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4th Year > Psych notes > Flashcards

Psych notes Flashcards

1
Q

mannerism vs stereotype vs tic

A

both are repeated movements

mannerisms are goal directed (e.g. sweeping hair out of face)

stereotypes are not goal directed (e.g. flicking fingers in air)

tics are like stereotypes in that they are purposeless actions but in this case they are involuntary

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2
Q

what system do you use to describe the cause of any psych problem

A

predisposing factors
precipitating factors
perpetuating factors

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3
Q

What is the psych version of:

conservative, medical, surgical

A

Social
Psychological
Biological

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4
Q

definition of delusion

A

a fixed, false belief that is held despite rational evidence to the contrary. it cannot be explained by religious or cultural background.

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5
Q

what are the two main features of psychosis

A
  1. delusion

2. hallucination

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6
Q

peak onset of schizophrenia/psychosis

A

15-25 in males

25-35 in females

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7
Q

lifetime risk of schizophrenia/psychosis

A

1%

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8
Q

theory for cause of schizophrenia positive and negative symptoms

A 
\+ = excess dopamine in mesolithic tract
- = too little dopamine in mesocortical tract
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9
Q

classic ‘voices’ in schizophrenia

A

2+ discussing or arguing about the patient
running commentary
thought echo

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10
Q

what are the positive and negative symptoms of schizophrenia

A

positive = first rank

  • thought
  • delusional perception
  • auditory hallucination
  • somatic perception
  • passivity

negative

  • apathy
  • blunted affect
  • anhedonia
  • social withdrawal
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11
Q

what is the mechanism of typical and atypical antipsychotics

A

D2 receptor blockers

atypical also blocks 5HT (which is what helps take away prolactin and EPSEs)

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12
Q

name the most common typical and atypical antipsychotics

A

typical = chlorpromazine, haloperidol

atypical = the pines, the dones, 2 pips and a rip (clozapine is most common)

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13
Q

name the EPSEs

A

dystonia (hours)
akathisia (days)
parkinsonism (weeks)
tardive dyskinesia (months-years)

(remember hyperprolactinaemia as a SE of typical too)

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14
Q

main 2 SEs of clozapine

A

agranulocytosis

weight gain

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15
Q

what drug can be given to reduce the EPSEs

A

anticholinergic = procyclidine

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16
Q

monoamine hypothesis for depression

A

that there isn’t enough monoamine neurotransmitters that explains the Sx:

  • dopamine
  • noradrenaline
  • serotonin
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17
Q

what is depressive stupor

A

when the psychomotor slowing with depression is so severe that the person just stops

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18
Q

is st johns wort effective for depression

A

yes, it’s as effective as SSRIs! but affects drug metabolism way more

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19
Q

SE of antidepressants

A 
hyponatraemia
sexual dysfunction
lower seizure threshold
citalopram can cause long QTc 
suicidality in first 3wks SSRIs
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20
Q

monitoring SSRIs?

A

ECG
UEs
FBC

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21
Q

what is mirtazapine

A

a noradrenaline and specific serotonergic antidepressant (NASSA)

it is 3rd line

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22
Q

which are the two SNRIs

A

venlafaxine and duloxetine

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23
Q

problem with TCAs in overdose

A

cardiotoxicity

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24
Q

main danger with MAO

A

hypertensive crisis after eating foods rich in tyramine like cheese. they are also dangerous to combine with any other type of antidepressants and have to withdraw and wait to weeks.

