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Psychiatry Flashcards

1
Q

List the features of panic disorder

A

Fear they are dying/having heart attack/stroke
Physical symptoms
Paroxysmal

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2
Q

Describe the features of PTSD

A

Significant life event - occurs weeks/months after
Avoidance of situations related to the traumatic event
Re-experiencing/flashbacks
Insomnia
Hyper-alert and hypervigilant
Detachment

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3
Q

What is the treatment of PTSD

A

EMDR
Trauma focused CBT
Medication is 2nd line

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4
Q

How long does a patient need to have depressive symptoms for a diagnosis of clinical depression

A

2 weeks

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5
Q

Describe the features of OCD

A

Recurrent intrusive ideas/obsessions
Recognises as from own mind
Resisted to a degree
Linked with the urge to carry out physical actions
Common themes - contamination, safety, sexual, violent

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6
Q

How is OCD treated

A

Exposure and response prevention

Medication is 2nd line

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7
Q

What are the treatments for specific phobia

A

Drugs are not useful
CBT
Systematic desensitisation
Flooding

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8
Q

What is psychosis

A

Loss of contact with reality
Hallucinations
Delusions
Thought disorder

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9
Q

Describe some similarities between the ICD-10 and DSM 5 diagnosis of schizophrenia

A 
Prescence of delusions or hallucinations
Mention of disorganised thinking or speech
Inclusion of catatonic behaviour
Includion of negative symptoms
Chronicity
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10
Q

List Scheniders 1st rank symptoms

A

Auditory hallucinations - audible thoughts, voice heard arguing or discussing, voices heard commenting on ones actions

Somatic hallucinations
Made actions
Made thoughts
Made emotions
Thought withdrawal 
Thought insertion 
Thought broadcast
Delusional perception
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11
Q

List some core symptoms of mania

A 
Elated or expansive mood
Overactivity 
Grandiosity 
Flight of ideas
Pressure of speech 
Decreased need for sleep
Overspending money 
Sexual disinhibition 
Mutism - very severe and rare
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12
Q

Describe some features of autism spectrum disorder

A

Social communication and interaction deficeits
Restricted or repetitive interests
Associated with low IQ and seizures though may be high functioning
Sensory abnormalities

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13
Q

Describe some features of attention deficit hyperactivity disorder

A

Overactivity and impulsivity
Inattention
Poorly modulated behaviour
Poor task persistence, difficulty organsiing self
Pervasive across sitations
Persistent over time
Some features should be present before age 12

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14
Q

List the subtypes of dementia

A

Alzheimers
Vascular
Lewy-body
Fronto-temporal dementia

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15
Q

List the causes of delirium

A 
Drugs - alcohol, opiates, anticonvulsants, recreational, post general anaesthetic  
Electrolyte imbalance - hyponatraemia and hypercalcaemia
Lacking medication/alcohol 
Infection 
Reduced sensory input - lack of sleep 
Intracranial 
Urinary/faecal retention
Metabolic
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16
Q

How is BMI calculated

A

Kg/m^2

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17
Q

What behaviour is bulimia associated with

A

Binging and purging

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18
Q

List some red flags in anorexia nervosa

A

Vital signs - reduced muscle power (sit stand test), pulse <40, temp <35, postural symptoms

BMI - high risk <13, medium risk 13-15

Bloods - low Na, Low K, raised LFTs, raised Ur, Cr, low glucose

ECG - bradycardia, increased QTc, t wave changes

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19
Q

List the CAGE questions

A

Cut down
Annoyed
Guilty
Eye opener

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20
Q

What should you ask in an alcohol history

A

What do you drink in a normal day, start from when you wake up
How many units a week?
When do you start drinking?
How has your drinking progressed?
Do you have to drink more now to reach the same effect you used to feel when drinking less?
What kind of alcohol?
Do you prioritise drinking over other activity?
Do you get cravings for alcohol?
Harmful use of alcohol?
Do you drink alone?
What happens if you do not have a drink?
Ever received detox/treatment for alcohol in the past?
Screen for physical symptoms - memory, appetite, weight loss, psychotic features and low mood
Affect on work, relationships, law and driving

