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MSRA 2022 > Psychiatry > Flashcards

Psychiatry Flashcards

1
Q

All deaths that occur while the patient is detained under the mental health act must be reported to the coroner regardless of mechanism of death - true or false?

A

True

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2
Q

What is section 4 of the mental health act?

A

Section 4 needs 1x doctor + 1 approved mental health professional / nearest relative without the opinion of a 2nd doctor. It provides a 72 hour window to bring the pt into hospital against their wishes for further assessment. YOU CANNOT GIVE TREATMENT AGAINST PATIENT WISHES UNDER A SECTION 4.

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3
Q

What is section 2 of the mental health act?

A

Section 2 allows you to detain and give treatment against a patient’s wishes for upto 28 days. Needs 2x doctors + an approved mental health professional / nearest relative. CANNOT BE RENEWED BUT PT CAN BE CONSIDERED FOR A SECTION 3 DURING THIS TIME IF NEED BE.

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4
Q

What is section 3 of the mental health act?

A

Section 3 allows you to detain and give treatment against a pt wishes for upto 6 months. Can be renewed for a further 6 months twice then in 12 month periods. Needs 2x doctors + a AMHP/NR.

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5
Q

What are the criteria to be eligible to sectioned?

A
  • Must be a danger to yourself or others
  • You need to be in hospital in order to receive the treatment you need
  • The treatment you need is available
  • You have a mental health disorder (being under the influence of drugs or alcohol doesn’t count!)
  • You won’t voluntarily accept the admission
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6
Q

What is section 5 (2) of the mental health act?

A

Allows a single doctor to detain a patient already voluntarily an inpatient in hospital for 72 hours. A recommendation on why detainment is necessary should be submitted to hospital management.

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7
Q

What is section 5 (4) of the mental health act?

A

Allows a single nurse qualified in mental health / learning disabilities to detain a patient already voluntarily an inpatient in hospital for 6 hours until further assessment can be made.

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8
Q

What are the key factors associated with increased risk of suicide?

A 
Male gender 
History of deliberate self harm 
Co-existent drug or alcohol abuse 
History of co-existent mental health disorder (schizophrenia carries upto a 10% risk of successful suicide) 
History of chronic illness 
Increasing age 
Unemployment 
Social isolation
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9
Q

True or false - mirtazapine is most sedative at lower doses than higher doses

A

True

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10
Q

What is the meaning of capgras syndrome?

A

a delusional belief where the patient thinks someone close to them has been replacement by an imposter

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11
Q

Which SSRI has the highest associated incidence of SSRI discontinuation syndrome on abruptly stopping?

A

Paroxetine (presents with sweating, headache and a needle-like sensation in the head)

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12
Q

True or false - tricyclic antidepressents such as amitriptyline can make alzheimer’s / dementia worse

A

True

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13
Q

What are the 2 presenting types of bipolar disease?

A 
Type I (most common) = mania + depression 
Type II = hypomania + depression
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14
Q

What is the lifetime prevalence of bipolar disease and when does it typically first present?

A

Lifetime prevalence = 2%

Typically presents in the late teens

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15
Q

What is the difference between mania and hypomania?

A 
Hypomania = elevated mood without the delusions/hallucinations/psychotic symptoms. May have reduced need for sleep, increased sexual energy etc. Typically lasts for shorter of periods of time as well than manic episodes. 
Mania = more extremely elevated mood/energy, doesn't have to be associated with psychotic symptoms but when it is typically associated with delusions of grandeur etc. Last for longer periods of time than hypomania.
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16
Q

How does NICE recommend you manage a patient presenting to the GP with mania/hypomania/suspected bipolar disease?

A

Hypomania - routine referral to community mental health

Mania or severe depression = urgent referral to community mental health

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17
Q

Scoring system to assess depression / anxiety

A

HAD (Hospital Anxiety and Depression Scale) -> can be used for anxiety and depression
PHQ-9 (Patient Health Questionnaire - 9) -> to assess depression

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18
Q

What are the Schneider’s First Rank Symptoms (strongly suggestive of a diagnosis of schizophrenia)?

A

Auditory hallucinations (hearing voices)
Thought broadcasting
Thought insertion/ withdrawal / interruption
Somatic hallucination
Delusional perception

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19
Q

What is the 1st line drug treatment for moderate to severe depression in under 18s

A

FLUOXETINE

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20
Q

What is the 1st line drug treatment for adults with moderate depression?

A

SSRI (fluoxetine, citalopram, sertraline)

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21
Q

What is the 2nd line drug treatment for moderate depression in adults?