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25
Q

Sx of serotonin syndrome

A 
sweating
tremor
confusion
restlessness
severe can be convulsions and death
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26
Q

how long do manic symptoms have to be around to call it mania

A

1 week (compared to 2 weeks of Sx for depression)

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27
Q

what is cyclothymic bipolar

A

subclinical depression + hypomania

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28
Q

type 1 vs type 2 bipolar

A

type 1 = mania + depression

type 2 = hypomania + depression

they often cycle so you have 2-3 episodes of each per year (>4 then its classed as rapid cycling BPAD)

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29
Q

5 investigations for mania

A
  1. collateral history
  2. examination
  3. FBC, TFT, CRP
  4. urine drug screen
  5. MRI/CT brain to rule out organic cause
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30
Q

what meds are used for bipolar in acute phase and to prevent another episode

A

acute = olanzapine

to prevent another = mood stabilisers
lithium
valproate
2nd line = carbamazepine

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31
Q

Main management point for acute phase of mania

A

STOP any antidepressants, steroids, DA agonists

GIVE olanzapine

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32
Q

what is the therapeutic window of lithium and at what point does toxicity start

A

0.6-1.0 mol/l = very narrow

toxicity starts at 1.2

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33
Q

Sx of lithium toxicity

A

coarse hand tremor + ataxia
D&V
polyuria/polydipsia (renal failure)
seizure, confusion, coma

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34
Q

common causes of lithium toxicity

A
  • drugs interfering with excretion (NSAIDs, diuretics, ACEi)
  • overdose
  • dehydration, D&V
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35
Q

how do you monitor someone on lithium

A

check lithium levels weekly until desired dose is achieved

must monitor U/Es and TFTs every 3 months as it can damage kidneys and cause hypothyroidism

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36
Q

men are ?x more likely to die from suicide

A

3-4

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37
Q

most common method of successful suicide

A

hanging (overdose is most common method of attempt, esp in women)

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38
Q

structure of suicide history

A

BEFORE
ACT
AFTER

PDFs

  • elicit RFs for ongoing risk to see whether they can go home
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39
Q

antidote for:
paracetamol
benzodiazepine
opioid

A

NAC
flumazenil
naloxone

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40
Q

when should you follow up an episode of self harm

A

if deemed safe to go home, follow up within a week

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41
Q

section 2

A

2 doctors can detain someone to assess then for up to 28d

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42
Q

section 3

A

2 doctors can detain someone for treatment for up to 6 months

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43
Q

section 5(2)

A

doctor can detain inpatient for MHA for up to 72 hours

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44
Q

section 5(4)

A

nurse can detain someone for assessment by a doctor for up to 6 hours

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45
Q

section 135

A

police can break into house and take them to a safe place

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46
Q

section 136

A

police can remove someone from public place and bring them to a safe place

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47
Q

section 17a

A

Community treatment order - can force an ex-inpatient to abide by a care coordinator’s treatment regime whilst in the community. If not readmit. This helps prevent readmission.

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48
Q

How to take an anxiety history

A 
Symptoms
Episodic or continuous
Drugs or alcohol
Avoidance
Timings trigger
Effect on life
Depression screen
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49
Q

what are the 3 anxiety conditions

A

GAD
PTSD
OCD
(also specific phobias e.g. agoraphobia is fear of masses of people)

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50
Q

how long must Sx be present to diagnose GAD

A

6m

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51
Q

difference between agoraphobia and social phobia

A

Agoraphobia hate massive crowds and open places

social phobia are ok in crowds but just don’t like small social groups where there is fear of being scrutinised

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52
Q

what triggers a panic in panic disorder

A

Nothing. Thats essential. If there is always one trigger (e..g crowds) then something like agoraphobia is more likely

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53
Q

what anxiety scale should we know

A

Beck anxiety inventory

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54
Q

prevalence of OCD

A

1%

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55
Q

word given for when a compulsion is resisted by patient

” when patient gives up to compulsion

A

egodystonic

egosyntonic

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56
Q

adjustment disorder vs PTSD

A

they are both reactions to adverse events. can involve dissociation, pseudohallucinations and strong mixed emotions

adjustment disorder = <1m
PTSD = >1m (but note that symptoms may not start for a couple months. usually starts within 6m)

57
Q

what region of the brain is hyperactive in PTSD

A

amygdala (emotion)

and hippocampus (memory) is atrophied

58
Q

is PTSD more common in men or women

A

women…

in an extreme trauma, 20% of women get PTSD compared to 8% of men

59
Q

symptoms of PTSD

A
  • re-experiencing (nightmares or flashbacks)
  • hyperarousal (inability to relax, enhanced startle reflex, insomnia, poor concentration, irritability)
  • avoidance
  • other (anhedonia, crying)
60
Q

