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3a > Psychiatry > Flashcards

Psychiatry Flashcards

1
Q

Define an illusion

A

-A misrepresentation of a ‘real’ sensory stimulus - this interpretation contradicts objective ‘reality’

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2
Q

Define pareidolia

A

Imposing a meaningful interpretation on a nebulous stimulus, usually visual

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3
Q

Define a hallucination

A

An experience involving the apparent perception of something not present

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4
Q

Give 2 sensory deceptions

A

-Illusions
-Hallucinations

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5
Q

Give 4 sensory distortions

A

-Changes in intensity
-Changes in quality
-Changes in spatial form
-Distortions of experience of time

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6
Q

Give the 5 main types of hallucination

A

-Visual
-Auditory : 2nd or 3rd person
-Somatic and tactile
-Gustatory
-Olfactory

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7
Q

What are the 5 special kinds of hallucination ?

A

-Functional
-Reflex
-Extracampine
-Hypnagogic
-Hypnapompic

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8
Q

What is a functional hallucination ?

A

-An auditory stimulus causes a hallucination

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9
Q

What is a reflex hallucination?

A

-Stimulus in one sensory modality produces a sensory experience in another

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10
Q

what is an extracampine hallucination ?

A

-Hallucination that is outside the limits of the sensory field (e.g. hears voices talking in Paris when they are in sydney)

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11
Q

What is a hypnagogic and hypnapompic hallucination ?

A

-> Hypnagogic : occur when the subject is falling asleep
-> Hypnapompic : occurs when the patient is waking up

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12
Q

What are the 4 thought disorders

A

-Disorders of stream of thoughts
-Disorders of possession of thoughts
-Disorders of content of thoughts
-Disorders of Form of thought

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13
Q

Give 2 types of disorders of stream of thoughts

A

-Disorders of tempo : flight of ideas, inhibition or slowness of thinking and circumstantiality.
-Disorders of continuity of thought : perseveration and thought blocking.

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14
Q

What is flight of ideas?

A

-Thought disorder (disorder of stream)
-Continuous, rapid speech that changes focus from moment to moment.

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15
Q

What is circumstantiality?

A

-Thought disorder (disorder of stream)
-Circutious, indirect speech in which the individual digresses to give unnecessary and often irrelevant details before arriving at the main point.

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16
Q

What is perseveration ?

A

-Thought disorder (disorder of stream).
-Repetition of a particular response, such as a word, phrase or gesture, despite the absence or cessation of a stimulus.

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17
Q

What is thought block ?

A

-Thought disorder (disorder of stream).
-Sudden interruption in the the train of thought, leaving a blank.

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18
Q

Give 2 types of disorder of possession of thought

A

-Obsessions and compulsions
-Thought alienation : thought insertion, thought withdrawal and thought broadcasting

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19
Q

What is thought alienation?

A

A sense of loss of control or personal possession of thinking.

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20
Q

Define thought insertion, withdrawal and broadcasting?

A

-> Insertion : one’s thoughts are not their own, they belong to someone else and have been inserted into them
-> Withdrawal : their thoughts are being removed from their own mind
-Broadcasting : a person believes their own thoughts can be heard or known by people around them

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21
Q

What is an example of a disorder of content of thinking ?

A

Delusion

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22
Q

Define a delusion

A

False, unshakable belief that is out of keeping with the patient’s social and cultural background.

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23
Q

What is a persecutory delusion ?

A

-When someone believes others are out to harm them despite evidence to the contrary

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24
Q

What is a grandiosity delusion ?

A

-Larger-than-life feelings of superiority and invulnerability
-Exaggerated sense of their own importance, power, knowledge or identity.

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25
Q

What is a nihilistic delusion ?

A

-Patient denies the existence of their body, mind, loved ones and the world around them

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26
Q

What is a poverty delusion ?

A

-A person is convinced that they are impoverished and believe that destitution is facing them and their family.

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27
Q

Give an example of a disorder of form of thinking

A

-Loosening of association

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28
Q

What is loosening of association

A

-Thought disorder (disorder of form)
-There is a lack of connection between ideas, the speech may wander between trains or thought.

