Psych conditions Flashcards
1
Q
Causes of cognitive decline
A
Dementia Depression Wilson's Disease Hypothyroidism Alcoholic dementia Brain injury
2
Q
Alzheimer’s presentation
A
Struggle to remember recent events
Gradual deterioration in global cognitive function - memory loss goes back in time
Amyloid plaques and tau protein
3
Q
Life expectancy for Alzheimer’s
A
7 years after diagnosis
4
Q
Treatment for Alzheimer’s
A
Donepezil (acetylcholinesterase inhibitor)
Memantine (NMDA receptor antagonist)
5
Q
Presentation of vascular dementia
A
Stepwise progression in memory loss, previous stroke, difficulty in concentration, seizures, speech disturbance
6
Q
Treatment for vascular dementia
A
Treat risk factors e.g. hypertension, AF. Only use AChE inhibitors if have co-existing Alzheimer’s
7
Q
Lewy body dementia presentation
A
Progressive cognitive impairment, early attention impairment, fluctuating cognition, visual hallucinations, parkinsonism
8
Q
Treatment of Lewy body dementia
A
Acetylcholinesterase inhibitors (donepezil, rivastigime) and memantine (NDMA inhibitor) can be used.
9
Q
What medication should be avoided in Lewy body dementia
A
Antipsychotics can lead to irreversible parkisonism.
10
Q
What are features of frontotemporal dementia (Pick’s disease)
A
Onset before 65 Insidious onset Relatively preserved memory Personality change and social conduct problems Disinhibition Increased appetite
11
Q
Management of frontotemporal dementia
A
AChE inhibitors (donepezil) or memantine
12
Q
What are some rarer causes of dementia
A
Huntington's CJD HIV B12 deficiency Syphilis
13
Q
Treatment for anxiety
A
Cognitive behavioural therapy, phobias - systematic desensitisation
SSRIs (sertraline)
AVOID BENZODIAZEPINES
may use proranolol etc to treat tremor
14
Q
Treatment for OCD
A
CBT, clomipramine (tricyclic antidepressant) or SSRIs
15
Q
Core depression symptoms
A
- Persistent sadness or low mood
- Loss of interest/pleasure
- Fatigue or low energy
16
Q
Diagnostic criteria for depression
A
At least 1 core symptom most days, most of the time for at least 2 weeks
17
Q
Associated depression symptoms
A
Disturbed sleeo Poor concentrtion or indecisiveness Low self-confidence Poor or increased appetite Suicidal thoughts Agitation or slowing of movements Guilt or self-blame
18
Q
What would be classed as mild depression
A
Four symptoms (at least one core symptom)
19
Q
What is moderate depression
A
Five to six symptoms
20
Q
What is severe depression
A
Seven or more symptoms +/- psychotic symptoms
21
Q
Two questionnaires to screen for depression
A
Hospital Anxiety and depression scale
PHQ-9
22
Q
Depression treatment
A
CBT, sleep hygiene, SSRI, TCA
23
Q
Examples of SSRI
A
Sertraline, citalopram, fluoxetine, paroxetine
24
Q
General side effects of SSRIs
A
GI symptomas, agitation, hyponatraemia
25
Side effects specific to citalopram
Prolonged QT interval, don't use in those with long QT syndrome
26
Which SSRI would be used post myocardial infarction
Sertraline
27
Which SSRI would be used in children
Fluoxetine
28
How should an SSRI be stopped
Dose gradually reduced over a 4 week period (not fluoxetine)
29
SSRI discontinuation symptoms
```
Increased mood change
Restlessness
Difficulty sleeping
Unsteadiness
Sweating
GI symptoms
Paraesthesia
```
30
SSRIs and pregnancy
Weigh up risks and benefits. Small increased risk of congenital heart defects in first trimester.
Can cause persistent pulmonary hypertension of newborn in third trimester.
