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Revision > Psychiatry > Flashcards

Psychiatry Flashcards

1
Q

Forms of delusion (5)

A
  • reference
  • control
  • guilt
  • grandiosity
  • persecution
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2
Q

Somatisation disorder

A

Multiple physical symptoms and investigations with no physical cause.

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3
Q

Hypochondriasis

A

Persistent belief in the presence of an underlying serious disease
Refuses to accept reassurance or negative result

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4
Q

Munchausen/fictitious disorder

A

Intentional production/ falsification of psychological signs and symptoms to obtain medical attention and treatment

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5
Q

Malingering

A

Fraudulent simulation or exaggeration of symptoms with the intention of financial or other gain

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6
Q

Conversion/ dissociative disorder

A

Loss of motor or sensory function without organic cause

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7
Q

La belle indifference

A

La belle indifference is defined as a paradoxical absence of psychological distress despite having a serious medical illness or symptoms related to a health condition.

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8
Q

Gander syndrome/ prison psychosis

A

Deliberately acts as if/she has physical or mental illness when they aren’t really sick

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9
Q

Cowards delusion / nihilistic delusion

A

Holds belief they are dead or do not exist

Or have lost their blood or internal organs

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10
Q

Capgras syndrome

A

Irrational belief someone they now has been replaced by an imposter

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11
Q

Fregoli delusion

A

Delusional belief the different people (>1) are in fact a single person that changes appearance / is in disguise

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12
Q

Acute alcohol withdrawal

  • symptoms
  • treatment
A

Sweating , agitation , tremors, altered mental ion
1 - Chlordiazepoxide
2- thiamine vit B1

If seizure of hallucination - delirium tremendous
- IV lorazepam or diazepam

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13
Q

Wenickes encephalopathy
Symptoms
treatment

A

CAS - confusion , ataxia, squint : ophthalmoplegia, nystagmus, diplopia

IV vitamin B1(thiamine), IV pabrinex or high potency Vit B complex

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14
Q

Medication to give alcoholic to serve as detergent when he takes alcohol

A

Disulfiram

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15
Q

Medication to help reduce withdrawal sx in alcoholics

A

Chlordiazepoxide

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16
Q

Acamprostate use

A

Reduces craving for alcohol

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17
Q

Chronic alcoholism liver fn

A

Raised MCV , GGT

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18
Q

Anorexia nervosa management
BMI <15
BMI 15-17.5
>17.5

A

BMI <15 ,+ rapid wt loss and evidence of system failure
= urgent referral to medical/pads ward

Severe electrolyte imbalance, Brady,hypoglycaemic
- acute medical ward regardless of BMI

15-17.5 + no system failure / complications =
Routine referral to eating disorder unit / local community mental health team

Severe self harm - high risk of suicide
- admit to an acute psychiatric ward

> 17.5 w/o complications - build trusting relationship and encourage self help books and food diary

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19
Q

Autism spectrum disorder

Features

A 
Impaired language and communication
“ social relationships
Compulsive behaviour 
Collects things 
Decreased IQ in most children
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20
Q

Management of insomnia in ADHD patient

A

1st line - sleep hygiene

2nd - melatonin

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21
Q

Mania vs hypomania

A

Mania - > 7days , severe functional impairment, may have psychotic symptoms

Hypomania - < 7 day , function not impaired, no psychotic symptoms

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22
Q

Treatment of bipolar disorder

A

Mood stabilisers - lithium

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23
Q

Features of lithium toxicity

A
  • coarse tremor (fine tremor at therapeutic level)
    -muscular twitching
  • nausea & vomitng
  • drowsiness, confusion
    __
    Hyperreflexia
    Seizure - severe toxicity
    Coma - severe toxicity
    Blurred vision
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24
Q

Management of lithium toxicity

A

Serum lithium levels
Mild-moderate toxicity- normal resuscitation + normal saline
Haemodialysis - severe toxicity

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25
Q

Diuretic and NSAID effect on lithium

A

Increase renal absorption of lithium - leads to toxicity

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26
Q

Lithium and planning pregnancy

A

Teratogenic - ebstein anomaly, thyroid disease, floppy baby syndrome

If planning to get pregnant - reduce gradually & stop before pregnancy confirmed

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27
Q

Woman on lithium gets pregnant

What should be done?

A

Consider stopping it gradually over 4 weeks if she is well

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28
Q

Woman on lithium while pregnant

What. Should be done?

