Psych Questions Flashcards
What are the first rank symptoms?
Delusions, auditory hallucinations, thought disorder, passivity experience
What is somatic passivity?
Experience of bodily sensations (including actions, thoughts, or emotions) imposed by external agency. ‘‘They’re making me feel cold all the time’
What is passivity of affect?
Forced by an external agent to feel emotions
What is passivity of impulse?
Forced by an external agent the desire to do things
What is passivity of volition
Forced by an external agent to perform actions
What is the strongest risk factor for future suicide completion?
Male gender
What factors are associated with a increased risk of completed suicide at a future date, for patients who have previously failed?
Efforts to avoid discovery, planning, leaving a written note, final acts, violent method
What is thought suppression?
Intentionally and temporarily withholding an idea or feeling from conscious awareness
What is displacement of thoughts?
Redirection of emotions or impulses to a neutral person or object
What are flashbacks in PTSD?
A form of pseudohallucination
How does a prodromal phase in schizophrenia affect prognosis?
Associated with a poor prognosis
What is a prodromal phase in schizophrenia associated with?
Social withdrawal and isolation
What factors are associated with a poor prognosis in schizophrenia?
Strong family history, gradual onset, low IQ, prodromal phase of social withdrawal, lack of obvious precipitant
What is malingering?
Falsification or profound exaggeration of illness to gain external benefits such as avoiding work or responsibility
What is the MoA of tricyclic antidepressants?
Inhibition of monoamine reuptake on the presynaptic membrane, via binding to the ATPase monoamine pump within the presynaptic membrane
What is a primary delusion vs. secondary delusion?
Primary delusion; those which cannot be described by any previous psychopathological state, such as a mood disorder. Most commonly seen in schizophrenia
Secondary delusions: relate to patients underlying mood. Often in mania or severe depression
How does alcohol withdrawal affect GABA and glutamate transmission?
Alcohol withdrawal results from decreased inhibitory GABA and increased NMDA glutamate transmission
What is the triad of symptoms in Korsaokoffs?
anteretrograde amnesia, retrograde amnesia, confabulation
When checking lithium levels, how long after taking a dose should the levels be checked?
12 hours post dose
What is a short acting bendozdiazepine?
Lorazepam
What is a long acting BDZ?
Diazepam
What drug class is clomipramine?
TCA
What classic side effects are caused by TCAs?
Anticholinergic: dry mouth, blurred vision, urinary retention. Also weight gain (due to antagonism of histamine receptors)
Also can lengthen QT interval
What is the mechanism of action of venlafaxine?
Serotonin and noradrenaline reuptake inhibitor
What is the first line drug treatment for PTSD?
Venlafaxine or an SSRI
What symptoms suggest depression rather than dementia?
Sleep disturbance, stress triggers, normal mini-mental state
When should a patient be prescribed an PPI with an SSRI?
when they are taking NSAIDs. This is due to increased GI bleeding risk
For a diagnosis of PTSD, how long should symptoms be present for?
1 month
What should be done for SSRI dose when a patient is starting ECT
Reduce dose but not stop it
Which antipsychotic has the most tolerable side effect profile?
Aripiprazole; particularly favourable for prolactin elevation
What should be done if clozapine doses are missed for more than 48 hours?
Dose needs to be restarted again slowly
What antipsychotic reduces seizure threshold?
Clozapine
What drug class is mirtazapine?
Noradrenergic and specific serotonergic antidepressant
What are symptoms of SSRI discontinuation syndrome?
Dizziness, electric shock sensations, anxiety. Also can be flu-like symptoms, hyperarousal, insomnia
What GI s/e can clozapine cause?
Constipation/intestinal obstruction
What are possible metabolic side effects of antipsychotics?
Dysglycaemia, dyslipidaemia, diabetes mellitus
What is clang associations in thought disorders?
Ideas only related by rhyme or being similar sounding
How long should antidepressants be continued after remission of symptoms to decrease risk of relapse?
At least 6 months
When is ECT indicated?
Life threatening major depressive disorder, where catatonia is present
What is echolalia?
The repitition of someone else’s speech including the questions being asked
What is copropraxia?
the involuntary performing of obscene or forbidden gestures or inappropriate touching
What is a possible side effect of SSRI use during the third trimester?
Risk of persistent pulmonary HTN of the newborn
What is a risk of SSRI use during the first trimester of pregnancy?
Increased risk of congenital heart defects
What SSRI particularly has risk of congenital malformations in the first trimester?
Paroxetine
Why do atypical antipsychotics increase the risk of stroke and VTE in the elderly?
Due to hyperprolactinaemia and weight gain, which increases the risk
What is the SSRI choice in children?
Fluoxetine
What is the difference between Knight’s move and flight of ideas?
Knight’s move thinking there are illogical leaps from one idea to another, flight of ideas there are discernible links between ideas
What are drugs that should be avoided in SSRIs?
- NSAIDs (give PPI)
- warfaring/heparin
- aspirin
- triptans
- MAOIs
What are the possible short term s/e of ECT?
Headaches, nausea, memory impairment, arrhythmias
When should lithium levels be checked after a dose change?
Checked a week later, and then weekly until the levels are stable
What test is used to differentiate organic from non organic leg paresis?
Hoover’s sign
What is the general treatment for acute dystonia secondary to antipsychotics?
Procyclidine
What is pseudodementia?
Depression-related cognitive dysfunction; depressive symptoms mimic the clinical picture of dementia.
What factors can suggest depression over dementia?
Short history+ rapid onset, biological symptoms, patient worried about poor memory, global memory loss (dementia characteristically causes recent memory loss)
What are the risk factors for the development of generalised anxiety disorder?
Aged 35-54, being divocerved or separated, living alone, being a lone parent
What is an alternative tx to SSRI in OCD?
Clomipramine (TCA)
What PHQ-9 scores divides ‘less’ and ‘more’ severe depression?
Less severe: <16
More severe: >16
What is akathisia?
Sense of inner restlessness and inability to keep still
How does frontal lobe injury typically present?
Motor symptoms (weakness or paralysis), difficulty with speech, disinhibition
What is ‘stopping of voluntary movement or staying still in an unusual position’?
Catatonia
What is the diagnostic criteria for insomnia?
Diagnosed after 3 months, if a person has trouble falling asleep or staying asleep at least 3 nights per week
What is the risk of developing schizophrenia if one monozygotic twin is affected?
50%
What type of urinary incontinence can tricyclic antidepressants cause?
Overflow incontinence
What is the difference between Knight’s move and flight of ideas?
Knight’s move thinking there are illogical leaps from one idea to another, flight of ideas there are discernible links between ideas
What is the regime for lithium monitoring?
Measured one week after starting, one week after dose change, then weekly until levels are stable. Once stable, they should be measured every 3 months. Always measured 12 hours post dose
How do benzodiazepines work?
Enhance the effect of the inhibitory GABA
