Psych passmed Flashcards
1
Q
What are the 3 clusters of personality disorders?
A
- Cluster A: odd and eccentric
- Cluster B: Dramatic, Emotional, or Erratic
- Cluster C: Anxious and Fearful
2
Q
What symptoms fit into cluster A?
A
- Paranoid
- Schizoid e.g lack of interest in activities or others + hypersensitive/unforgiving
- Schizotypical e.g. odd perceptions and ideas of reference
3
Q
What symptoms fit into cluster B?
A
- Antisocial
- Borderline (Emotionally Unstable)
- Histrionic e.g using sexual behaviours and attention seeking
- Narcissistic
4
Q
What symptoms fit into cluster C?
A
- Obsessive-Compulsive
- Avoidant
- Dependent
5
Q
What is the difference between a schizoid and schizotypical personality disorder?
A
schizoid: usually does not care about their condition or taking steps to improve their life.
schizotypal: will likely feel a great deal of depression and anxiety as they struggle with relationships and discomfort in social situations
6
Q
What is the treatment for OCD?
A
Exposure and response therapy
If functional impairment: add SSRI or TCA
7
Q
What is the chosen SSRI for body dysmorphic disorder?
A
Fluoxetine
8
Q
What is the treatment for PTSD?
A
- Trauma-docused CBT (at least 1 month)
- Eye movement desensitisation and reprocessing/CBT (1-3 months + non-combative)
- Venalfaxine or SSRI
9
Q
How do you differentiate between PTSD and acute stress disorder?
A
Acute stress disorder is < 4 weeks after event
10
Q
What is cotard syndrome?
A
person believing they are dead or non-existent - associated with severe depression
11
Q
What is capgras syndrome?
A
patients believe that a relative or friend has been replaced by an identical impostor - associated with schizophrenia
12
Q
What is charles bonnet syndrome?
A
patients with significant vision loss have vivid, often recurrent visual hallucinations - have insight (RF; peipheral vision loss, increasing age, social isolation)
13
Q
What is De Clérambault syndrome?
A
patients believe another individual is infatuated with them, often despite the individual being imaginary, deceased or someone the patient has never met
14
Q
What are the physiological abnormalities associated with anorexia?
A
most things low
G’s and C’s raised: growth hormone, glucose, salivary glands, cortisol, cholesterol, carotinaemia
15
Q
What medication should be avoid with SSRIs due to serotonin syndrome?
A
Triptans
16
Q
Why should citalopram/haloperidol be avoided in elderly population?
A
increased QT interval + torsades de pointe
17
Q
How do you differentiate between OCD and psychosis?
A
Level of insight
18
Q
What side-effect is more common with typical antipsychotics compared to atypical?
A
- Acute dystonic reactions e.g torticollis, opisthotonus, dysarthria and oculogyric crises
These fall under ESPEs - Hyperprolactinemia,
19
Q
What is a more common side effect in atypical antipsychotics compared to typical?
A
Metabolic effects e.g diabetes, weight gain, hyperlipidemia, hypercholesterolemia. hyperglycaemia
20
Q
What are examples of ESPEs?
A
- Parkinsonism
- acute dystonia (sustained muscle contraction (e.g. torticollis, oculogyric crisis)
- akathisia (severe restlessness)
- tardive dyskinesia (late onset of choreoathetoid movements, abnormal, involuntary, may occur in 40% of patients, may be irreversible, most common is chewing and pouting of jaw)
21
Q
What is acute dystonia, akathisia and Parkinsonism managed with?
A
Procyclidine - antichollingeric
22
Q
How do anticholingerics work?
A
block and inhibit the activity of the neurotransmitter acetylcholine (ACh) at both central and peripheral nervous system synapses.
23
Q
How do you differentiate between flight of ideas in bipolar vs schizohphrenia?
A
Bipolar: links between topics
Schizo: no links (Knights move/looseness of association)
24
Q
What does circumstantiality mean?
A
inability to answer a question without giving excessive, unnecessary detail. However, this differs from tangentiality in that the person does eventually return to the original point.
25
When is ECT indicated?
life-threatening major depressive disorder, where catatonia in present
26
When is ECT contraindicated?
Raised ICP
27
How long should you take antideprassants to prevent relapse?
6 months after remission (for 2+ depressive episodes 2 years)
28
What can use of antidepressants in pregnancy cause?
1. first trimester gives a small increased risk of congenital heart defects
2. third trimester can result in persistent pulmonary hypertension of the newborn
3. Paroxetine has an increased risk of congenital malformations, particularly in the first trimester
29
What are the symptoms of chronic insomnia?
