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A TO REVISE - PHASE 3A > PSYCH TO DO > Flashcards

PSYCH TO DO Flashcards

1
Q

ECT
What are some adverse effects of ECT?

A
  • Short-term retrograde amnesia
  • Headache
  • Confusion + clumsiness
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2
Q

DEPRESSION
What are 2 theories speculating the causes of depression?

A
  • Stress vulnerability = someone with high vulnerability will withstand less stress before becoming mentally unwell
  • Monoamine hypothesis = depression caused by deficiency in monoamines (serotonin, noradrenaline) hence why Tx works
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3
Q

DEPRESSION
What are the biological causes of depression?

A
  • Personal/FHx + genetics
  • Personality traits (dependent, anxious, avoidant)
  • Physical illness (hypothyroid, anaemia, childbirth)
  • Iatrogenic (beta-blockers, steroids, substance misuse)
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4
Q

DEPRESSION
What are the three core symptoms of depression?

A
  • Low mood
  • Anhedonia
  • Anergia
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5
Q

DEPRESSION
What are some psychological symptoms of depression?

A
  • Guilt, worthlessness, hopelessness
  • Self-harm/suicidality
  • Low self-esteem
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6
Q

DEPRESSION
What are some cognitive symptoms of depression?

A
  • Beck’s triad = negative views about oneself, the world + the future
  • Poor concentration + impaired memory
  • Avoiding social contact + performing poorly at work (social Sx too)
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7
Q

DEPRESSION
What are some investigations for depression?

A
  • FBC, ESR, B12/folate, U+Es, LFTs, TFTs, glucose, Ca2+
  • ECG, MSE + risk assessment
  • Urine drug screen
  • PHQ-9 + HADS to screen for depression
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8
Q

DEPRESSION
What is the management of psychotic depression?

A
  • ECT first line + v effective in severe cases followed by antidepressant
  • Antipsychotic initiated before antidepressant if ?primary psychotic disorder then add SSRI
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9
Q

DEPRESSION
What is atypical depression?
What is the management?

A
  • Mood depressed but reactive
  • Hypersomnia (>10h/day)
  • Hyperphagia (excessive eating + weight gain)
  • Leaden paralysis (heaviness in limbs ≥1h/day)
  • Oversensitivity to perceived rejection
  • Phenelzine or another MAOI, if not SSRI
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10
Q

DEPRESSION
What is dysthymia?
What is the management?

A
  • Chronic, low-grade or sub-threshold depressive Sx which don’t meet diagnostic criteria over a long period of time
  • Typically >2y of mildly depressed mood + diminished enjoyment, less severe but more chronic
  • SSRIs + CBT first line
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11
Q

SELF-HARM + SUICIDE
What are some risk factors for suicide?

A

SAD PERSONS –
- Sex (M>F)
- Age (peaks in young + old)
- Depression
- Previous attempt
- Ethanol
- Rational thinking loss (psychotic illness)
- Social support lacking (unemployed, homeless)
- Organised plan (avoid discovery, plan, notes, final acts)
- No spouse
- Sickness (physical illness)
0–4 low, 5–6 mod (?hospital), ≥7 high

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12
Q

SELF-HARM + SUICIDE
What are some protective factors for suicide?

A
  • Married men
  • Active religious beliefs
  • Social support
  • Good employment
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13
Q

BIPOLAR DISORDER
What are the 4 types of bipolar?

A
  • Bipolar 1 = mania + depression in equal proportions, M>F
  • Bipolar 2 = more episodes of depression, mild hypomania (easy to miss), F>M
  • Cyclothymia = chronic mood fluctuations over ≥2y (episodes of depression + hypomania, can be subclinical)
  • Rapid cycling = ≥4 episodes of (hypo)mania or depression in 1 year
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14
Q

BIPOLAR DISORDER
What are some potential causes of bipolar?

A
  • Structural brain abnormalities, neurotransmitter imbalances
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15
Q

SCHIZOPHRENIA
What is schizophrenia?

A
  • Splitting or dissociation of thoughts, loss of contact with reality
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16
Q

SCHIZOPHRENIA
What is the neurodevelopmental hypothesis in schizophrenia?