SEs of benzos

A

IT IS A SEDATIVE!

sleepiness, unseatdiness, memory and concentration, agitation/aggression, addictive

61
Q

safety concerns with benzos

A

not more than 4 weeks

avoid alcohol –> rest depression

62
Q

addiction signs with benzos

A 
can't sleep
agitated
dizzy
blurred vision
confused, hallucinations, fits
63
Q

example of short and long acting benzo

A

short - lorazepam

long - diazepam

64
Q

what are the Z-drugs and what are they used for

A

short term treatment of insomnia

zopiclone, zolpidem, zalepon

65
Q

what is semantic memory

A

memory about things about the world e.g. paris is the capital of france

66
Q

What are the areas of cognition that you need to ask about in a delirium/dementia history

A 
Memory and learning
Attention
Personality
Language and speech
Executive function
Visuospatial perception
67
Q

investigations for ?dementia

A 
MMSE, MOCA
To rule out organic cause:
- FBC, U/E, LFT, TFT, glucose, B12/folate, calcium, syphilis
- CXR, cultures, MSU
- CT/MRI head if unsure
68
Q

Management of dementia

A

Conservative

  • PT/OT to help with mobility and self-care
  • Do they need carers?
  • psychological support e.g. reminiscence therapy
  • AChEi/memantine
  • antidepressants if co-existing
69
Q

What are the 4 A’s of Alzheimer’s presentation

A

Amnesia - recent memory problem
Agnosia - recognising things
Apraxia - doing skilled tasks
Aphasia - finding words for things

70
Q

progression/presentation of vascular dementia vs AD

A

stepwise with sudden onset due to infarcts in cortex from arteriolosclerosis being the cause

ALSO

there is relative preservations of personality and insight. instead, there is PATCHY COGNITION

71
Q

what is the picture with DLB

A

fluctuating confusion
Parkinsonism
Vivid visual hallucinations

72
Q

most affected area with DLB

A

circulate gyrus (the strip above the corpus callosum below the cortex)

73
Q

can you give antipsychotics to DLB

A

No, they have a sensitivity to them

74
Q

FTD presentation

A

changes in persoanlity, emotion, mood

later motor and expressive language deficits (Broca’s)

75
Q

most common type of FTD

A

Pick’s disease

76
Q

presentation of Huntington’s

A

Middle age prodrome = irritability, depression, incoordination

Later = chorea, dementia, fits/death

77
Q

what is HIV dementia

A

10% of patients with HIV get early dementia –> apathy and withdrawal with subcritical features such as tremor, ataxia, myoclonus

78
Q

triad for normal pressure hydrocephalus

A 
wet = incontinent
wobbly = ataxia
weird = confused/dementia
79
Q

definition of delirium

A

acute confusional state that affects all areas of cognition and is fluctuating in nature

80
Q

types of delerium

A

hyperactive
hypoactive (under diagnosed)
mixed

81
Q

causes of delirium

A

PINCHME - Pain, Infection, Nutrition, Constipation, Hydration/hypoxia/hypothermia, Medication (TCAs, anticholinergics), environment

82
Q

investigations for delirium

A

CT head for stroke

AND

full septic screen (incl. CXR/urine dip) and bloods

83
Q

first line sedative for delirium

A

haloperidol (or olanzapine)

beware benzos make delirium worse

84
Q

what is pseudodementia

A

the memory problems associated with severe depression. in contact to true dementia, onset is rapid (<1-2m) and answers are ‘i don’t know’ instead of trying and getting answer wrong in true dememtia. also pseudos struggle/fatigue with cognitive tasks.

85
Q

drug for bad sleep and depression in elderly

A

mirtazapine good sedative effect if sleep is a problem

86
Q

substance misuse history structure. example alcohol.