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29
Q

Loosening of association vs flight of ideas

A

In loosening of association there is an illogicality between speech often seen in schizophrenia where as flight of ideas characterises hypomania

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30
Q

Give 2 disorders of memory

A

-Dissociative amnesia
-Confabulation

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31
Q

What is dissociative amnesia

A

-Sudden amnesia that occurs during periods of extreme trauma and can last for hours or even days

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32
Q

What is confabulation

A

-Falsification of memory occuring in clear consciousness in association with organic pathology
-Creation of false memories in the absence of intentions of deception.

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33
Q

Define thought echo

A

-A person hears his or her own thoughts as if they were being spoken aloud

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34
Q

Define concrete thinking

A

-Thinking focused on immediate experiences and specific objects or events

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35
Q

What is flattening of affect

A

-Observable absence of emotional reactivity
-Includes : lack of facial expression, monotone voice, lack of eye contact and lack of body language.

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36
Q

Define blunted affect

A

-Reduced emotional response to an environmental stimulus.

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37
Q

Define pseudo-hallucination

A

-Involuntary sensory experience, vivid enough to be regarded as a hallucination. but is recognised as unreal by the person experiencing it

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38
Q

Define catatonia

A

Abnormality of movement and behaviour arising from a disturbed mental state

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39
Q

Define stupor

A

Unresponsiveness from which a person can be aroused only by vigorous physical stimulation

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40
Q

Define belle indifference

A

-Paradoxical absence of psychological distress despite having a serious medical illness or symptoms related to a health condition

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41
Q

Define incongruence of affect

A

When a patients observable mood differs from what they say and their actions

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42
Q

Define pressure of speech

A

When speech is accelerated or frantic and conveys urgency seemingly inappropriate to the situation

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43
Q

What is poverty of speech?

A

General lack of additional, unprompted content with brief replies and less spontaneous speech

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44
Q

What is poverty of thought?

A

-Reduced spontaneity and productivity of thought as evidenced by speech that is vague or full of simple of meaningless repetitions or stereotyped phrases

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45
Q

Define anhedonia

A

Inability to feel pleasure in normally pleasurable activities

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46
Q

Define akathisia

A

Intense sensation of unease or an inner restlessness

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47
Q

Define depersonalisation

A

when a person persistently or repeatedly has the feeling that they’re observing themselves from outside there body

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48
Q

Define derealisation

A

Mental state where are person feels detached from their surroundings, often to the point that they think the people and objects around them do not seem real

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49
Q

Define dissociation

A

Disconnection between a person’s thoughts, memories, feelings, actions or sense of who he or she is

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50
Q

Define an obsession

A

-Repeated thoughts, urges or mental images that cause anxiety
-Unpleasant, repetitive, intrusive, irrational and recognised as the patients own thoughts.

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51
Q

Define a compulsion

A

-Repetitive behaviours or mental acts that person feels driven to perform in response to an obsession

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52
Q

Define delirium

A

‘Acute confusional state’ -> state of mental confusion that can happen when you become medically unwell

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53
Q

Define somatic passivity

A

Experience of bodily sensations imposed by an external agency

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54
Q

Define an overvalued idea

A

A solitary, abnormal belief that is neither delusional nor obsessional in nature, but which is preoccupying to the extent of dominating the suffer’s life

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55
Q

Define a stereotyped behaviour

A

A repetitive or ritualistic movement, posture or utterance

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56
Q

What are the 2 common characteristics of OCD?

A

-Obsessions
-Compulsions
-Can be either or both

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57
Q

How is OCD with mild functional impairment managed ?

A

-CBT including exposure and response prevention.
-If insufficient consider SSRI

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58
Q

How is OCD with moderate or severe functional impairment managed ?

A

-SSRI + more intensive CBT

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59
Q

Define acute stress disorder

A

-Acute stress reaction occurring within 4 weeks after a person has been exposed to a traumatic event

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60
Q

Give 5 features of acute stress disorder

A

-Intrusive thoughts : flashbacks, nightmares
-Dissociation : in a daze, time slowing
-Negative mood
-Avoidance
-Arousal : hyper-vigilance, sleep disturbance

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61
Q

How is acute stress disorder managed?