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21
Q

Describe alcohol dependence

A

Strong desire to take the drugs
Difficulties in controlling its use
Persisting in its use despite harmful consequences
Slience - higher priority given to the drug than other activities and obligation
Increased tolerance and sometimes a physical withdrawal

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22
Q

What is a section 5(2)

A

Temporary hold while waiting for assessment - 72hrs

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23
Q

What is a section 2

A

For treatment and assessment - 28days

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24
Q

What is a section 3

A

For treatment - 6 months

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25
Q

What is a section 136

A

Police - to take person to place of safety

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26
Q

When is mental health act used

A

When threshold for admission is met and at significant risk to themselves and the patient is not willing

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27
Q

List some risk factors for completed suicide

A 
Male 
Bimodal age distribution 
Single/unattached
Unemployment 
Substance misuse
Past psych history 
History of DSH 
Recent psych inpatient
Planned
Violent means
Made efforts not to be found
Final acts
Believed act would be fatal 
Sorry and angry that the act failed
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28
Q

How do you test mental capacity

A

Does the patient have a disorder of the mind or brain - if no then assume person has capacity

If yes then 
Can they understand the information 
Can they retain the information 
Can they weigh up the pros and cons 
Can they communicate their decision
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29
Q

List the symptoms of depression

A

Core symptoms - low mood, anhedonia and fatigue
Other symptoms - difficulty concentrating, reduced attention span, sleep disturbance, early morning wakening (>2hrs earlier), decreased appetite, weight loss, loss of libido, diurnal mood variation, feelings of worthlessness and guilt, recurrent thoughts of self harm and suicide

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30
Q

Describe the management of mild depression

A

Exercise
Sleep hygiene advice
CBT

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31
Q

Describe the management of moderate/severe depression

A

Medication - SSRI
Exercise, sleep hygiene advice
CBT or interpersonal therapy
Inpatient admission if risk to self or others - consider use of the mental health act

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32
Q

List some general symptoms of an anxiety disorder

A

Autonomic symptoms - palpitations, sweating, tremor, dry mouth
Chest and abdo symptoms - breathing difficulty, feeling of choking, chest pain, nausea, abdominal distress
Symptoms involving mental state - feeling dizzy or fearful
General symptoms - hot flushes, cold chills, numbness, restlessness, feeling tense or irritable

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33
Q

How long must anxiety symptoms be present for a diagnosis of generalised anxiety disorder to be made

A

6 months

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34
Q

What medication can be used in anxiety disorders

A

SSRI and propranolol (beta blocker)

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35
Q

List some positive symptoms of schizophrenia

A

Hallucinations
Catatonia
Neologisms
Tangential speech

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36
Q

List some negative symptoms of schizophrenia

A

Anhedonia
Blunting of affect
Poverty of speech
Marked apathy

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37
Q

List some risk factors for schizophrenia

A

Male
Heavy cannabis use
Social isolation
FH

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38
Q

What is ECT used

A

Catatonic schizophrenia

Treatment resistant depression

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39
Q

Describe Alzheimer’s disease

A

Most common type of dementia
Progressive global impairment of cognitive function
Short term memory first, followed by confusion, irritability, aggression, long term memory loss, mood swings and incontinence

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40
Q

List some risk factors for Alzheimer’s disease

A

Female
Caucasian
Advanced age
Vascular disease

41
Q

Describe vascular dementia

A

Stepwise decline
Stroke <3months of symptoms starting
CV risk factors present

42
Q

Describe dementia with Lewy bodies

A

Fluctuating confusion
Parkinsonian features - tremor, bradykinesia, festinating gait, ataxia leading to falls, micrographic
Visual hallucinations
Intermittent loss of consciousness
Short term memory often preserved to a greater extent than in Alzheimer’s but visuospatial difficulties more pronounced

