psych high yield Flashcards
De Clerambault’s syndrome
presence of a delusion that a famous person is in love with them, with the absence of other psychotic symptoms as is the case
Capgras syndrome
delusion that a person closely related to the patient has been replaced by an impostor
De Frégoli syndrome
delusion of identifying a familiar person in various people they encounter
Othello syndrome
delusion of sexual infidelity on the part of a sexual partner
Ekbom syndrome
delusional parasitosis - describes the delusion of infestation
acute stress vs ptsd?
ptsd diagnosed can only be diagnosed after 4 weeks
somatisation vs hypochondriasis?
somatisation = persistent belief of multiple physical symptoms lasting for at least 2 years
hypochondriasis = persistent belief in the presence of a serious underlying disease (in this case, a brain tumour)
hypochondriasis is worrying about cancer (as they both contain the letter C and it is an example of a serious underlying disease) and somatisation disorder is worrying about multiple physical symptoms (as they both contain the letter S)
cluster A personality disorders:
wernicke’s encephalopathy triad and what causes it:
confusion, ataxia, opthalmoplegia
(also nystagmus)
associated with lesions in the mamillary bodies
caused by chronic B12 (thiamine) deficiency eg chronic alcoholism / malnutrition
what is korsakoff syndrome
complication of wernicke’s encephalopathy: anterograde & retrograde amnesia + confabulation
complication of SSRI in first trimester pregnancy?
small increased risk of congenital heart defects
poor prognostic factors for schizophrenia:
low iq
gradual onset
family history
lack of obvious precipitant
prodromal phase of social withdrawal
male
poor baseline
predominant negative symptoms
younger age of diagnosis
first line drug treatment ptsd:
venlafaxine (or ssri)
knights move vs flight of ideas:
knight’s move = illogical leaps from one idea to another, flight of ideas = discernible links between ideas
antipsychotic choice in hyperprolactinaemia?
aripiprazole
main side effects of clozapine?
agranulocytosis / neutropenia, lower seizure threshold
demographic most likely to commit suicide
men age 35-49
when to take blood test after lithium dose?
12 hours
risk of ssri use in third trimester pregnancy?
persistent pulmonary hypertension
first line treatment for acute stress reaction
CBT (acute stress = within 4 weeks of trauma)
side effects of ssris
GI upset
Anxiety and agitation
QT interval prolongation (especially associated with citalopram)
Sexual dysfunction
Hyponatraemia
Gastric Ulcer
management of lithium toxicity?
IV fluid therapy and alkalisation of the urine -> enhance excretion of the drug
benzos for agitation and seizures
haemodialysis if renal function is poor
features of cannabis intoxication:
drowsiness, impaired memory, slowed reflexes and motor skills, bloodshot eyes, increased appetite, dry mouth, increased heart rate, paranoia
features of opioid intoxication:
drowsiness, confusion, decreased respiratory rate, decreased heart rate, constricted pupils
features of lsd intoxication:
labile mood, hallucinations, increased blood pressure, increased heart rate, increased temperature, sweating, insomnia, dry mouth
what receptor does methamphetamine act on
TAAR-1
features of stimulant intoxication:
euphoria, increased blood pressure, increased heart rate, increased temperature
features of opioid withdrawal:
Agitation
Anxiety
Muscle aches or cramps
Chills
Runny eyes & nose
Sweating
Yawning
Insomnia
GIdisturbance such as abdominal cramps, nausea, diarrhoea and vomiting
Dilated pupils
‘Goose bump’ skin
Increased heart rate and blood pressure
Munchausen’s syndrome
intentionally fake signs and symptoms (e.g. adding blood to urine and complaining of pain) in order to gain attention and play “the patient role”
what is malingering
patients intentionally fake or induce illness for secondary gain; e.g. drug seeking, disability benefits, avoiding work or prison time
what is la belle indifference
an inappropriate lack of concern over the symptoms they are experiencing. For example, a patient who is suddenly unable to walk proclaims that it is not of any worry to them.
- associated with conversion disorder
what is conversion disorder
presentation of neurological symptoms without any underlying neurological cause (e.g. paralysis, pseudoseizures, sensory changes).