A

-Trauma based CBT
-Benzodiazepines for acute symptoms

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62
Q

When do symptoms of alcohol withdrawal start to show and what are they ?

A
  • 6-12 hours
    -Tremor, sweating, tachycardia, anxiety
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63
Q

When is the peak incidence of seizures in alcohol withdrawal ?

A

36 hours
(24-48hrs)

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64
Q

What is the peak incidence of delirium tremens ?

A

72 hrs

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65
Q

What are the 10 signs of delirium tremens ?

A

-Coarse tremor
-Confusion
-Delusions
-Auditory and visual hallucinations
-Fever
-Tachycardia
-Severe agitation
-HTN
-Ataxia
-Arrhythmias

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66
Q

What is the first line treatment for alcohol withdrawal ?

A

-long acting benzodiazepines
-Chlordiazepoxide o
-IV high dose B vitamines (pabrinex), followed by regular lower dose thiamine

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67
Q

what effect does alcohol have on the body?

A

-Stimulates GABA receptors in the brain
-GABA receptors have a ‘relaxing’ effect on the brain –Also inhibits NMDA-type glutamate receptors, having a further inhibitory effect on the electrical activity of the brain

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68
Q

What is the mechanism of alcohol withdrawal ?

A

-Decreased inhibitory GABA and increased NMDA glutamate transmission -> extreme excitability of the brain with excess adrenergic activity

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69
Q

Give 3 diagnostic criteria for anorexia

A

-Restriction of energy intake relative to requirements leading to a significantly low body weight in the context of age, sex, developmental trajectory and physical health.
-Intense fear of gaining weight or becoming fat, even though underweight
-Disturbance in the way in which ones body weight or shape is experiences

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70
Q

What is the first line treatment for children and adolescents with anorexia?

A

-Focused family therapy
-CBT is second line

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71
Q

What are the treatment options for adults with anorexia ?

A

-CBT with eating disorder focus
-MANTRA

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72
Q

Give 4 physical features of anorexia

A

-Reduced BMI
-Bradycardia
-Hypotension
-Enlarge salivary glands

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73
Q

Give 7 physiological abnormalities in anorexia

A

-Hypokalaemia
-Low FSH, LH, oestorogens and testosterone
-Raised cortisol and growth hormone
-Impaired glucose tolerance
-Hypercholesterolemia
-Hypercarotinaemia
-Low Ts

-C’s and H’s increase, eveything else decreases

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74
Q

What is the mechanism of typical antipsychotics ?

A

-Dopamine receptor (D2) antagonists blocking dopaminergic transmission in the mesolimbic pathways

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75
Q

What are 2 common adverse effects of TYPICAL antipsychotics ?

A

-Extrapyramidal SE
-Hyperprolactinaemia

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76
Q

What is the mechanism of action of ATYPICAL antipsychotics ?

A

-Act on various receptors (D2, D3, D4, 5-HT)

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77
Q

what are the common adverse effects of ATYPICAL antipsychotics ?

A

-Metabolic effects

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78
Q

Give the 4 extrapyramidal SE of typical antipsychotics

A

-Acute dystonia
-Tardive dyskinesia
-Parkinsonism
-Akathisia

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79
Q

what is acute dystonia ?

A

-Sustained muscle contraction (toricollis, oculogyric crisis)

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80
Q

How can acute dystonia be managed ?

A

-Procyclidine

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81
Q

What is tardive dyskinesia ?

A

-Abnormal, involuntary movements (e.g. chewing and pouting of jaw)

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82
Q

What are the risks of antipsychotics in the elderly ?

A

-Increased risk of stroke
-Increased risk of venous thromboembolism

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83
Q

Give 5 common side effects of tricyclic antidepressants (e.g. amitriptyline)

A

Anticholinergic : can’t see, can’t pee, can’t spit, can’t shit

-Dry mouth
-Hesitancy
-Blurred vision
-Constipation
-Weight gain

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84
Q

What are 2 common SE of haloperidol and citalopram on ECG?