31
Examples of SNRIs
Venlafaxine, duloxetine, mirtazapine
32
Examples of tricyclic antidepressants
Amitriptyline, clomipramine, imipramine
33
Side effects of tricylclic antidepressants
Drowsiness
Dry mouth
Blurred vision
Constipation
34
Difference between manic episode and bipolar disorder
Two manic episodes = bipolar disorder
35
What is mania
```
7 DAYS OR MORE
Elated/irritable mood
Overactive, increased energy, reduced need for sleep
Poor concentration
Pressured speech
Grandiose, overconfident
Socially/sexually dis inhibited
Psychotic symptoms (grandiose delusions, delusions of reference, auditory hallucinations)
```
36
What is hypomania
```
4 DAYS OR MORE
Elated, overactive, social/sexual disinhibition, poor sleep
Continues to function
Partial insight retained
NO PSYCHOTIC SYMPTOMS
```
37
Management of acute mania
Atypical antipsychotics (quetiapine, olanzapine)
Sodium valproate
Benzodiazepines
Urgent referral to CMHT
38
Long term mood stabilisation for bipolar
Lithium, sodium valproate, carbamazepine
Atypical antipsychotics - quetiapine, olanzapine
For depressive episodes - fluoxetine (must stop in mania)
39
Side effects of lithium
```
Nausea/vomiting
Fine tremor
Nephrotoxicity, polyuria
Thyroid enlargement/hypothyroidism
T wave flattening
Weight gain
Idiopathic intracranial hypertension
Leucocytosis
```
40
How is lithium monitored
12 hours post dose.
After starting chek weekly and then every three months once stabled.
Thyroid and renal functioned check 6 monthly
41
What can precipitate lithium toxicity
Dehydration
Renal failure
Diuretics, NSAIDs, metronidazole
42
Features of lithium toxicity
```
Coarse tremor
Hyperreflexia
Acute confusion
Polyuria
Seizure
Coma
```
43
How is lithium toxicity managed
Fluid resuscitation, haemodialysis if severe
44
Risk factors for completed suicide
Male, young, divorced, mental illness, chronic illness, substance misuse, previous attempt, note, attempts to not be found, violent methods
45
What is the physiological cause of psychosis
Excess dopamine in the mesolimbic pathyway
46
What are the first rank symptoms in schizophrenia
Auditory hallucinations, somatic hallucinations, thought withdrawal, thought insertion, thought broadcasting, delusional perceptions, passivity
47
What are the positive symptoms of schizophrenia
Hallucinations, delusions, passivity phenomena, thought alienation, lack of insight, disturbance in mood
48
What are the negative symptoms of schizophrenia
Blunting of affect, amotivation, poverty of speech, poverty of thought, deterioration in functioning, lack of insight
49
Other features of schizophrenia
Incongruity/blunting of affect, neologisms, catatonia
50
What is catatonia
Adopts strange poses (rigid) and inability to speak. Waxy flexibility (maintain position after being placed in it)
51
Typical antipsychotics
Haloperidol, chlorpromazine
| Commonly cause parkinsonian side effects
52
Atypical antipsychotics
Olanzepine, quetiapine, risperidone, clozapine
| Less likely to cause parkinsonism but cause metabolic side effects like weight gain
53
What is clozapine
Atypical antipsychotic, ONLY used for treatment resistant.
Risk of fatal agranulocytosis
Reduced seizure threshold
54
What is neuroleptic malignant syndrome
Rare condition seen in patients taking antipsychotics. May also occur with dopaminargic drugs such as levodopa (usually when stopped or reduced in dose).
Occurs within days of staring antipsychotic
55
Features of neuroleptic malignant syndrome
```
Pyrexia
Muscle rigidity
hypertension, tachycardia
Delirium with confusion
raised creatinine - rhabdomyolysis causing AKI
```
56
What are some extrapyramidal side effects of antipsychotics
Akathisia, dyskinesia, dystonia
57
What are some cautions on the use of antipsychotics in the elderly
Increased risk of stroke and VTE
58
What is Akathisia
Feeling of restlessnness and the inability to sit still. Usually legs are most affected.
59
Treatment of akathisia
Remove cause e.g. antipsychotic.