A

Check lithium levels monthly until 36 weeks

Then weekly until birth

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29
Q

How often should lithium levels be checked

A

1 week after starting
Every 3 months
- check lithium 12 hours after last dose (narrow therapeutic range)

LFT U&E -every 6 months

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30
Q

2 important tests to be done before initiating lithium

A

Thyroid & kidney function

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31
Q

Tests to be done before prescribing amiodarone

A

Serum U&E s

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32
Q

SSRI + lithium in bipolar patient

A

SSRI can worsen episodes of mania

Antidepressants precipitate manic episodes
Should be stopped if mania is worsened

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33
Q

Advice on stopping antidepressants

A

Continue for at least 6 months in total even if there is improvement

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34
Q

First line in depression - how long do they take to work

A

SSRIs - take 2-4 weeks to work

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35
Q

Depression management

A

Psychotherapy - CBT + SSRIs(fluoxetine, sertraline, citalopram)
No response 2- 4 weeks - check adherence to meds
If adherent and no response after 4 weeks - up the dose or change SSRI
Or shift to different class of antidepressants - mirtazapine

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36
Q

Best antidepressants in MI patients

A

SSRIs - sertraline

2nd line - citalopram

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37
Q

SSRIs

A

Citalopram
Fluoxetine - DOC when antidepressant indicated
Sertraline - post MI
Paroxetine

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38
Q

SNRIs

A

Venlafaxine , Duloxetine

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39
Q

Tricyclic antidepressants

A

Amitriptyline

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40
Q

Presynaptic alpha antagonist

A

Mirtazapine

^ atypical antidepressant

41
Q

Postpartum blues
Features
Treatment

A

3-7 days following birth
Common in primi
Anxious tearful irritable , crying

T- reassurance

42
Q

Postnatal depression
Features
Treatment

A

Peaks @ 3-4 weeks postpartum , can occur anytime in first 6 months
Occasional thoughts of harming baby
- feels she can’t look after baby properly or wont be a good mother

T - CBT , then SSRIs
If breastfeeding — sertraline

43
Q

Puerperal psychosis.
Feature
Treatment

A 
2-4 days postpartum, - peaks @ 2 weeks 
Can present anytime after delivery 
Severe mood swings + disordered perception 
Thought of harming baby 
Suicidal thoughts

t- ECT , mood stabilisers, antidepressant

44
Q

Depressed person, no point in living
Refuses help/treatment
What should you do?

A

Compulsory admission under the mental health act

45
Q

Hormone disturbance in Schizophrenia

A

Dopamine

46
Q

Schizophrenia symptoms

A

Auditory hallucinations
Thought disorders - insertion, withdrawal, broadcast, blocking
Passivity phenomena - body sensation controlled externally
Delusional perceptions

47
Q

Management of schizophrenia

A

Risperidone , Olanzapine

Quetiapine

48
Q

Hypnagogic hallucination

A

Auditory hallucination while going to sleep

49
Q

Hypnopompic hallucination

A

Auditory hallucination waking up

50
Q

Management of panic attacks - long term

A

CBT
SSRIs - sertraline, fluoxetine
Acute episode - simple breathing exercise + reassurance

51
Q

Panic disorder management

  • before attack
  • during
A

Before - b blocker

During - rebreathe into paper bag

52
Q

Management of GAD

A

CBT

SSRI - sertraline

53
Q

Othello syndrome

A

Over jealousy, suspecting unfaithful partner

54
Q

Ekbom’s syndrome

A

Delusion of parasite infection

55
Q

OCD

1st line of treatment

A

CBT

- exposure and response prevention (part of CBT)

56
Q

PTSD

Features

A 
Symptoms present for >1 month 
Re -experiencing 
Avoidance
Hyperarousal 
Emotional numbing - depersonalisation 
Depression
57
Q

PTSD treatment

A

1- CBT
2- SSRI

Watchful wait for mild symptoms <4weeks

58
Q

Agoraphobia

Management

A

Fear of open spaces

- CBT + graded exposure

59
Q

Opioid/heroin overdose
Low RR low HR low BP pinpoint pupils
Treatment

A

Naloxone

60
Q

Opioid addict wants to quit, what will help combat withdrawal?

A

Methadone

61
Q

Tourette’s

Age group

A

Repetitive tics - motor + vocal

6-13 yrs old

62
Q

Asperger syndrome affects __

A

Social net reactions + behaviour

63
Q

Rents syndrome

A

Normal development until 2-3 yrs old

Regression in motor social language and coordination skills after

64
Q

Willis ekbom syndrome vs ekbom syndrome

A

WEs - restless leg syndrome, check ferritin
If low give iron , if normal give dopamine agonist

Ekbom - delusion of parasite infestation

65
Q

Incongruent affect seen in

A

Bipolar disorder

Schizophrenia

66
Q

Long term antipsychotic us + continuous involuntary movements
Management

A

Tardive dyskinesia
Depot injection of atypical antipsychotics- risperidone, olanzapine
Not oral!