A

-QT interval elongation
-Torsades de pointes (VT)

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85
Q

What is a benefit of atypical compared to typical antipsychotics?

A

-Reduction in extrapyramidal side effects

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86
Q

Give 6 examples of atypical antipsychotics

A

-Clozapine
-Olanzapine : higher risk of dyslipidemia, dysglycaemia, DM and obesity
-Risperidone
-Quetiapine
-Aripiprazole : good SE profile, esp for prolactin elevation

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87
Q

When should clozapine be introcued for management of schizophrenia?

A

-If it is not controlled despite sequential use of 2 or more antipsychotic drugs (of which one is second-generation), each for at least 6-8 weeks

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88
Q

Give 5 SE of clozapine

A

-Agranulocytosis, neutrpaenia
-Reduced seizure threshold
-Constipation
-Myocarditis : baseline ECG should be done before commencing treatment
-Hypersalivation

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89
Q

How often does clozapine require FBC monitoring ?

A

-Weekly for first 18 wks
-Fortnightly for next 38wks
-After that, monthly monitoring

90
Q

What is the diagnostic criteria for insomnia ?

A

-Trouble falling asleep or staying asleep on at least 3 nights a week for at least 3 mnths

91
Q

Give 7 symptoms of SSRI discontinuation syndrome

A

-GI symptoms : pain, cramping, D&V
-Increased mood change
-Restlessness
-Difficulty sleeping
-Unsteadiness
-Sweating
-Parasthesia

92
Q

What is the action of benzodiazepines ?

A

-Enhance the inhibitory neurotransmitter gamma-aminobutyric acid (GABA) by increasing the FREQUENCY of chloride channels

93
Q

Give 5 functions of benzodiazepines

A

-Sedation
-Hypnotic
-Anxiolytic
-Anticonvulsant
-Muscle relaxant

94
Q

What time period are benzodiazepines recommended to be prescribed for and why ?

A

-2-4 wks
-People develop a tolerance and dependence to them

95
Q

How should a benzodiazepine be withdrawn?

A

-Withdrawn in steps of about 1/8 (range 1/10 to 1/4) of the daily dose every fortnight

96
Q

What are the 8 features of benzodiazepine withdrawal
6 of which involve the letters of benzodiazepines an two T’s

A

-Insomnia
-Irritability
-Anxiety
-Tremor
-Loss of appetite
-Tinnitus
-Perspiration
-Perceptual disturbance
-Seizures

97
Q

Define bipolar

A

-Chronic mental health disorder characterised by periods of mania/hypomania and depression.

98
Q

What is bipolar type 1?

A

-Mania and depression

99
Q

What is bipolar type 2?

A

-Hypomania and depression

100
Q

What is mania ?

A

-Abnormally elevated mood or irritability
-Lasts for at least 7 days
-Severe functional impairment in social and work setting
-May present with psychotic symptoms
-In an exam, with mania there will often be psychotic symptoms

101
Q

what is hypomania ?

A

-Abnormally elevated mood or irritability
-Decreased or increased function for 4 or more days
-No psychotic symptoms
-Causes less functional impairment to work or social settings

102
Q

What is first line for long term treatment of bipolar ?

A

-Lithium + psycholoigcal intervention

103
Q

What can be used to treat bipolar long term if lithium is ineffective ?

A

-Valporate

104
Q

How is an episode of mania/hypomania in bipolar managed?

A

-Stop antidepressant
-Give antipsychotic : olanzapine, haloperidol

105
Q

How is an episode of depression in bipolar managed ?

A

-Psychological therapy + antidepressant (fluoxetine is first line)

106
Q

What 2 co-morbidities are people with bipolar at risk of?

A

-DM and cardiovascular disease

107
Q

Define bulimia

A

-ED characterised by episodes of binge eating, followed by intentional vomiting or other purgative behaviours such as the use of laxatives or diuretics or exercising

108
Q

Give the 5 criteria in the DSM 5 for a diagnosis of bulimia ?