A
  • Hypoxic brain injury, viral infections in-utero, TLE + cannabis smoking = risk of schizophrenia indicating brain development link
  • Imaging has showed enlarged ventricles (poor prognostic feature), small amounts of grey matter loss + smaller, lighter brains
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17
Q

SCHIZOPHRENIA
What is the neurotransmitter hypothesis in schizophrenia?

A
  • Excess dopamine + overactivity in mesolimbic tract = +ve Sx
  • Lack of dopamine + underactivity in mesocortical tracts = -ve Sx
  • Overactivity of dopamine, serotonin, noradrenaline + underactivity of glutamate + GABA
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18
Q

SCHIZOPHRENIA
What are the 6 different types of schizophrenia?

A
  • Paranoid (most common)
  • Hebephrenic
  • Simple
  • Catatonic
  • Undifferentiated
  • Residual (‘burnt out’)
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19
Q

SCHIZOPHRENIA
What are the features of…

i) catatonic
ii) undifferentiated
iii) residual

schizophrenia?

A

i) Psychomotor disturbance such as posturing, rigidity + stupor
ii) Sx do not fit neatly into other subtypes
iii) Previous +ve symptoms less marked, prominent -ve Sx

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20
Q

SCHIZOPHRENIA
What are the first rank symptoms of schizophrenia?
What is the relevance?

A
  • Delusional perceptions
  • Auditory hallucinations (3 types)
  • Thought alienation (insertion, withdrawal + broadcasting)
  • Passivity phenomenon, incl. somatic
  • ≥1 for at least 1m is strongly suggestive Dx
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21
Q

SCHIZOPHRENIA
What are some secondary symptoms of schizophrenia?
What is the relevance?

A
  • 2nd person auditory or hallucinations in other modalities
  • Other delusions (persecutory, reference)
  • Formal thought disorder
  • Lack of insight
  • Negative Sx (incl. catatonia)
  • ≥2 for at least 1m is strongly suggestive Dx
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22
Q

SCHIZOPHRENIA
What is the difference between positive and negative symptoms of schizophrenia?

A
  • +ve = presence of change in behaviour or thought, something added (all of the first rank + secondary Sx)
  • -ve = decline in normal functioning, something removed
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23
Q

SCHIZOPHRENIA
What are the negative symptoms of schizophrenia?

A

Often early prodromal, 5As –
- Affect blunting, flattening or incongruity
- Anhedonia + amotivation
- Asociality
- Alogia (poverty of speech)
- Apathy
(Delusional mood = ominous feeling of something impending)

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24
Q

SCHIZOPHRENIA
What are some…

i) psychiatric
ii) organic
iii) substance

differentials for schizophrenia?

A

i) Delusional disorder, transient psychosis, mania, psychotic depression
ii) TLE, encephalitis, delirium, syphilis/HIV, SOL
iii) Drug-induced psychosis, alcoholic hallucinosis, steroid-induced

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25
Q

PARAPHRENIA
What is paraphrenia?
How does it compare to schizophrenia?

A
  • Late-onset schizophrenia >45y
  • Less emotional blunting + personality decline, F>M
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26
Q

GAD
What are 3 cardinal features of GAD?

A
  • Symptoms of muscle + psychic tension
  • Causes significant distress + functional impairment
  • No particular stimulus
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27
Q

GAD
What model can be used to explain the causes of GAD?

A

Triple vulnerability –
- Generalised biological
- Generalised psychological (diminished sense of control)
- Specific psychological (stressful events)

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28
Q

GAD
What are some organic differentials for GAD?

A
  • Endo = hyperthyroidism, pheochromocytoma, hypoglycaemia
  • CVS = arrhythmias, cardiac failure, anti-hypertensives, MI
  • Resp = asthma (excessive salbutamol), COPD, PE
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29
Q

GAD
What is the ICD criteria of GAD?
What are the groups of symptoms present in GAD?