Dopamine agonists - pramipexole, ropinirole
Benzodiazepines
60
What is dyskinesia
Involuntary muscle movements similar to tics or tremor. Includes abnormal face and lip movements e.g. lip smacking and pouting
61
What is tardive dyskinesia
Chronic dyskinesia due to long term antipsychotic treatment e.g. haloperidol
62
What is dystonia
Repetitive muscle contractions result in twisting of limbs or abnormal fixed postures
63
What is cyclothymia
Rapid cycling between depressive and hypomanic states
64
What is thought echo
A patient hears aloud their thoughts shortly after thinking them
65
What is loosening of association
Speech that is fragmented jumping from one topic to the next unrelated idea
66
What is circumstantiality
Patient talks a lot and goes of topic before coming to answer
67
What is perseveration
Repetition of same response regardless of question
68
What is confabulation
Fabricated memories
69
What is psychomotor retardation
Slowed speech, movement and impaired cognitive functioning
70
What is thought disorder
Disruption in the structure of thought, disordganised speech. Includes pressure of speech, poverty of speech, thought blocking
71
What is flattening of affect
No expression or emotion
72
What is blunting of affect
Reduced expression or emotion
73
What is incongruity of affect
Wrong emotion for situation
74
What is Belle indifference
Associated with conversion disorder, they are not bothered by paralysis
75
What is depersonalisation
Feel outside their body
76
What is derealisation
Surroundings dont feel real
77
What are some classes of hypnotics
Benzodiazepines, Z-drugs, antihistamines, clomethiazole, melatonin, barbiturates
78
Name benzos used for hypnotics
Nitrazepam, may have residual effects the following day, GABA agonists
79
Name Z-drug hypnotics
Zoiclone, zolpidem tartrate, act on benzodiazepine receptor, GABA agonists
80
What are barbiturates
Severe insomnia, avoided in elderly. Phenobarbital. GABA agonist
81
What is dialectic behavioural therapy
Type of talking therapy for those who feel emotions very strongly (EUPD)
82
What is psychoanalytic psychotherapy
Classic psychiatry - talks about whats on your mind and the unconscious feelings behind it
83
Treatment of catatonia
Benzodiazepines
84
What can precipitate seortonin syndrome
SSRIs, TCAs, SNRI, MAOI, MDMA, St. John's wort. Change in dose
85
Symptoms of serotonin syndrome
Three categories - neuromuscular hyperactivity (tremor, hyperreflexia, clonus) autonomic dysfunction (tachy cardia, hypertension, hyperthermia, diarrhoea) altered mental state (confusion, agitation, mania)
86
Treatment of serotonin syndrome
Benzodiazepines, cyproheptadine (blocks serotonin production) IV fluids. Medicine withdrawal
87
Treatment of neuroleptic malignant syndrome
Bromocriptine mesylate - a dopamine agonist
88
When can you restrain a patient
If they are putting themselves or others at risk, if restraining them is proportionate to risk, and if you have tried the least restrictive option first
89
What is the most important thing about restraint and de-escalation
LEAST RESTRICTIVE OPTION FIRST
90
Process of rapid tranquilisation
IM lorazepam or haloperidol combined with IM promethazine (antihistamine)
91
Stats of delirium
```
30% of elderly patients admitted to hospital
>65
background of dementia
frailty or multimorbidity
polypharmacy
```
92
Precipitating events for delirium
```
Infection - UTI
Hypercalcaemia/hypoglycaemia/dehydration/other metabolic causes
Change of environment
Severe pain
Alcohol withdrawal
Constiption
```
93
Features of delirium
```
Memory disturbance (short term)
Agitated/withdrawn
Disorientation
Mood change
Visual hallucinations
Disturbed sleep cycle
Poor attention
```
94
Management of delirium
Treat underlying cause, modify environment.