A

-> Recurrent episodes of binge eating
-> A sense of lack of control over eating during the episode
-> Recurrent inappropriate compensatory behaviour in order to prevent weight gain
-> The binge eating and compensatory behaviours occur at least once a week for 3 mnths
-> Self-evaluation is unduly influenced by body shape and weight

109
Q

How is bulimia managed ?

A

-In children : family therapy
-CBT-ED
-Fluoxetine has a limited role

110
Q

What is Charles-Bonnet syndrome (CBS) ?

A

-Persistent and recurrent complex hallucinations, occurring in clear consciousness

111
Q

Give 5 RF for CBS

A

-Advanced age
-Peripheral visual impairment
-Social isolation
-Sensory deprivation
-Early cognitive impairment

112
Q

Give 3 characteristics of CBS

A

-There is generally a background of visual impairment
-Insight is usually preserved
-Must be an absence of any other significant neuropsychiatric disturbance

113
Q

What is the most common opthalmological condition associated with CBS?

A

-Age-related macular degeneration
-Glaucoma
-Cataract

114
Q

Define Cotard syndrome

A

-Rare disorder where a person believes that they (or in some cases just part of their body) is either dead or non-existent

115
Q

What is De Clerambault’s syndrome ?

A

-Form of paranoid delusion where a person believes a famous person is in love with them
-also known as erotomania

116
Q

What is delusional parasitosis ?

A

-Where a person has a delusion that they are infested by bugs

117
Q

What 6 factors would suggest a diagnosis of depression over dementia ?

A

-Short Hx, rapid onset
-Biological Sx : weight loss, sleep disturbance
-Patient worried about poor memory
-Reluctant to take tests, disappointed with results
-MMS exam score : variable
-Global memory loss

118
Q

What kind of memory loss does dementia characteristically cause ?

A

-Recent memory loss

119
Q

What are the 9 criteria in the DSM 5 for depression

A
  1. Depressed mood, most of the day, nearly every day
  2. Markedly dimished interest or pleasure in activities
  3. Significant weight loss/gain or appetite increase/loss
  4. Insomnia or hypersomnia
  5. Psychomotor agitation or retardation
  6. Fatigue
  7. Feelings of worthlessness, excessive or inappropriate guilt
  8. Diminished ability to think or concentrate
  9. Recurrent thoughts of death, suicidal ideation, suicide attempts
120
Q

What 2 assessment tools are used to diagnose depression ?

A

-HAD scale
-PHQ-9

121
Q

What is the management of subthreshold depressive symptoms or mild depression ?

A

-CBT

122
Q

What is the management of moderate/severe depression ?

A

-SSRI
-CBT

123
Q

According to the IDC-10, how long must an episode last to be classed as depression ?

A

2 wks

124
Q

When is ECT used ?

A

-Patients with severe depression, refractory to medication (e.g. catatonia)

125
Q

What is an absolute contraindication for ECT?

A

-Raised ICP

126
Q

Give 5 short term side effects of ECT

A

-Headache
-Nausea
-Short term memory impairment
-Memory loss of events prior to ECT
-Cardiac arrhythmia

127
Q

What is one reported long term side effect of ECT?

A

-Impaired memory

128
Q

Define anxiety

A

-Excessive worry about a number of different events associated with heightened tension

129
Q

What are alternative causes of anxiety?

A

-Hyperthyroid
-Cardiac disease
-Medication induced anxiety

130
Q

What medications can trigger anxiety?

A

-Salbutamol
-Theophylline
-Corticosteroids
-Antidepressants
-Caffeine

131
Q

Explain the step-wise approach to managing GAD

A
  1. Education about GAD + active monitoring
  2. Low intensity psychological interventions
  3. High intensity psychological interventions or drug treatment
132
Q

What is the 1st line drug treatment for GAD?

A

-Sertraline
-If ineffective try alternative SSRI or SNRI (e.g. duloxetine, venlafaxine)

133
Q

How is panic disorder managed?