A

Alternate SSRI or TCA (Amitriptyline) or SNRI (venlefaxine, duloxetine)

Avoid SNRI or TCA if at higher risk of overdose.

If switching between anti-depressents you should cross-taper (slowly reduce the dose of one while increasing the other)

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22
Q

What are the typical blood tests in anorexia nervosa?

A

HIGH cholesterol, HIGH growth hormone, HIGH cortisol, HIGH blood glucose, HIGH carotin
LOW FSH +LH

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23
Q

Acute dystonia?

A

torticollis + oculogyric crisis

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24
Q

What is optimal management of PTSD

A

If mild + <4 wks - can watch + wait
if not:
1st line = Eye movement desensitisation and reprocessing (EMDR)
2nd line of above doesn’t work -> drug tx with eg Mirtazapine, Paroxetine (+ phenelzine, unlicensed, specialists only)

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25
Q

A score of what on the mini mental state exam is suggestive of dementia?

A

Score < 24

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26
Q

Symptoms of acute versus chronic schizophrenia?

A

Acute - POSITIVE symptoms -> Schneider’s first rank symptoms -> auditory / somatic hallucination, though disorders, delusional perceptions, passivity of feelings

Chronic - NEGATIVE symptoms -> depression, apathy, social withdrawal, loss of affect

27
Q

what is the first line drug for schizophrenia?

A

Risperidone

Atypical antipsychotic

28
Q

what is a agoraphobia?

A

fear of leaving home / being in public / crowded places

29
Q

what are the different stages of detaining someone unde the mental health act England?

A

1) section 135 / section 136 is a warrant for the police to move a person from their home / the community respectively into a place of safety (POS) -> from then they have 24 hrs to get a Mental Health Act Assessment (2x doctors + approved mental health act practitioner)
->
Section 2 -> 28 days detained then needs re-assessment

->
Section 3 -> upto 6 months then needs re-assessment (pt needs a diagnosis for this)

IF PATIENT ALREADY IN HOSPITAL (either for a physical condition or in a psych hospital then wants to leave)

  • > section 5 -> bides time for mental health act assessment.
  • > section 5(4) - by nurses, lasts upto 6 hrs
  • > section 5 (2)- by medics, lasts upto 72 hrs
30
Q

what is echopraxia?

A

when someone involuntarily copies your movements/behaviour repetitively

31
Q

What is the presentation of borderline / impulsive personality disorder?

A

Unstable, impulsive, fear of being abandoned

32
Q

What is the presentation of dependent / asthenic personality disorder?

A

Inadequacy that leads to them to want to hand over responsibility over their lives to others

33
Q

What is the presentation of histrionic / narcissistic personality disorder?

A

Attention seeking behaviour to maintain themselves as the centre of attention

34
Q

What drugs should you avoid giving alongside lithium?

A

Low sodium increases the risk of lithium toxicity -> so should avoid DIURETICS alongside lithium -> especially thiazide diuretics

35
Q

Which group of drugs are common culprits at causing NEUROLEPTIC MALIGNANT SYNDROME?

A

Neuroleptic malignant syndrome -> muscle rigidity + fever + autonomic dysfunction

More commonly occurs in the TYPICAL / 1ST GENERATION ANTIPSYCHOTICS.

36
Q

Typical / 1st generation antipsychotics?

A

= more likely to cause neuroleptic malignant syndrome and extrapyramidal side effects
= promazine, chlorpromazine, prochlorperazine, haloperidol

37
Q

Atypical / 2nd generation antipsychotic?

A

less likely to cause extrapyramidal side effects / NMS
BUT instead are associated with WEIGHT GAIN + GLUCOSE INTOLERANCE
=
Olanzapine, Quetiapine, Clozapine, Risperidone, Aripiprazole

CLOZAPINE = an atypical anti-psychotic used for RESISTENT schizophrenia -> needs regular monitoring as can cause NEUTROPENIA / AGRANULOCYTOSIS

38
Q

1st line treatment for schizophrenia?

A

Should be started after the FIRST episode of psychosis because high risk of progression to future episodes.
Should NOT start antipsychotic in primary care UNLESS in liaison with a consultant psych.

1st line = oral antipsychotic (Risperidone) + psychological therapy (CBT)

39
Q

Which SSRI must have a wash-out period before starting another anti-depressent?

A

FLUOXETINE
need to wait 4-7 days between weaning a patient off fluoxetine before starting a new type of anti-depressent due to it’s long half life

40
Q

Main indications for electroconvulsive therapy?