A

ASDM (for alcohol)

Alcohol use

  • now, before, future:
  • present use
  • past use/attempts to stop
  • desire about future use

Social effects
- self, work, friends, family, finances, police, driving

Dependence
- 6 criteria (compulsions, lack of control, tolerance, withdrawal, neglect, persistence)

Mood

  • screen for depression
  • assess risk

Rest of history

87
Q

what is operant conditioning

A

behaviours that are rewarded are repeated

88
Q

key dopaminergic pathway in addiction?

A

mesolimbic pathway

89
Q

current alcohol guidelines

A

14 units a week spread evenly over at least 3 days, with as least some alcohol free days

90
Q

alcohol abuse vs addiction

A

abuse = harm to persons work or social life

addiction = signs of addiction like compulsion, tolerance, withdrawal, narrowing of repertoire etc

91
Q

onset and duration of delirium tremens

A

48-72 hours into abstinence. lasts 3-4 days if not fatal

92
Q

Tx of delirium tremens

A

benzo (chlordiazepoxide or diazepam)

IM thiamine

93
Q

Wernicke’s syndrome cause

A

B1 deficiency

94
Q

Wernicke’s triad

A

confusion
ataxia
ophthalmoplegia

95
Q

what does wernickes progress to if left untreated

A

Korsakoff’s syndrome

96
Q

Korsakoff’s syndrome presentation

A

permanent anterograde amnesia - patient confabulates to fill gaps

97
Q

what is acampraste

A

an anti-craving drug used to prevent relapses in alcohol misuse

98
Q

what is antabuse a.k.a. disulfram

A

blocks an enzyme and mimics flush reaction making the consumption of alcohol unpleasant

99
Q

what receptor do opioids work on

A

mu opioid receptor (normally for endogenous endorphin hormone)

100
Q

withdrawal symptoms of opioids

A

opposite of effect itself (because you get a NA storm where its been suppressed for so long):

  • tachycardia
  • restlessness
  • dilated pupils
  • (and a flu like ache)
101
Q

how do you treat withdrawal of opioids

A

lofexifine (or clonidine), which is an alpha2 adrenergic agonist

102
Q

what can we use as substitute drugs for opioid abuse and why are they helpful

A

blocks euphoric effects of herion whilst preventing withdrawal Sx

  • methadone (long acting full agonist)
  • buprenorphine (partial agonist)
103
Q

how is methadone given and when is it weaned

A

daily OBSERVED drinking of the fluid. weaned after 12 weeks or so

compliance is measured using urinalysis

104
Q

management of acute opioid overdose

A

IM naloxone

105
Q

what is naltrexone

A

a long acting version of naloxone that is given IM and is sometimes used instead of methadone/buprenorphine (which are 1st line)

106
Q

how addictive are stimulants

A

not PHYSICALLY as addictvive as opioid or benzos

107
Q

relationship between psychosis and cannabis

A

early use can precipitate psychosis in the short term and schizophrenia in the long term

108
Q

what is somatisation

A

unconscious expression of psychological distress as physical symptoms

unconscious and unintentional

109
Q

what is hypochondriasis

A

worrying about a specific illness (often cancer). stuff like that must be going on for >6m

unconscious and unintentional

110
Q

factitious disorder

A

Munchausens = inventing Sx to get treatment because they like it

conscious and intentional

111
Q

malingering

A

inventing symptoms for financial or some other benefit (e.g. to sell on drugs)

conscious and intentional

112
Q

conversion disorder

A

following a stress or conflict, people genuinely believe that they can’t do something physical e.g. move, see, hear, remember

unconscious and unintentional

113
Q

SCOFF questionnaire

A

do you make yourself sick when you eat

have you lost control over your eating

have you lost more than one stone in weight recently

do you think you’re fat

does food dominate your life

114
Q

cutoff BMI for anorexia

A

<17.5

115
Q

Symptoms of anorexia

A

General

  • leathery
  • fatigue
  • cold
  • infections

GI

  • constipation
  • bloating/abdo pain

reproductive

  • amenorrhea
  • libido/impotence
116
Q 
red flags for anorexia --> admit straight away
BMI
weight loss rate
temp
BP
HR
Sats
ECG
A 
bmi <13
>1kg/week loss
T <34.5
BP <80/50
HR <40
Sats <92% or limbs blue and cold
purpura 
long QT and flat T (hypoK) on ECG
biochemical anomalies
117
Q