A

-CBT or drug Tx
-SSRI’s are 1st line but if ineffective after 12 wks try imipramine or clomipramine (tricyclic)

134
Q

What characteristics are often seen in both mania and hypomania ?

A

-Mood : predominately elevated, possible irritable
-Speech & thought : pressured, flight of ideas, poor attention
-Behaviour : insomnia, loss of inhibitions, increased appetite

135
Q

Give 2 features of an atypical grief reaction

A

-Delayed grief : more than 2 weeks passes before grieving begins
-Prolonged grief : normal grief reactions may take up to and beyond 12 mnths

136
Q

Define chronic insomnia

A

-Trouble falling or staying asleep at least 3 nights per week for 3 mnths or longer

137
Q

Give 3 short term management options for insomnia

A

-Identify potential causes
-Advise good sleepy hygiene : no screens, limit caffeine, fixed bed times etc
-Hypnotics : ONLY if daytime impairment is severe

138
Q

Give 6 RF for insomnia

A

-Female
-Older
-Lower educational attainment
-Unemployment
-Economic inactivity
-Widowed, divorced or separated

139
Q

What hypnotics are recommended for treating insomnia ?

A

-Short acting benzos (not diazepam)
-Non-benzodiazepines (zopiclone, zolpidem, zaleplon)

140
Q

What causes wernicke-korsafoff syndrome ?

A

-Alcohol excess
-This leads to thiamine (vit B1 deficiency)
-Wernicke’s comes first and leads to Korsakoff’s if untreated

141
Q

Give 3 features of wernicke’s encephalopathy

A

-Confusion
-Oculomotor disturbances
-Ataxia

142
Q

Give 2 features of Korsakoff’s syndroime

A

-Memory impairment (anterograde and retrograde). Anterograde : inability to acquire to new memories
-Behavioural changes

143
Q

When do hallucinations in alcohol withdrawal begin?

A

12-24 hrs

144
Q

What is lithium?

A

-Mood stabilising drug used in bipolar disorder

145
Q

Give 6 adverse effects of lithium

A

-GI : N&V, diarhoea, weight gain
-Leucotysosis
-Thyroid enlargement -> hypothyroidism
-Idiopathic intracranial HTN

146
Q

How can lithium effect an ECG?

A

-T wave flattening/inversion

147
Q

How can lithium effect levels of parathyroid hormone

A

-Increase the levels
-leading to hypercalcaemia

148
Q

How can lithium effect the kidneys ?

A

-Nephrotoxicity -> polyuria, secondary to nephrogenic diabetes insipidous

149
Q

When should lithium levels be checked ?

A

-12 hrs post dose

150
Q

How often should lithium levels be checked?

A

-Weekly when first commenced or changing dose
-Then checked every 3 mnths

151
Q

Give 7 symptoms of lithium toxicity

A

TOXICCC

T : Tremor (coarse)
O : Oliguric renal failure
X : ataXia
I : Increased reflexes
CCC : Convulsions, Coma, Consciousness reduced

152
Q

What blood level of lithium defines toxicity

A

-1.5mEq/L or higher
-Severe once at 2.0mEq/L or above

153
Q

Give 3 risk factors for OCD

A

-Genetics
-Psychological trauma
-Paediatric autoimmune neuropsychiatric associated with streptococcal infections (PANDAS)

154
Q

Give 4 conditions associated with OCD

A

-Depression
-Schizophrenia
-Tourette’s
-Anorexia

155
Q

What is Othello’s syndrome ?

A

-A person is convinced their partner is cheating on them

156
Q

Give 5 features of a paranoid personality disorder

A

-Hypersensitifity and an unforgiving attitude when insulted
-Unwarranted tendency to question loyalty of friends
-Reluctance to confide in others
-Preoccupation with conspirational beliefs and hidden meaning
-Unwarranted tendency to perceive attacks on their character

157
Q

Give 7 features of schizoid personality disorder

A

-Indifference to praise and criticism
-PREFERENCE FOR SOLITARY ACTIVITIES
-LACK OF INTEREST IN SEXUAL INTERACTIONS
-Lack of desire for companionship
-Emotional coldness
-Few interests
-Few friends or confidants other than family

