptans, ci: selegiline/ rasagiline (MAO-B),
best antidepressant for patient on anti-epileptics?
Sertraline
What can you not prescribe with amoxetine?
SSRIs: fluoxetine, peroxetine, citalopram, escitalopram
antidepressent for patient taking clozapine/ methadone/theophylline?
sertraline
antidepressents with dedating effects?
mirtazipine, trazadone, lofepramine
antidepressent discontinuation sx?
dizzy, nausea, anxiety, diarrhoea, flu sx, headache, diarrhoea
SNRI names and risk?
venlafaxine- CI arrythmias, HTN, recent MI. likely discontinuation sx
duloxetine- CI HTNhepatic/ renal impariemnt
SSRI - names and risks?
weight gain?
torsade?
best for HF/ MI?
other SE?
paroxetine - WG, high disontnuation sx
Citalopram/ escitalopram - QT
Sertraline - good for MI/HF, risks hepatic impairment
SE: bleeding, ED, SIADH, GI, headaches, anxiety/suicide
CI: mania, poorly controlled epilepsy
Which anti-depressents class give anti cholinergic sx and bad for bundle branch block/ heart issues?
TCAs - amitryptiline/ nortryptiline
SE: dry mouth, urine retention, blurred vision, cognitive impairement, constipation
antidepressent better for erectile dysfunction/ elderly?
mirtazipine - sedation, weight gain, increased appetite (CI MAOi)
19YO lively, flirty, enthusiastic, inappropriate sexually provocative, influenced by others?
histrionic
detatched, cold, indifferent to praise, social norms, little pleasure in activities, limited capacity to express emotions, lack of sexual desire
shizoid
surgeon who dedicates life to distract herself from inadequate family?
compensation - cope with inferiority
stressed GP, acts out at home is aggressive?
displacement - redirects negative emotion to less threatening opponent
Med student drinking like rugby player?
identification - make themselves like someone else
Well dressed presented to ED 1000miles from home with amnesia?
dissociative fugue
newly started risperidone, has lower limb restlessness but able to sleep fine?
akasthisia.
restless legs - effects sleep
belief that famous person is in love with you?
de clerambault’s
belief that familiar person is identified in strangers?
fregoli
shizophrenia negative sx?
lack of motivation, oncongruity, blunting affect, depresison, povert of speech,h
shizophrenia positive sx?
thought disorder, delusions, auditory hallucinations
TCAS less sedative?
lofepramine, imipramind, nortypriptiline
amitryptiline type of incontinence?
overflow incontinent
paresis of left leg. asked patient to SLR right leg. pressure under heel of left leg felt?
hoover’s sign. positive in conversion disorder (non organic cx of leg paresis)
most things in anorexia low except Gs and Cx?
G’s and C’s raised: growth hormone, glucose, salivary glands, cortisol, cholesterol, carotinaemia
Extra pyramidal SE? extra potato?
Extra pyramidal effects - Parkinsonism, Oculogyric crisis, TArdive dyskinesia,TOrticollis (dystonia),
short term low mood and stress began in response to a clear external stressor (job loss)
adjustment disorder
delusional disorder?
fixed, false belief (being spied on by his neighbours) that persists despite a lack of evidence. The belief is non-bizarre, meaning it could happen in reality, but there is no substantial evidence, and the patient’s overall functioning is relatively intact
How do benzos and barbiturates work?
Frequently Bend - During Barbeque
Benzos increased frequency of chloride ion channels, icnrease GABA effect.
barbiturates increase duration of chloride channels
Poor prognosis factors for shizophrenia?
strong family history
gradual onset
low IQ
prodromal phase of social withdrawal
lack of obvious precipitant
tx for severe depression, life threatening with catatonia?
ECT
Alcohol withdrawal - time to reach sx/ seizures/ delerium tremens?
sx - 6-12 hrs
seziures 36 hrs
delerium tremens 72 hrs
difference between OCD and OCPD?
OCD - intrusive thoughts and unwanted behaviours
OCPD - rational and desirable thoughts
TX GAD drugs?
sertraline, then alternate SSRI/ SNRI then pregablin. if no response for 12 weeks, try imipramine/ chloropramine
wandering from a topic without returning to it.
tangetiality
new word formations, which might include the combining of two words
neologisms
ideas are related to each other only by the fact they sound similar or rhyme.
clang associations
loosening of associations, where there are unexpected and illogical leaps from one idea to another. It is a feature of schizophrenia.
knight’s move associations
leaps from one topic to another but with discernible links between them.
flight of ideas
repetition of ideas or words despite an attempt to change the topic
perservation