| Haloperidol first line sedative
95
Types of delirium
Hypoactive (most common)
Hyperactive (most recognised)
Mixed
96
Anorexia criteria
BMI below 18.5 (this may now be excluded)
1. Restriction of energy intake to lose weight
2. Intense fear or gaining weight even though underweight
3. Disturbance in perception of body
97
Symptoms of anorexia
Low BMI, rapid weight loss, dieting that worries family, social withdrawal, disproportionate concern about weight, menstrual changes, dizziness, palpitations
98
Treatment for anorexia
Family therapy <18, CBT. Fluoxetine
99
Signs of anorexia
Bradycardia, hypoension, enlarged salivary glands, hypokalaemia, low FSH, LH, impaired glucose tolerance, low T3
100
Bulimia criteria
Recurrent episodes of binge eating with a sense of lack of control
Compensatory purging (laxative, fasting, exercise, vomiting)
Distorted view of body image
101
Treatment for bulimia
Family therapy <18, CBT, fluoxetine
102
what is anankastic personality disorder
another name for OCD
103
What is phenelzine
Monoamine oxidase inhibitor. Avoid in ECT therapy, avoid tyramine rich food (cheese, salami, marmite) as can cause life-threatening hypertensive crisis
104
What would be used as a mood stabiliser second line to lithium in bipolar
sodium valproate
105
what is the treatment for delirium tremens
pabrinex+high dose benzo
106
which vitamin is thiamine
B1
107
Name the 5 ICD-10 criteria for delirium
```
impairment of consciousness
global disturbance in cognition
psychomotor disturbance
disturbance of sleep-wake cycle
emotional disturbances
```
108
name some ICD10 criteria for agoraphobia
```
fear of:
crowds
public spaces
travelling alone
travelling away from home
+ 1 symptom of autonomic arousal
```
109
What blood results would you find in neuroleptic malignant syndrome
```
raised creatinine kinase
raised WCC
deranged LFTs
acute renal failure
metabolic acidosis
```
110
Which drug can treat and prevent extra-pyramidal side effects of antipsychotics
procyclidine (anti-cholinergic)
111
What can be used to reverse the sedative effects of benzos
flumazenil
112
What is the first-line treatmet for PTSD
Trauma-focused CBT, EMDR is used more specifically
113
What is knights move thinking
Anther term for loosening of association!
114
How long should an SSRI be triad for in OCD
12 weeks
115
Name some drugs that are known to induce delerium
Furosemide
oxybutinin
propranolol
ranitidine
116
When do you do blood tests for clozapine
once a week for 18 weeks then fortnightly for a year, then monthly
117
symptoms of GAD
```
excessive worry
distress and functional impairment
restlessness
easily fatigued
poor concentration
irritability
muscle tension
trembling
sweating
dry mouth
palpitations
dizziness
```
118
mnemonic for remembering delirium triggers
```
Pain
Infection
Nutrition
Constipation
Hydration
Medications
Electrolyte disturbance
```
119
how is acetlycysteine infusion fiven
within eight hours of ingestion if levels are above the treatment line.
Given in three infusions, the first over an hour
120
when can activated charcoal be given for overdose
within one hour of ingestion
121
what can be used other than chlorodiazepoxide for alcohol withdrawal
lorezepam - remember its just a fancy name for a benzo
122
first line management for borderline personality disorder
dialectical behavioural therapy
123
withdrawal symptoms within 24 hours of high cocaine use
```
anxiety
increased hunger
fatigue
irritability
lack of motivation
```
124
Which antidepressants have the strongest association with hyponatraemia
SSRIs,
| consider hyponatraemia in those presenting with drowsiness, confusion and convulaions
125
What can be used as an alcohol deterrent
disulfiram - causes diaphoresis, palpitation, flushing, nausea and headache if alcohol is ingested
126
why would morphine, oxycodone and oxybutinin cause delirium
all cause constipation
127
what blood tests should be monitored on lithium
TFT, U&Es, eGFR
128
what tests should be done to exclude an organic cause for anxiety
24-hour urine metanephrines (phaeochromocytoma) (causes panick attacks due to high adrenaline)
ECG
FBC + iron
TFTs
129
what is lillliputain
seeing lots of small people - typically seen in selirium tremens
130
what combination of drugs is most likely to cause serotonin syndrome
SSRI + MAOI
131
mechanism of disulfiram
nuild up of acetaldehyde to cause flushing and headache on consumption of alcohol
132
side effects of mirtazapine
SNRI, drowsiness, weight gain
133
absolute contraindication for ECT
raised ICP (only absolute)
134
poor prognostic factors for schizophrenia
gradual onset, low IQ, family history, premorbid social withdrawal, no obvious precipitant
135
examples of drugs that can induce psychosis
```
anti malarial
bromocriptine
levodopa
steroids
alcohol
cocaine
amphetamine
MDMA
ket
```
136
which tool is used to screen for post natal depression
Edinburgh scale
137
methylphenidate drug reacctions
carbamazepine
isocarboxazid (MAOI)
linezolid (antibiotic)
risperidone (atypical antipsychotic)