1. >3 months + 3+ days a week
30
What medications can be used for acute insomnia?
short-acting benzodiazepines or non-benzodiazepines (zopiclone, zolpidem and zaleplon).
Diazepam is not recommended but can be useful if the insomnia is linked to daytime anxie
31
What are the 2 types of bipolar disorder?
type I disorder: mania and depression (most common)
type II disorder: hypomania and depression
32
How do you differentiate between mania and hypomania?
Mania has psychotic symptoms
33
What are the symptoms of neuroepileptic malignant syndrome?
1. muscular rigidity
2. fever
3. altered mental status
4. autonomic dysfunction (such as tachycardia and hypertension)
5. occurs within a couple of months of starting an antipsychotic.
Mnemonic: FEVER
Fever, Encephalopathy, Vitals unstable, Elevated enzymes, Rigidity of muscles
34
What should also be prescribed if a patient is taking an SSRI and NSAID (e.g mefenamic acid)
PPI
35
What drug class is mirtazapine?
noradrenergic and specific serotonergic antidepressant
36
What is fregoli syndrome?
one or more familiar persons, usually persecutors following the patient, repeatedly change their appearance.
37
What is the first-line treatment for personality disorders?
DBT
38
When do the symptoms of alcohol withdrawel begin?
6-12 hours
39
When do seizures with alcohol withdrawel start?
36 hours
40
When does delirium tremens begin?
48-72 hours - treated with oral lorazepam
41
What is the treatment for alcohol withdrawel?
1. Long-acting benzos e.g. diazepam or chlorodizepoxide
2. Acamprosate (anti-craving) inhibit GABA-> /Disulfiram (vomit) for maintenance 6-12 months after abstinence
42
When are lithium levels checked?
12 hours post dose every 3 months
Thyroid/renal every 6 months as it can cause hypothyroidism
43
What is tardive dyskinesia?
long term typical antipsychotics and is characterised by uncontrolled facial movements such as lip-smacking.
44
What is akathisia?
severe restlessness with patients having difficulty in sitting still. Patients may rock, tap their legs or cross and uncross the legs. It typically occurs with long term use of antipsychotics
45
What are the side effects of mirtazapine?
increased appetite and sedation
46
What is a side effect of MAOs
Tyramine cheese reaction
47
What is used to prevent wernickes encephalopathy?
Paribnex
48
What are examples of SNRIs?
Duloxitine and venlafaxine
49
What is the first line SSRI for GAD?
sertraline
50
What are a common SE of SNRIS?
Hypertension
51
What should be monitored when taking SSRIS?
U&Es for hyponatremia
52
What are the symptoms of korskakoff syndrome?
1. anterograde amnesia: inability to acquire new memories
2. retrograde amnesia
3. confabulation
53
What is conversion disorder?
typically involves loss of motor or sensory function. May be caused by stress
54
What is somatisation disorder?
multiple physical SYMPTOMS present for at least 2 years
patient refuses to accept reassurance or negative test results
55
What is malingering?
fraudulent simulation or exaggeration of symptoms with the intention of financial or other gain
56
What score is used to assess alcohol withdrawal?
CIWA-Ar
57
What score is used to assess the severity of schizophrenia?
Positive and Negative Syndrome Scale (PANSS)
tactile and visual hallucinations which are more commonly associated with organic illnesses than with schizophrenia.
58
What can cause dose alterations when taking clozapine?
Smoking status (if stopping, dose must be increased)
59
What is the acute management of mania?
Starting antipsychotics and stopping other meds
if agitated: IM benzo or neuroleptic
60
What should be done before commencing ECT in depressed patient?
Reduce SSRI dose
61
What is the first-line SSRi choice in children/adolescents?
Fluoxetine
62
What is the treatment for tardive dyskinesia?
Tetrabenzine
63
What is the treatment for akathisia?
Propranalol
64
What can antipsychotics increase the risk of in elderly?
1. stroke
2. VTE
65
If a patient has a hepatic failure, what is the preferred treatment for alcohol withdrawal?
Lorazapam
66
What are the long term side effects of lithium?
hyperparathyroidism and resultant hypercalcaemia
- stones, bones, abdominal moans, and psychic groans
Hypothyroidism
67
What are somatic symptoms?
biological/melancholic symptoms
- Early morning waking
- Loss of libido, appetite, weight
68
Which antidepressant is known for weight gain/sedation?
Mirtazipine
69
What are the SE of discontinuing SSRIs?
GI disturbances e.g diarrohoea + electric shock sensations
70
Which antipsychotic reduces seizure threshold?
Clozapine
71
Why do atypical and typical antipsychotics cause breast tenderness?
They cause prolactinemia
72
Which antipsychotic causes the least amount of prolactin elevation?