organic causes to rule out of weight loss

A 
hyperthyroidism
coeliac
IBD
Addison's
chronic infection
118
Q

investigations for anorexia OSCE ting

A 
blood test (TFT, coeliac screen, FBC, LFT, U/Es, albumin)
ECG
119
Q

3 scales of treatment plan based onseverity

A

mild = try 8 weeks of community based treatment

moderate = refer to eating disorders clinic now

severe = admit

120
Q

mortality with anorexia nervisa

A

5-10% (a lot is suicide)

121
Q

referring syndrome cause

A

during refeeding ,phosphate becomes low

122
Q

Sx of refeeding syndrome

A 
rhabdomyolysis
resp failure
cardiac failure
hypotension
seizures
123
Q

Mx of refeeding syndrome

A

stop refeeding and introduce food more slowly this time over 4-7 days, monitoring for phosphate. give additional thiamine and vitamin B

124
Q

key feature of bulimia

A

purging behaviour AND BMI>17.5

125
Q

purging behaviour in bulimia

A

vomiting
exercising
diuretics
laxative

126
Q

SSRIs in eating disorders?

A

in bulimia yes
in anorexia no

but CBT and therapy in both

127
Q

presentation of ADHD (with timeline cutoff)

A

IN 2 OR MORE SETTINGS FOR >6 months

  1. inattention
  2. hyperactivity
  3. impulsivity
128
Q

think of 6 questions for inattention and 6 for hyperactiivty

A

INATTENTION
o Fails to give close attention to detail or makes careless mistakes in schoolwork or other activities
o Difficulty sustaining attention in tasks or play activities
o Does not seem to listen when spoken to directly
o Does not follow through on instructions
o Difficulty organising tasks and activities
o Avoids, dislikes or is reluctant to engage in tasks that require sustained mental effort
o Loses things
o Distracted by extraneous stimuli o Forgetful in daily activities

HYPERACTIVITY
o Fidgets and squirms
o Leaves seat in classroom
o Runs about or climbs excessively
o Difficulty playing quietly
o ‘On the go’ or acts as if ‘driven by a motor’ o Talks excessively
o Blurts out answers
o Difficulty in waiting turn
o Interrupts or intrudes on others
129
Q

screening tool for ADHD

A

connors questionnaire

130
Q

investigations for ADHD

A
  1. conors
  2. parent interview
  3. school observation
131
Q

1st line Mx for ADHD

A

parent training/education programmes

+/- methyphenidate

132
Q

ASD triad

A
  1. social awkwardness
  2. repetitive behaviours
  3. SALT difficulty
133
Q

investigations for child with ?ASD

A

hearing test!

SALT assessment

134
Q

cutoff IQ for learning disability

A

<70

135
Q

causes of learning difficulty

A 
prenatal
- chromosomal, infection, intraventribular haemorrhage, alcohol abuse
perinatal
- stroke, HIE, infection, kernicterus 
postnatal
- meningitis, encephalitis, head injury
136
Q

6 factors for dependence (e.g. alcohol)

A
  1. compulsion to drink
  2. lack of control
  3. tolerance
  4. neglect of alternative pleasures
  5. withdrawal symptoms
  6. persistence despite negative impact

–> note that narrowing of repertoire is an extra one but isn’t part of the crucial 6 questions

137
Q

Clozapine monitoring

A

weekly for 18w
two-weekly for rest of year
monthly thereafter

138
Q

What can cause lithium toxicity (5)

A 
ACEi
dehydration
NSAIDs
diuretics (especially thiazide)
metronidazole

4th Year (10 decks)

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