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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
What is a section 136
Police - to take person to place of safety
26
When is mental health act used
When threshold for admission is met and at significant risk to themselves and the patient is not willing
27
List some risk factors for completed suicide
``` 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 ```
28
How do you test mental capacity
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 ```
29
List the symptoms of depression
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
30
Describe the management of mild depression
Exercise Sleep hygiene advice CBT
31
Describe the management of moderate/severe depression
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
32
List some general symptoms of an anxiety disorder
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
33
How long must anxiety symptoms be present for a diagnosis of generalised anxiety disorder to be made
6 months
34
What medication can be used in anxiety disorders
SSRI and propranolol (beta blocker)
35
List some positive symptoms of schizophrenia
Hallucinations Catatonia Neologisms Tangential speech
36
List some negative symptoms of schizophrenia
Anhedonia Blunting of affect Poverty of speech Marked apathy
37
List some risk factors for schizophrenia
Male Heavy cannabis use Social isolation FH
38
What is ECT used
Catatonic schizophrenia | Treatment resistant depression
39
Describe Alzheimer's disease
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
40
List some risk factors for Alzheimer's disease
Female Caucasian Advanced age Vascular disease
41
Describe vascular dementia
Stepwise decline Stroke <3months of symptoms starting CV risk factors present
42
Describe dementia with Lewy bodies
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
Describe frontotemporal dementia
``` Aggression Inapproiate social behaviour Emotional blunting Incontinence Speech and language difficulty Often insidious onset with earlier age of onset ```
44
What are some differentials to dementia in memory loss
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
Describe hypomania
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
Describe adjustment disorder
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
What investigations would you do for someone following an alcohol history
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
Describe the management of alcohol dependence
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
Name and describe two screening tools for eating disorders
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
Describe the features of anorexia
Underweight BMI <17.5 Distorted body image Food dominates May utilise other methods of weight loss - excess exercise, talking laxatives, diuretics, appetite suppressants
51
Describe the features of bulimia
``` Normal or overweight Binge eating Purging Eating patterns irregular Amenorrhoea and oligomenorrhoea Erosion of teeth, sore throat and reflux due to purging ```
52
What bloods should be taken in eating disorders
FBC U&Es LFTs Glucose
53
Describe the management of eating disorders
Advice on healthy eating Psychotherapy - CBT, interpersonal therapy Medication - SSRI to reduce binge and purge or if comorbid depression
54
List the 8Cs for reasons of self harm
``` Coping Control Cleanse Confirmation of existence Creating comfortable numbness Chastisement Communication ```
55
Give some examples of antiphsyctics
Olanzapine - treatment resistant schizophrenia - risks Aripiprazole Quetiapine Risperidone
56
Which anti-hypertensive may be a cause of depression
Beta blocker
57
List some SSRIs
Sertraline Citalopram Fluoxetine Paroxetine
58
What drug class is venlafaxine
SNRI
59
What drug class is moclobemide
RIMA - reversible monoamine oxidase inhibitor
60
What drug class is dosulepin
Tricyclic
61
How long must a 2nd depressive episode be treated for
2 years
62
How do you distinguish between mania and hypomania
Hypomania - can function | Mania - impaired functioning
63
What percentage of manic patients go on to have a depressive episode
90%
64
List the risks of mental illness
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
Which section should be used in A&E
Section 2
66
Which section cannot be used in A&E
Section 5(2) - patient needs to already be admitted and in A&E not classed as admission
67
List some drugs which can be useful in treating mania
Olanzapine - antipsychotic | Clonazepam and lorazepam
68
How can lorazepam be given
Oral or IM
69
Describe lithium level monitoring
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
List some side effects of lithium
Renal impairment Thyroid impairment - hypothyroid Parathyroid impairment
71
Describe the use of CBT in mania
Not useful in acute phase Useful in depression May improve concordance to medication
72
When is lithium used in mania
As a preventative measure
73
What is the recommended duration of treatment with benzodiazepines
2-4 weeks
74
How do you reduce the dose of long term benzodiazepines
Reduce the dose by an 1/8 the daily dose every fortnight
75
Describe how benzodiazepines work
Increase the activity of GABA | GABA is an inhibitory neurotransmitter so they decrease neuronal excitability
76
Which benzodiazepine is the hardest to withdraw from
Lorazepam - shortest half life
77
Which class of drug should be started if SSRIs have not worked
SNRI - venlafaxine
78
How long can it take SSRIs to work
8 weeks
79
Which neurotransmitters does venlafaxine work on
Serotonin and noradrenaline - reuptake inhibitors | at higher doses also dopamine reuptake inhibitor
80
Describe puerperal psychosis
Occurs in the first 3 weeks post natal Affective in nature Acute onset
81
Which antidepressant should be avoided in pregnancy
Paroxetine - risk of cardiac abnormality
82
Which fetal abnormality is associated with lithium use during pregnancy
Ebstein's anomaly - cardiac - tricuspid valve
83
Which drug when taken in pregnancy has been associated with cleft lip
Benzodiazepines
84
Is lithium safe in breast feeding
No
85
When is the Edinburgh post natal depression scale used
When a post natal woman presents with either low mood or anhedonia or both
86
What is neoligism
Made up words | Seen in psychosis
87
Describe knights move thinking or loosening of associations
Thoughts have no relation to one another - psychosis
88
Describe flight of ideas
Thoughts are slightly linked - mania
89
Describe delusions of passivity
Delusions of control and where the person thinks someone or something is controlling them
90
Describe how you start medication in psychosis
Start low and go slow
91
Describe the presentation and inheritance of hungtintons chorea
``` Autosomal dominant Low mood Memory problems Chorea Happens earlier and more severe in later generations ```
92
Name some Alzheimer's drugs and give their drug class
NMDA receptor partial agonist - memantine | Acetylcholinesterase inhibitors - donepezil, rivastigmine, galantamine
93
Which electrolyte disturbances are seen in bulimia nervosa
Hypokalaemia | Hypocalcaemia
94
What is the HCR-20
Assess the risk to others
95
What is the PCL-R
Assess for psychopathy
96
What is the PHQ-9
Depression score done in GP
97
List and describe extrapyramidal side effects of antipsychotic medication
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
List some drugs used in opiate withdrawal in the outpatient setting
Buprenorphine (partial opiate agonist) Methadone (long acting synthetic opiate) Lofexidine (alpha adrenergic agonist)

Finals (18 decks)

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