43
Q

Describe frontotemporal dementia

A 
Aggression
Inapproiate social behaviour
Emotional blunting 
Incontinence 
Speech and language difficulty 
Often insidious onset with earlier age of onset
44
Q

What are some differentials to dementia in memory loss

A

Normal ageing
Delirium
Depressive pseudodementia - memory impairment and difficulty with attention and concentration
Metabolic disturbance - uraemia, hypothyroidism, hypercalcaemia, hypoglycaemia, vit B12 defiency
Brain tumour
Parkinsons disease - memory loss after >1yr diagnosis of PD

45
Q

Describe hypomania

A

Persistent, milder form of mania with slightly elated mood that alternates with irritability, high energy levels and restlessness
Delusions and hallucinations are not present

46
Q

Describe adjustment disorder

A

Insomnia, poor concentration, avoiding important jobs, skipping school or work - signs mimic mania
Low mood and anxiety in the context of an identifiable stressor

47
Q

What investigations would you do for someone following an alcohol history

A

General physical exam - malnourishment, liver and cardiac disease
Bloods - FBC, U&Es, CRP, LFT, Clotting, lipids, glucose, GGT, vitamin levels (thiamine)
USS/CT/MRI and echo

48
Q

Describe the management of alcohol dependence

A

General - advice about adverse effects of alcohol, vitamin supplements including thiamine, support and advice, financial support

Acute alcohol withdrawal - Inpatient admission? IV pabrinex or oral thiamine, reducing regimen of chlordiapoxide (tremor and delirium tremens)

Abstinence - naltrexone (reduces pleasurable effect of alcohol), disulfiram (causes an unpleasant reaction if drinking), Acamprosate (reduces craving)

49
Q

Name and describe two screening tools for eating disorders

A

SCOFF Sick - do you ever make yourself sick because you are uncomfortably full
Control - do you worry you have lost control over how much you eat?
One stone - have you lost greater than 6kg/a stone over the past 3 months
Feel fat - do you believe you are fat
Food dominates - do you feel food dominates your life

WAIF
Weight - weight and height for BMI 
Amenorrhoea - have you periods been regular? 
Induced vomiting/exercise/laxative
Fear of fatness
50
Q

Describe the features of anorexia

A

Underweight BMI <17.5
Distorted body image
Food dominates
May utilise other methods of weight loss - excess exercise, talking laxatives, diuretics, appetite suppressants

51
Q

Describe the features of bulimia

A 
Normal or overweight 
Binge eating 
Purging 
Eating patterns irregular
Amenorrhoea and oligomenorrhoea 
Erosion of teeth, sore throat and reflux due to purging
52
Q

What bloods should be taken in eating disorders

A

FBC
U&Es
LFTs
Glucose

53
Q

Describe the management of eating disorders

A

Advice on healthy eating
Psychotherapy - CBT, interpersonal therapy
Medication - SSRI to reduce binge and purge or if comorbid depression

54
Q

List the 8Cs for reasons of self harm

A 
Coping 
Control
Cleanse 
Confirmation of existence
Creating comfortable numbness
Chastisement 
Communication
55
Q

Give some examples of antiphsyctics

A

Olanzapine - treatment resistant schizophrenia - risks
Aripiprazole
Quetiapine
Risperidone

56
Q

Which anti-hypertensive may be a cause of depression

A

Beta blocker

57
Q

List some SSRIs

A

Sertraline
Citalopram
Fluoxetine
Paroxetine

58
Q

What drug class is venlafaxine

A

SNRI

59
Q

What drug class is moclobemide

A

RIMA - reversible monoamine oxidase inhibitor

60
Q

What drug class is dosulepin

A

Tricyclic

61
Q

How long must a 2nd depressive episode be treated for

A

2 years

62
Q

How do you distinguish between mania and hypomania

A

Hypomania - can function

Mania - impaired functioning

63
Q

What percentage of manic patients go on to have a depressive episode

A

90%

64
Q

List the risks of mental illness

A

Risk to self - self neglect or self harm or suicide
Risk to others - family, children, public, risk of violence
Risk of deteriorating mental health