A
  • Difficulty controlling worry, present for more days than not for ≥6m
  • ≥4 symptoms with ≥1 from autonomic arousal section
  • Autonomic arousal, physical, mental, general, tension, other
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30
Q

GAD
What are the investigations for GAD?

A
  • History, MSE + risk assessment
  • GAD-7 + Hospital Anxiety + Depression Scale (HADS) questionnaire
  • Exclude organic (FBC, U+Es, LFTs, TFTs, fasting glucose, PTH)
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31
Q

PANIC DISORDER
What is panic disorder associated with?
What are some risk factors?

A
  • Meds like SSRIs, BDZs, zopiclone withdrawal
  • Widowed, divorced or separated, living in city, limited education, physical or sexual abuse, FHx
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32
Q

PANIC DISORDER
What are the 3 key elements of panic disorder?

A
  • Sudden onset panic attack with ≥4 characterised Sx
  • Not necessarily associated with a specific stimulus
  • Pt preoccupied with suffering death or severe life-threatening illness
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33
Q

PTSD
What are the 4 core symptoms of PTSD?
How long do they need to be present for to diagnose?

A

HEAR (≥1m) –
- Hyperarousal
- Emotional numbing
- Avoidance + rumination
- Re-experiencing (involuntary)

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34
Q

ANOREXIA NERVOSA
What is the diagnostic criteria for anorexia?

A

FEED ≥3m with absence of binge eating –
- Fear of fatness
- Endocrine disturbance
- Extreme weight loss
- Deliberate weight loss

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35
Q

ANOREXIA NERVOSA
How may endocrine disturbance present?

A
  • Amenorrhoea
  • Reduced libido/fertility
  • Abnormal insulin secretion
  • Delayed/arrested puberty if onset pre-pubertal
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36
Q

ANOREXIA NERVOSA
What are some complications of anorexia?

A
  • Osteoporosis, thyroid issues, cardiac atrophy
  • Electrolyte disturbances (hypokalaemia > arrhythmias)
  • Decrease in WBC > increased infections
  • Death due to health complications or suicide
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37
Q

ANOREXIA NERVOSA
What screening tool can be used in anorexia?

A

SCOFF –
- Do you ever make yourself SICK as too full?
- Do you ever feel you’ve lost CONTROL over eating?
- Have you recently lost more than ONE stone in 3m?
- Do you believe you’re FAT when others say you’re thin?
- Does FOOD dominate your life?

38
Q

ANOREXIA NERVOSA
In anorexia, most things are low apart from what?

A

Gs + Cs –
- GH, Glucose, salivary Glands
- Cortisol, Cholesterol, Carotinaemia

39
Q

ANOREXIA NERVOSA
What risk assessment tool can be used for assessing if a patient with anorexia needs inpatient psychiatric admission?

A

Management of Really Sick Patients with Anorexia Nervosa (MARSIPAN)

40
Q

ANOREXIA NERVOSA
What are the MARSIPAN indicators of admission?

A
  • BMI <13, severe malnutrition or dehydration
  • HR <40, ECG changes
  • BP <90 systolic, <70 diastolic esp with postural drop
  • Temp <35
  • Severe electrolyte disturbances (K+, Na+, Mg2+, phosphate = low)
  • SUSS test of 0 or 1
  • Significant suicide or serious self-harm risk
41
Q

ANOREXIA NERVOSA
What are the biological treatments for anorexia nervosa?

A
  • Fluoxetine, chlorpromazine + TCAs may be used for weight gain
42
Q

ANOREXIA NERVOSA
What is the pathophysiology of refeeding syndrome?

A
  • Reduced carb consumption leads to reduced insulin secretion so the body switches from carb > fat + protein metabolism
  • Electrolyte stores depleted as needed to convert glucose>energy
  • Reintroducing food causes abrupt shift from fat>carb metabolism + insulin secretion surges, driving electrolytes from serum>cells to help convert glucose>energy causing further serum concentration decrease
43
Q

ANOREXIA NERVOSA
What is the clinical presentation of refeeding syndrome?

A
  • Fatigue, weakness, confusion, dyspnoea (risk of fluid overload)
  • Abdo pain, vomiting, constipation, infections
44
Q

ANOREXIA NERVOSA
What are the biochemical features of refeeding syndrome?