158
Q

Give 8 features of a schizotypal
personality disorder

A

-Ideas of reference
-ODD BELIEFS and magical thinking
-Unusual perceptual disturbances
-Paranoid ideation and suspiciousness
-Odd, eccentric behaviour
-LACK OF CLOSE FRIENDS other than family members
-Inappropriate affect
-Odd speech without being incoherent

159
Q

Give 8 features of an antisocial personality disorder

A

-Failure to confirm to social norms + law breaking behaviour
-Men>women
-Deception
-Impulsiveness or failure to plan ahead
-Irritability and aggressiveness
-Reckless disregard for the safety of self or others
-Consistent irresponsibility
-Lack of remorse

160
Q

Give 9 features of EUPD

A

-Efforts to avoid real or imagined abandonment
-Unstable interpersonal relationships which alternate between idealisation and devaluation
-Unstable self image
-Impulsivity
-Suicidal behaviour
-Affective instability
-Chronic feelings of emptiness
-Difficulty controlling temper
-Quasi psychotic thoughts

161
Q

Give 6 features of a Histrionic personality disorder

A

-Inappropriate sexual seductiveness
-Need to be centre of attention
-Shallow expressions of emotion
-Suggestibility
-Self dramatisation
-Physical appearance used for attention seeking

162
Q

Give 8 features of a narcissistic personality disorder

A

-Grandiose sense of self importance
-Sense of entitlement
-Taking advantage to achieve own needs
-Lack of empathy
-Excessive need for admiration
-Chronic envy
-Arrogant and haughty attitude
-Preoccupation with fantasies of unlimited success, power or beauty

163
Q

Give 7 features of an OCD persoanlity disorder

A

-Occupied with details, rules, lists, order
-Demonstrates perfectionism that hampers with completing tasks
-Extremely dedicated to work and efficiency to the elimation of spare time activities
-Is meticulous, scrupulous and rigid about etiquettes of morality, ethics or values
-Not capable of disposing worn out or insignificant things even if they have no sentimental meaning
-Unwilling to pass on tasks or work with others except if they surrender to exactly their way of doing things
-Takes on stingy spending style towards self and others, shows stiffness and stuborness

164
Q

Give 7 signs of an avoidant personality disorder

A

-Avoidance of occupational activities which involve significant interpersonal contact due to fear of criticism or rejection
-Unwillingness to be involved unless certain of being liked
-Preoccupied with ideas that they are being criticised or rejected in social situations
-Restraint in intimate relationships due to fear of being ridiculed
-Reluctance to take personal risks due to fear of embarrassment
-Views self as inept and inferior to others
-Social isolation accompanied by craving for social contact

165
Q

Give 8 signs of a dependent personality disorder

A

-Difficulty making everyday decisions without excessive reassurance from others
-Need for others to assume responsibility for major ereas of their life
-Difficulty in expressing disagreement with others due to fear of losing support
-Lack of initiative
-Unrealistic fears of being left to care for themselves
-Urgent search for another relationship as a source of care and support when a close relationship ends
-Extensive efforts to obtain support from others
-Unrealistic feelings that they cannot care for themselves

166
Q

What is the first line psychological therapy for personality disorders

A

Dialectical behaviour therapy

167
Q

Give features post-concussion syndrome

A

-Headache
-Fatigue
-Anxiety/depression
-Dizziness

168
Q

How long do symptoms have to be present for a diagnosis of PTSD

A

A month

169
Q

Give 4 features of PTSD

A

-> Re-experiencing : flashbacks, nightmares, repetitive and distressing intrusive images
-> Avoidance : avoiding people, situations or circumstances resembling or associated with the event
-> Hyperarousal : hypervigilance for threat, exaggerated startle response, sleep problems, irritability and difficulty concentrating
-> Emotional numbing : lack of ability to experience feelings, feeling detached

170
Q

How is PTSD managed ?

A

-Trauma focused CBT
-Venlafaxine or SSRI such as sertraline if needed

171
Q

What is the strongest risk factor for developing schizophrenia?