65
Q

Which section should be used in A&E

A

Section 2

66
Q

Which section cannot be used in A&E

A

Section 5(2) - patient needs to already be admitted and in A&E not classed as admission

67
Q

List some drugs which can be useful in treating mania

A

Olanzapine - antipsychotic

Clonazepam and lorazepam

68
Q

How can lorazepam be given

A

Oral or IM

69
Q

Describe lithium level monitoring

A

Narrow therapeutic index
Level monitored 5 days after starting treatment and until levels are in range 0.6-1
Monitor every 3 months thereafter

70
Q

List some side effects of lithium

A

Renal impairment
Thyroid impairment - hypothyroid
Parathyroid impairment

71
Q

Describe the use of CBT in mania

A

Not useful in acute phase
Useful in depression
May improve concordance to medication

72
Q

When is lithium used in mania

A

As a preventative measure

73
Q

What is the recommended duration of treatment with benzodiazepines

A

2-4 weeks

74
Q

How do you reduce the dose of long term benzodiazepines

A

Reduce the dose by an 1/8 the daily dose every fortnight

75
Q

Describe how benzodiazepines work

A

Increase the activity of GABA

GABA is an inhibitory neurotransmitter so they decrease neuronal excitability

76
Q

Which benzodiazepine is the hardest to withdraw from

A

Lorazepam - shortest half life

77
Q

Which class of drug should be started if SSRIs have not worked

A

SNRI - venlafaxine

78
Q

How long can it take SSRIs to work

A

8 weeks

79
Q

Which neurotransmitters does venlafaxine work on

A

Serotonin and noradrenaline - reuptake inhibitors

at higher doses also dopamine reuptake inhibitor

80
Q

Describe puerperal psychosis

A

Occurs in the first 3 weeks post natal
Affective in nature
Acute onset

81
Q

Which antidepressant should be avoided in pregnancy

A

Paroxetine - risk of cardiac abnormality

82
Q

Which fetal abnormality is associated with lithium use during pregnancy

A

Ebstein’s anomaly - cardiac - tricuspid valve

83
Q

Which drug when taken in pregnancy has been associated with cleft lip

A

Benzodiazepines

84
Q

Is lithium safe in breast feeding

A

No

85
Q

When is the Edinburgh post natal depression scale used

A

When a post natal woman presents with either low mood or anhedonia or both

86
Q

What is neoligism

A

Made up words

Seen in psychosis

87
Q

Describe knights move thinking or loosening of associations

A

Thoughts have no relation to one another - psychosis

88
Q

Describe flight of ideas

A

Thoughts are slightly linked - mania

89
Q

Describe delusions of passivity

A

Delusions of control and where the person thinks someone or something is controlling them

90
Q

Describe how you start medication in psychosis

A

Start low and go slow

91
Q

Describe the presentation and inheritance of hungtintons chorea

A 
Autosomal dominant 
Low mood
Memory problems
Chorea 
Happens earlier and more severe in later generations
92
Q

Name some Alzheimer’s drugs and give their drug class

A

NMDA receptor partial agonist - memantine

Acetylcholinesterase inhibitors - donepezil, rivastigmine, galantamine

93
Q

Which electrolyte disturbances are seen in bulimia nervosa

A

Hypokalaemia

Hypocalcaemia

94
Q

What is the HCR-20

A

Assess the risk to others

95
Q

What is the PCL-R

A

Assess for psychopathy

96
Q

What is the PHQ-9

A

Depression score done in GP

97
Q

List and describe extrapyramidal side effects of antipsychotic medication

A

Tardive dyskinesia - repetitive lip movements
Acute dystonia - sustained muscle contraction resulting in repetitive movements and unusual postures
Akathisia - restlessness
Parkinsonism - rigidity, bradykinesia and tremor

98
Q

List some drugs used in opiate withdrawal in the outpatient setting

A

Buprenorphine (partial opiate agonist)
Methadone (long acting synthetic opiate)
Lofexidine (alpha adrenergic agonist)

Finals (18 decks)

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