- not an intentional process, symptoms are very much “real” to the patient, linked to emotional stress
% risks of getting schizophrenia if following family members have it: first cousin, grandparent/uncle/nephew, parent/sibling, both parents/identical twin
2% risk with an affected first cousin
5% risk with an affected grandparent, aunt/uncle, niece/nephew
10% risk if either a parent or sibling is affected
50% if both parents are affected or an identical twin is affected
negative schizophrenia symptoms:
Alogia (poverty of speech)
Anhedonia (inability to derive pleasure)
Incongruity/blunting of affect
Avolition (poor motivation)
prognosis of schizophrenia?
25% never have another episode, 25% improve substantially on treatment, 25% have some improvement and 25% are resistant to treatment
rule of quarters
ddx for schizophrenia?
- substance induced psychotic disorder (commonly drugs of abuse, but can be iatrogenic e.g. steroids)
- organic psychosis caused by infection, brain injury and CNS diseases such as Wilson’s disease
- metabolic disorder such as hyperthyroidism and hyperparathyroidism
- dementia and depression can also co-occur with psychosis
what is russell’s sign
scarring of knuckles from repeated induced vomiting - linked to bulimia
physical features of bulimia?
parotid gland swelling, dental erosion, russells sign
what is pica
eating non-food items or food items in obscene quantities
what is mitmachen
motor symptom of schizophrenia where the patient’s limbs can be moved without resistance to any position but return to their original position once the limb is released
what is muddling
form of speech disruption seen in schizophrenic patients where both thought blocking (speaking about two completely unrelated concepts) and fusion (the fusing of two completely different concepts into one) occur at the same time
difference between bipolar I and bipolar II?
bipolar I will experience an episode of mania
bipolar II will experience a hypomanic episode
cotard delusion
patient believes they are dead or have had organs removed
charles bonnet syndrome
organic brain syndrome of the elderly associated with visual field defects
- cortical input from other areas (eg. memory association areas) closely involved with the occipital lobe are hypothesised to fill in for a visual deficit, producing a hallucinogenic effect
side effect of lithium in pregnancy?
Ebstein’s abnormality
- leaflets of the tricuspid valve are displaced, resulting in a large right atrium and a small right ventricle
fronto-temporal dementia (Pick’s disease):
cognitive impairment, personality change and disinbition
vasular dementia:
sudden onset cognitive decline and stepwise deterioration as a result of multiple infarcts (background of cardiovascular disease)
alzheimers:
chronic and progressive dementia
caused by a build up of amyloid protein deposits around brain cells and tau protein tangles within brain cells
lewy-body dementia:
abnormal protein deposits (Lewy Bodies) cause cognitive decline associated with parkinsonism (rigidity, tremor, bradykinesia)
side effects of sodium valproate:
vomiting, alopecia, liver toxicity, pancreatitis, pancytopenia, weight gain, oedema, anorexia and tremor
side effects of carbamezapine:
CARBAMEAN:
Confusion
Ataxia
Rashes
Blurred vision
Aplastic anaemia
Marrow (bone marrow) suppression
Eosinophilia
ADH release
Neutropenia
side effects of lithium:
hypothyroidism, nephrogenic diabetes, weight gain, diarrhoea, leukocytosis, poor concentration, drowsiness
ecg changes on refeeding syndrome:
prominent u waves, prolonged QT, ST depression
criteria for treating someone using MHA:
can only be used to treat mental health conditions
- must have a mental disorder
- must be a risk to their health/safety or the safety of others
- must be a treatment (however this can include nursing care, not just drugs)
what is dementia broadly speaking
impairment of intellect, memory and personality
causes of delirium:
DELIRIUMS:
D - Drugs and Alcohol (Anti-cholinergics, opiates, anti-convulsants, recreational)
E - Eyes, ears and emotional
L - Low Output state (MI, ARDS, PE, CHF, COPD)
I - Infection
R - Retention (of urine or stool)
I - Ictal
U - Under-hydration/Under-nutrition
M - Metabolic (Electrolyte imbalance, thyroid, wernickes
(S) - Subdural, Sleep deprivation
features of lithium toxicity:
GI symptoms -> neurological features of ataxia, tremor, confusion and nystagmus
often precipitated by dehydration / illness