Aripiprazole - atypical antipsychotic
73
What suffix do atypical antipsychotics end in?
-zole, -pine, -done
74
What is the difference in MOA of atypical and typical antipsychotics?
Typical - block dopamine pathways
Atypical - block dopamine and serotonoin pathways
75
What is the difference between tangibility and circumstantiality?
With circumstantiality you return to topic
76
What medication is given for resistant schizophrenia?
Clozapine
77
What are the side effects of clozapine?
1. Myocarditis (chest pain)
2. Agranulocytosis
3. arrythmias
4. Excessive salivation
5. Reduced seizure threshold
6. constipation/intestinal obstruction (most common)
78
What are Schneiders first rank symptoms for scizhophrenia?
WASBID
Withdrawel (thought)
3rd person Auditory hallucinations
Somatic passivity
Broadcast (thought(
Insertion (thought)
Delusional perceptions
79
What is the MOA of benzos?
effect of the inhibitory neurotransmitter gamma-aminobutyric acid (GABAa) by increasing the frequency of chloride channels
80
What is a common SE of benzos?
Anterograde amnesia
81
If SSRIs do not work for GAD, what is next step?
another SSRI-> SNRIs then pregabalin
82
Why should SSRIs and MAOs not be combined?
Risk of serotonin syndrome as SSRIs increase serotonin levels whilst MAOs prevent them from being metabolised - more serotonin in blood
83
What is the suffix for MAOs?
-zine, -Giline
84
How to differentiate between dementia and depression?
Depression causes global memory loss and short term - may be preceded by a traumatic incident
85
How does schizoaffective disorder present?
symptoms of both psychotic and mood disorders present together during one episode, or within two weeks of each other.
86
What type of incontinence can amitryptiline cause?
Overflow incontinence
87
What is the suffix for TCAs?
-tyrptiline and -mine
88
What factors indicate a poor prognosis of schizo?
strong family history
gradual onset
low IQ
prodromal phase of social withdrawal
lack of obvious precipitant
89
What is the suffux for SSRIs?
-pram and -ine.
90
What should be ruled out when diagnosing anxiety?
Thyroid disorders
91
What is the first line treatment for acute stress disorder?
Trauma-focused CBT
92
What side effects are associated with TCAs?
1. Dry mouth
2. blurred vision
3. urinary retention
4. mydriasis
5. Weight gain
1-4 anticholinergic 5: antihistaminic
93
What side effetcs are associated with lithium?
1. increased urinary frequency
2. thirst
3. mild tremor
94
What is the moa of MOA inhibitors?
inhibit the action of MAO enzymes, resulting in increased concentrations of serotonin, norepinephrine, and dopamine.
95
What is the suffix for benzos?
-lam and -pam
96
What is the gold standard investigation for adenomyosis?
MRI pelvis
97
What is the management of bipolar affective disorder?
1. Maintenance - lithium -> Valproate
2. Acute manic/mixed episode - atypical antipsychotic
3. depressive episode - atypical antipsychotic + ssri
98
What are the signs of lithium toxicity?
1. Coarse tremor (fine tremor is normal SE)f
2. Ataxia
3. Vomit
4. seizure/slurred speech
5. raised creatinine
6. hyperreflexia
urgent referral to hospital
99
What is the max dose of sertraline?
200mg daily
100
What is the choice antidepressant in breastfeeding women?
Sertraline or paroxitine
101
If a dose of clozapine has been missed for <48 hours...
Re-titrate slowly
102
What is the choice SSRI following MI?
Sertraline
103
How does wernickes present?
1. ophthalmoplegia (often a lateral rectus palsy and/or horizontal nystagmus)
2 confusion
3. ataxia (though any cerebellar signs can be present).
104
Which atypical antipsychotic most associated with prolactin elevation?
Risperidone
105
What is a section 2?
admission for assessment for up to 28 days, not renewable
an Approved Mental Health Professional (AMHP) or rarely the nearest relative (NR) makes the application on the recommendation of 2 doctors
one of the doctors should be 'approved' under Section 12(2) of the Mental Health Act (usually a consultant psychiatrist)
treatment can be given against a patient's wishes
106
What is a section 3?
admission for treatment for up to 6 months, can be renewed
AMHP along with 2 doctors, both of which must have seen the patient within the past 24 hours
treatment can be given against a patient's wishes
107
What is a section 4?
72 hour assessment order
used as an emergency, when a section 2 would involve an unacceptable delay or in outpatients
a GP and an AMHP or NR
often changed to a section 2 upon arrival at hospital
108
What is a section 5(2) and 5(4)?