67
Q

Akathisia

A

Long term antipsychotic use + continuous sensation of restlessness

68
Q

Brocas aphasia

A

Broken speech

Know and understand what they are saying

69
Q

Wernickes aphasia

A

Difficulty with speech comprehension

Fluent speech that doesn’t are sense

70
Q

Normal grief reaction

Stages

A 
<6 months after major life event 
Denial & isolation
Anger
Depression 
Bargaining 
Acceptance
71
Q

Adjustment disorder

A

<6 months after major life event
Crying hopeless withdrawn

Normal grief = subtype of adjustment disorder

72
Q

Acute stress reaction

A

Duration < 4 weeks

Starts few mins or hrs after stressful event

73
Q

Antisocial personality disorder

Features

A

M>F
Criminal act
Lack of remorse
Aggressive

74
Q

Borderline personality disorder

Features

A 
Unstable interpersonal relationships
 Marked impulsivity , inability to control anger 
Mood swings 
Self harm attempts
Dramatic attention seekers
75
Q

Side effects of SSRIs

Avoid use w/

A

GI symptoms - most common
- increased risk of GI bleed
SIADH
Avoid w/- NSAIDs, aspirin, warfarin, triptans

Fluoxetine - anorgasmia (delayed ejaculation)

76
Q

Side effect haloperidol

A

Sexual dysfunction

Gynecomastia

77
Q

Rapid tranquillisation in acute psychosis

A

Lorazepam > haloperidol > olanazapine

Acute episode - halo is drug of choice, esp in elderly

78
Q

Contraindication of haloperidol

A

Parkinson’s

Alzheimer’s

79
Q

Erotomania

A

Delusional belief that someone oh higher social status falls in love with them and makes amorous advances

Delusion of love

80
Q

Folic a deux/ shared psychosis

A

Shared delusional disorder

81
Q

Serotonin syndrome

A 
Overdose of SSRI
Neuromuscular excitation - hyperreflexia, myoclonus, rigidity 
ANS excitation - hyperthermia
Altered mental state 
Nause, diarrhoea
82
Q

Neuroleptic malignant syndrome vs SSRI syndrome

A

Similar features in both
1 with SSRI use
NMS - dopamine antagonist overdose (metoclopramide) or potent antipsychotic - clozapine , risperidone

83
Q

LSD overdose (5)

A 
Mydriasis - dilated pupils 
Flushing sweating 
Tremors
Hyperreflexia 
Delusions + hallucinations** - smelling colours , seeing sounds
84
Q

Ecstasy overdose

A

Nausea, flushing , hyperthermia , tachycardia, tachypnea , thirst
Seeing spots of colour when eyes OPEN

LSD - colours when eyes closed

85
Q

Paracetamol overdose

- investigations

A

On admission - FBC UE LFT INR blood gases glucose

Serum paracetamol 4 hours after ingestion**

86
Q

When IV n-acetylcysteine should be given (6)

A

Staggered paracetamol overdose - tablets not takenWithin 1 hr
Doubt over the time of ingestion
patient presents >8hr after ingestion
Jaundice or liver tenderness
Unconscious pt w/ suspected overdose
4 hr post ingestion plasma conc - on or above treatment line

87
Q

Critical dose of paracetamol

A

150 mg/kg in 24 hrs - approx 24 tablets

88
Q

Activated charcoal use in paracetamol overdose

A

If presents within 1 hr - give activated charcoal 1g/kg = max 50g
+ paracetamol ingested >=150mg/kg or 24 tabs

89
Q

Liver transplant referral in paracetamol over dose

When?

A 
Arterial pH <7.3, 24 hrs after ingestion 
OR all of the following :
PT >100 s
Creatinine > 300 umol/l
Grade 3 or 4 encephalopathy
90
Q

Delirium tremens vs alcohol hallucinosis

A

DT - hallucinations begin > 48 hrs after alcohol intake in chronic alcoholic

AH- few hrs after acute alcohol intake

91
Q

AUDIT questionnaire (7)

A

Wake up drinking
Remorse/guilt
> = 8 units on single occasion male / female >= 6
No memory of wha happened night before being drunk
Self injury or injury to others
Cants stop once they start
Health professional is concerned

92
Q

Important association/ side effect of citalopram

A

Associated with a cute angle closure glaucoma

93
Q

Depressed patient on warfarin / heparin

Med to be given?

A

Mirtazapine (may cause INR to rise slightly )

Don’t give SSRI

94
Q

Drug of choice in psychotic depression

A

TCA - amitriptyline

Continue 6-9 months after symptom resolution

95
Q

Drug induced Parkinson’s

Treatment

A

2ry to antipsychotic meds - dopamine deficiency

Stop or lower dose
If not suitable - give anticholinergic - procyclidine

96
Q

Acute stress reaction
Features
Management

A

Few mins or hrs after stressful stimulus
Can last up to 4 weeks
Characterised by :
Flashbacks + avoidant + hyperarousal

Mgmt - reassure
If severe and affects daily functions - trauma focused CBT

*PTSD if >4 weeks

97
Q

Risk factors of suicide

A 
Previous attempts= greatest risk ;or self harm 
Depression and other mental illness
Alcohol and drug abuse
Low SE status 
Divorce
98
Q

Most appropriate treatment of psychotic depression

A

ECT

Refer to CBT afterwards

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