A

Severe depression
Severe psychosis
Catatonia
Mania

41
Q

What are RELATIVE and ABSOLUTE contraindications for electroconvulsive therapy?

A

ABSOLUTE - recent subdural or subarachnoid bleed

RELATIVE - recent MI or stroke

42
Q

1st line treatment for OCD?

A

CBT with EXPOSURE + RESPONSE PREVENTION (exposing them to the thing that makes the anxious repeatedly)

If that fails or they have severe functional impairment -> SSRI + more intensive CBT

43
Q

What severity of depression is associated with what PHQ9 score?

A

Mild depression - 5-9
Moderate - 10 -14
Moderately severe - 15-19
Severe - 20 or above

44
Q

Which factors indicate a POOR prognosis in schizophrenia?

A

Male gender
Young age at onset
Predominantly negative symptoms
Insidious onset of initial symptoms

ALL indicate a poor prognosis

(if they’re older when they develop it this is a positive sign)

45
Q

Bipolar I v Bipolar iI

A

Bipolar i -> MANIC episodes + SEVERE DEPRESSIVE EPISODES = MOST COMMON
Bipolar II -> hypomania + depressive episodes (less extreme, less common)

46
Q

typical presentation of dyslexia?

A

boys more common
difficulty with phonemes / syllables
family component, linked to autism and ADHD
Screen for it using the GAPS test in 3-6 year olds

47
Q

Oestrogen replacement therapy for postnatal depression?

A

evidence of SOME benefit

but should NOT be used if breast feeding

48
Q

What is a pseudo-hallucination?

A

A hallucination that the patient is aware is not real life -> can sometimes lead into full blown psychosis but not always

49
Q

What is dissociative identity disorder?

A

the new name for multiple personality disorder

50
Q

what is a dissociative fugue?

A

often a response to trauma, you forget who you are, where you are from and everything about your past

51
Q

typical presentation of amphetamine use?

A

Amphetamine = speed, whizz, uppers, billy, amp

Side effects –> mood swings, irritability, panic attacks, comedown

52
Q

Patients that are dependent on alcohol are required by law to disclose to the DVLA - true or false?

A

TRUE

53
Q

After psychological therapies, what drugs are recommended to maintain abstinence from alcohol?

A

1st line -> psychological therapy
2nd line -> Acamprosate or Naltrexone (reduce cravings) + Psychological therapy

Alternative options:

  • Disulfiram -> produces an acute sensitivity if you drink on it
  • Nalmefene -> reduces the high associated with alcohol in high risk drinkers that don’t need immediate detoxification
54
Q

What is the typical presentation of cocaine withdrawal?

A

Ants crawling on the skin (fornication)

+ Paranoia

55
Q

typical presentation of anti-depressant discontinuation reaction?

A

Higher risk with short acting anti-depressants like Venlafazine and Duloxetine
= VIVID DREAMS + LIMB NUMBNESS + GI UPSET

56
Q

what is systemic therapy?

A

Systemic therapy = support for the whole family unit

= talking therapies with the whole family present but also individual sessions

57
Q

what are examples of tests for frontal lobe function?

A
  • Verbal fluency (how many words can you say that start with the letter ‘a’)
  • Clock drawing
  • Abstract thinking (What’s the link between a cat and dog)
  • Response inhibition / motor perseveration (tap once when i tap twice)
  • Estimating (how much do you think this weighs)
58
Q

What is 1st line in the management of moderate ADHD in children?

A

Methylphenidate + psychotherapy

59
Q

What duration of symptoms is needed to diagnosis a manic episode?

A

7 days + of manic symptoms

60
Q

what duration of symptoms is needed to diagnose a hypomanic episode?

A

4 days + of hypomania

61
Q

Which antipsychotic requires MONITORING EXCLUSIVELY IN SECONDARY CARE ?

A

Clozapine

due to the risk of neutropenia / agranulocytosis

62
Q

What is the 1st line treatment for seasonal affective disorder?

A

Early morning light therapy

63
Q

Medical management of Alzheimer’s dementia?

A

Moderate Alzheimer’s:
1st line = acetylcholinesterase inhibitor = Donepezil, Rivastigmine, Galantamine
2nd line -> if acetlycholinesterase inhibitor contraindicated = Memantine

Severe Alzheimer’s:
1st line = Memantine

64
Q

Which dementia assessment tools take less than 5 mins and are suitable for use in the community?

A

GPCOG
6-item cognitive impairment test (6-CIT)
Abbreviated Mental Test Score (AMTS)

MSRA 2022 (23 decks)

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