A
  • Hypophosphataemia main disturbance due to role of converting glucose>energy
  • Hypokalaemia, hypomagnesaemia + thiamine deficiency too
  • Abnormal fluid balance
45
Q

ANOREXIA NERVOSA
What should be monitored before + during refeeding?

A
  • U+Es (Na+, K+), phosphate, magnesium, glucose, ECG, fluid balance
46
Q

BULIMIA NERVOSA
What is the diagnostic criteria for bulimia?

A

BPFO ≥2 a week for ≥3m –
- Behaviours to prevent weight gain
- Preoccupation with eating (compulsion to eat but regret after)
- Fear of fatness
- Overeating ≥2/week

47
Q

BULIMIA NERVOSA
What are some investigations for bulimia?

A
  • SCOFF
  • BP (low), temp, SUSS test
  • ECG (arrhythmias from hypokalaemia)
  • FBC (anaemia), LFTs, urinalysis, serum proteins
  • Monitor U+Es, calcium, magnesium, phosphate in vomiting, laxative abuse, diuretics or waterloading (for deceitful weighing)
48
Q

BULIMIA NERVOSA
What metabolic abnormalities may be present?

A
  • Hypochloraemic hypokalaemic metabolic alkalosis due to vomiting
  • Hypokalaemia > muscle weakness + arrhythmias
49
Q

PERSONALITY DISORDERS
What are cluster A personality disorders?

A
  • Characterised by odd, eccentric thinking or behaviour
  • MAD
50
Q

PERSONALITY DISORDERS
What are some differentials of schizotypal personality disorder?

A
  • Autism
  • Asperger’s
  • Schizophrenia (50% may develop it)
51
Q

PERSONALITY DISORDERS
What are cluster B personality disorders?

A
  • Characterised by dramatic, overly emotional or unpredictable thinking or behaviour (BAD)
52
Q

PERSONALITY DISORDERS
What is a psychopath?
What is a sociopath?

A
  • When they get in trouble with the law
  • Same traits but without law involvement
53
Q

PERSONALITY DISORDERS
In terms of EUPD, what is the difference between…

i) impulsive type?
ii) borderline type?

A

i) Difficulties with impulsive + risky behaviours (unsafe sex, gambling) + anger
ii) Difficulties with relationships, self-harm + feelings of emptiness

54
Q

PERSONALITY DISORDERS
What are cluster C personality disorders?

A
  • Characterised by anxious, fearful thinking or behaviour (SAD)
55
Q

PERSONALITY DISORDERS
What are some investigations for personality disorders?

A
  • Assessed (Hx + MSE) more than once
  • Minnesota Multiphasic Personality Inventory (MMPI)
  • Eysenck Personality Inventory + Personality Diagnostic Questionnaire
56
Q

PERSONALITY DISORDERS
What is the biological management of personality disorders?

A
  • Only use to treat comorbid conditions or if Sx distressing (e.g. antipsychotics in group A to reduce suspiciousness)
57
Q

PERSONALITY DISORDERS
What are the psychological therapies for personality disorders?

A
  • Dialectical behavioural therapy for EUPD
  • CBT (change unhelpful ways of thinking)
  • Cognitive analytical therapy (recognise + change unhelpful patterns in relationships + behaviours)
  • Psychodynamic therapy (looks at how past experiences affect present behaviour)
58
Q

WERNICKE’S
How does Wernicke’s present?

A

Triad –
- Ataxia
- Confusion
- Ophthalmoplegia + nystagmus

59
Q

KORSAKOFF’S
What are some causes of Korsakoff’s?

A
  • Heavy alcohol drinkers
  • Head injury, post-anaesthesia
  • Basal or temporal lobe encephalitis
  • CO poisoning
  • Other causes of thiamine deficiency (anorexia, starvation, hyperemesis)
60
Q

LITHIUM TOXICITY
What is lithium toxicity?
What can precipitate it?