5(2) - patient who is a voluntary patient in hospital can be legally detained by a doctor for 72 hours
5(4) - same but nurse for 6 hours
109
What is a section 136?
someone found in a public place who appears to have a mental disorder can be taken by the police to a Place of Safety
can only be used for up to 24 hours, whilst a Mental Health Act assessment is arranged
110
What is a section 135?
a court order can be obtained to allow the police to break into a property to remove a person to a Place of Safety
111
What is a section 17(a)
Supervised Community Treatment (Community Treatment Order)
can be used to recall a patient to hospital for treatment if they do not comply with conditions of the order in the community, such as complying with medication
112
What's the diagnosis criteria for bulimia?
the binge eating and compensatory behaviours both occur, on average, at least once a week for three months.
113
over what time period are SSRIs stopped?
Withdraw slowly over 4 weeks (exception: fluoxetine)
114
What is echopraxia?
meaningless repetition or imitation of the movements of others.
115
What is copraxia?
involuntary performing of obscene or forbidden gestures or inappropriate touching.
116
What is Palilalia
automatic repetition of one's own words, phrases or sentences.
117
Schizophrenia inheritance?
monozygotic twin has schizophrenia = 50%
parent has schizophrenia = 10-15%
sibling has schizophrenia = 10%
no relatives with schizophrenia = 1%
118
What test can be done to diagnose conversion disorder?
1. Hoovers - differentiate organic from non-organic leg paresis. In non-organic paresis, pressure is felt under the paretic leg when lifting the non-paretic leg against pressure, this is due to involuntary contralateral hip extension
2. Positive drop arm test
119
What area is damaged in korsakoff and wernickes?
medial thalamus and mammillary bodies of the hypothalamus
120
What is the treatment of opioid addiction?
Detoxification: methadone -> naltrexone -> buprenophrine (sublingual)
Overdose: Naloxone
121
What are the 4 features of a second part of a capacity assessment?
the ability to understand, weigh-up, retain and communicate the decision made
122
What is the first stage of the 2 stage capacity assessment?
Is there an impairment of or disturbance in the functioning of the person’s mind or brain?
Is the impairment or disturbance sufficient that the person lacks the capacity to make that particular decision?
123
What cognitive test is commonly used?
6CIT
124
How often is clozapine monitored?
1. a minimum of 1 blood test per week for the first 18 weeks.
2. reduced to fortnightly until 1 year.
3. After this monthly blood tests are needed.
125
SE of ECT
retrograde amnesia
126
What is refeeding syndrome
Rapidly increasing insulin levels lead to shifts of potassium, magnesium and phosphate from extracellular to intracellular spaces. This is potentially fatal if refeeding is too rapid.
Symptoms of refeeding syndrome may include oedema, confusion and tachycardia. Blood tests initially show hypophosphataemia and it is treated with phosphate supplementation.
1. Hypophosphatemia
2. Hypomagnesemia
3. Hypokalaemia (tall tented t waves + prominent u waves +short qt)
127
DSM symptoms for mania?
Elevated self-esteem
Reduced need for sleep
Increased rate of speech
Flight of ideas
Easily distracted
An increased interest in goals or activities
Psychomotor agitation (pacing, hand wringing etc.)
Increased pursuit of activities with a high risk of danger
128
Most common SE of SSRI?
GI disturbances e.g. ulcers
129
What drug interaction with lithium can lead to renal impairment?
NSAIDs -> lithium toxicity
130
Management of paracetamol overdose?
1. <1 hour of ingestion: activated charcoal
2. Acetylcysteine infusion over 1 hour. (3 doses)
131
How does opioid toxicity present?
CNS depression, respiratory depression and pupillary
constriction
132
How does cocaine withdrawal present?
Anxiety
Increased hunger
Fatigue
Irritability
Lack of motivation
24-10wks-6months
133
What drugs are used in the long term management of BPD?
Carbamazepine
Lithium
Olanzapine
Sodium Valproate
134
What tests are done when diagnosing GAD?
24-hour urine metanephrines
Electrocardiogram
Full blood count and iron studies
Thyroid function tests
135
What hallucination do you get with delirium tremens?
Lilliputian
136
What drug is used in the treatment of serotonin syndrome?
Cyproheptadine
137
What scores are used to measure alcohol dependence?
Audit/cage
138
What metabolic disturbance can panic disorder cause?
Hypocalcaemia
hyperventilation -> increase Ph + reduce CO2 -> alkalosis causes albumin to bind with calcium
139
Time frames for serotonin syndrome vs NMS?
Serotonin: 24 hours
NMS: days to weeks
140
Bipolar management in pregnancy?
Switch from lithium to antipsychotic
141
Treatment of obsessive compulsive personality disorder?
DBT
142
what medication can cause anterograde amnesia
lorazapam