A
  • Serum lithium >1.5mmol/L
  • > 2mmol/L = life-threatening
  • Dehydration, renal failure, diuretics, anti-HTNs + NSAIDs
61
Q

LITHIUM TOXICITY
What is the clinical presentation of lithium toxicity?

A
  • Ataxia, dysarthria, confusion (drunk)
  • COARSE tremor, blurred vision, hyperreflexia
  • N+V, diarrhoea
  • Myoclonus, seizures + coma if severe
62
Q

LITHIUM TOXICITY
What are some complications of lithium toxicity?

A
  • Arrhythmias (VT)
  • Acute renal failure
  • Syndrome of irreversible lithium-effectuated neurotoxicity (SILENT) after cessation of lithium >2m = truncal ataxia, ataxic gait, scanning speech, incoordination
63
Q

LITHIUM TOXICITY
What is the management of lithium toxicity?

A
  • ABCDE approach as emergency
  • Stop + check lithium levels, serum creatinine, U+Es
  • IV fluids (bolus + 1.5–2x maintenance
  • ?Whole bowel irrigation with polyethene glycol for severe, acute ingestion
  • Haemodialysis
64
Q

LITHIUM TOXICITY
When would you do haemodialysis in lithium toxicity?

A
  • Serum [Li] >5mmol/L
    OR >4 + renal dysfunction
    OR severe toxicity (seizures, coma, life-threatening arrhythmias)
65
Q

ACUTE DYSTONIA
What is an acute dystonic reaction?

A
  • Sustained painful muscle contraction in ≥1 muscle groups
66
Q

ACUTE DYSTONIA
What is the management of acute dystonia?

A
  • ABCDE approach as emergency
  • Anticholinergic – IM procyclidine
  • Stop antipsychotic (switch to atypical as less EPSEs)
67
Q

NMS
What is the pathophysiology of neuroleptic malignant syndrome (NMS)?

A
  • Dopamine antagonism often due to typical antipsychotic OD or acute withdrawal of Parkinson’s meds
68
Q

NMS
How quickly does NMS present?

A
  • Onset within 2w of drug or dose change (onset + progression slow)
  • May last 7–10d after PO or 21d after depot
69
Q

NMS
What is the clinical presentation?

A

Bodybuilder–
- Pyrexia >38 + diaphoresis
- Muscle rigidity (diffuse “lead-pipe” rigidity)
- Confusion, agitation, altered consciousness
- Tachycardia, high/low BP
- Hyporeflexia

70
Q

SEROTONIN SYNDROME
What is the clinical presentation of serotonin syndrome?

A

Sx onset + recovery fast–
- Neuro = confusion, agitation
- Neuromuscular = myoclonus, tremors (incl. shivering), hyperreflexia, ataxia
- Autonomic = hyperthermia, diarrhoea, tachycardia, mydriasis

71
Q

SEROTONIN SYNDROME
What are some investigations for serotonin syndrome?

A
  • FBC, U+Es, biochemistry (Ca2+, Mg2+, phosphate), CK, drug toxicology scren
  • ECG monitoring for prolonged QRS or QTc interval
72
Q

SEROTONIN SYNDROME
What is the management of serotonin syndrome?

A
  • ABCDE
  • Stop offending agent
  • IV access to correct volume + reduce risk of rhabdomyolysis as in NMS
  • BDZs like slow IV lorazepam for agitation, seizures + myoclonus
  • Serotonin receptor antagonists like PO cyproheptadine or chlorpromazine if severe
73
Q

SEROTONIN SYNDROME
What is the management of serotonergic drug OD?

A
  • ?Gastric lavage ± activated charcoal
74
Q

LEARNING DISABILITIES
What is a learning disability?

A
  • Condition of arrested or incomplete development of mind, characterised by impairment of skills that contribute to overall intelligence (language, cognition, social) which has manifested during developmental period
75
Q

LEARNING DISABILITIES
How is a learning disability different to learning difficulties?

A
  • Learning difficulties (dyslexia) are difficulties in acquiring knowledge + skills to the normal level expected of those of the same age, especially due to a mental disability or cognitive disorder
76
Q

LEARNING DISABILITIES
What is the triad in learning disabilities?

A
  • Low intellectual performance (IQ < 70)
  • Onset during birth or early childhood
  • Wide range of functional impairment
77
Q

LEARNING DISABILITIES
What physical disorders may be present in those with learning disabilities?

A
  • Motor disabilities (ataxia, spasticity)
  • Epilepsy
  • Impaired hearing/vision
  • Incontinence
78
Q

LEARNING DISABILITIES
How is mild learning disability characterised by…

i) IQ?
ii) mental age?
iii) mobility?
iv) speech?
v) academia?
vi) self-care?

A

i) 50–69
ii) 9–12
iii) Mobile
iv) Mostly adequate
v) Difficulties reading + writing
vi) Most independent

79
Q

LEARNING DISABILITIES
How is moderate learning disability characterised by…

i) IQ?
ii) mental age?
iii) mobility?
iv) speech?
v) academia?
vi) self-care?

A

i) 35–49
ii) 6–9
iii) Mobile
iv) Simple-no speech, may sign, reasonable comprehension
v) Limited, some learn to read, write + count
vi) Lifelong supervision, may need prompting + support

80
Q

LEARNING DISABILITIES
How is severe learning disability characterised by…

i) IQ?
ii) mental age?
iii) mobility?
iv) speech?
v) academia?
vi) self-care?

A

i) 20–34
ii) 3–6
iii) Marked impairment
iv) Simple-no speech, may sign, reasonable comprehension
v) Limited, some learn to read, write + count
vi) Lifelong supervision, may need prompting + support

81
Q

LEARNING DISABILITIES
How is profound learning disability characterised by…

i) IQ?
ii) mental age?
iii) mobility?
iv) speech?
v) academia?
vi) self-care?

A

i) <20
ii) <3
iii) Severe impairment
iv) Basic non-verbal comms, understands basic commands
v) None
vi) Complete dependency

82
Q

ADHD
What are some risk factors for ADHD?

A
  • Epilepsy, low socioeconomic status, learning difficulties
  • Premature or LBW
  • Brain damage (in vitro or after severe head injury later)
83
Q

ADHD
What is the triad of symptoms in ADHD?

A
  • Inattention
  • Impulsivity
  • Hyperactivity
84
Q

DBT
What are the two components to DBT?

A
  • Individual therapy = therapist validates pt’s responses, reinforces adaptive behaviours + facilitates analysis of maladaptive behaviours + their triggers
  • Group therapy = teaching on mindfulness, interpersonal effectiveness skills (problem solving, communication), emotional modulation skills
85
Q

GENDER DYSPHORIA
What act is relevant to gender dysphoria?

A
  • Gender recognition act 2004
  • Allows transsexual people to legally change their gender
  • Have to demonstrate Dx of gender dysphoria + have lived as gender role for ≥2y
86
Q

GENDER DYSPHORIA
What are some risks of the hormone therapy?

A
  • Oestrogen = clots, gallstones, high triglycerides
  • Testosterone = polycythaemia, acne, dyslipidaemia
  • Both = elevated LFTs, infertility, weight gain
87
Q

SELF-HARM
What are some risk factors for self-harm?

A

Female
Social deprivation,
Single or divorced,
LGBTQ+,
mental illness

88
Q

SCHIZOPHRENIA
What are the features of hebephrenic schizophrenia?

A

Dx in adolescents with mood changes, unpredictable behaviour, shallow affect + fragmentary hallucinations, poor outlook as -ve Sx may develop rapidly

89
Q

SCHIZOPHRENIA
What are the features of simple schizophrenia?

A

Pts never really experienced +ve Sx, mostly -ve

90
Q

TIC DISORDERS
What might cause them?

A
  • Stress, gestational + perinatal insults, PANDAS
91
Q

ANOREXIA NERVOSA
What are the consequences of refeeding syndrome?

A

Can lead to cardiac arrhythmias, convulsions, cardiac failure, coma + death

92
Q

OCD
What is a potential cause of OCD?

A

Neurochemical dysregulation of 5-HT system

A TO REVISE - PHASE 3A (16 decks)

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