A

Family history
Monozygotic twins - 50%

172
Q

Give 5 factors favouring delirium over dementia

A

-Impairment of consciousness
-Fluctuation of symptoms : worse at night, periods of normality
-Abnormal perceptions (e.g. illusions and hallucinations)
-Agitation, fear
-Delusions

173
Q

What needs to be monitored when a patient is on and SSRI?

A

U&E’s - risk of hyponatraemia

174
Q

what needs to be monitored particularly when taking citalopram ?

A

ECG - risk of QT interval elongation

175
Q

What kind of medication is venlafaxine and what needs to be monitored when taking it

A

SNRI - serotonin and noradrenaline
Blood pressure - increased risk of HTN

176
Q

what needs to be monitored if a patient is taking mirtazapine ?

A

BMI - weight gain association

177
Q

What SSRIs is preferred generally, post MI and in children and adolescents ?

A

-Generally : citalopram and fluoxetine
-Post MI : sertraline
-Children and adolescents : fluoxetine

178
Q

What is the most common SE of SSRI’s

A

-GI symptoms
-If patient also requires NSAIDs they should be given a PPI due to increased risk of GI bleeding

179
Q

Give 5 SSRI interactions

A

-NSAIDs : co prescribe PPI
-Warfarin/heparin (consider metazapine instead)
-Triptans ! Increased risk of serotonin syndrome
-MAOIs

180
Q

When should people be reviewed when prescribed SSRIs and how long should they be continued following remission

A

-2 wks after initiation
-Continue for 6 mnths following remission

181
Q

what antidepressant can be helpful in the elderly who also suffer from insomnia and poor appetite?

A

Mirtazapine
Its a sedative and increases appetite
Blocks alpha2-adrenergic receptors

182
Q

what are monoamine oxidase inhibitors and how do they work

A

-Block monoamine oxidase in the presynaptic cell that breaks down serotonin and noradrenaline
-E.g. tranylcypromine, phenelzine

183
Q

What are SE of monoamine oxidase inhibitors (phenelzine)

A

-Hypertensive crisis associated with certain ripe cheese

184
Q

Define section 2

A

Admission for up to 28 days, not renewable
Requires 2 doctors (one section 12 approved) & AMHP
Treatment given with patients wishes

185
Q

Define section 3

A

Admission for up to 6 mnths, can be renewed
AMHP + 2 doctors (one section 12 approved)
Treatment can be given against patients wishes

186
Q

Define a section 4

A

72 hr assessment order
Used as emergency when section 2 would involve a delay
a GP, AMHP, NP
Often changed to section 2 on arrival to hospital

187
Q

Define section 5(2)

A

Patient who is a voluntary pt in hospital can be detained by doctor for 72 hrs

188
Q

Define section 5(4)

A

Allows a nurse to detain a patient who is voluntarily in hospital for 6 hrs

189
Q

Define a section 17a

A

-Community treatment order
-Can be used to recall a pt to hospital for treatment if they do no comply with conditions in the community (e.g. complying with medication

190
Q

Define a section 135

A

court order can be obtained to allow police to break into a property to remove a person to place of safety

191
Q

Define section 136

A

-Someone in a public place who appears to have a mental disorder can be taken by police to a place of safety
-Used for up to 24 hrs

192
Q

What are the 1st rank symptoms of schizophrenia

A

-Auditory hallucinations (2 or more voices discussing pt in third person, thought echo, commenting on patietns behaviour)
-Thought alienation
-Somatic passivity/passivity phenomenon
-Delusion perceptions

193
Q

Give 6 second rank symptoms of schizophrenia

A

-Impaired insight
-Negative symptoms : blunting of affect, anhedonia, alogia, avolition
-Decreased speech
-Neologisms
-Catatonia

194
Q

what is 1st line management of schizophrenia

A

Oral atypical antipsychotics

195
Q

what 7 factors are associated with poor prognosis in schizophrenia

A

Gradual onset
Strong family history
Low IQ
Prodromal phase of social withdrawal
Lack of obvious precipitant
Male
Teenage onset

196
Q

what is schizoaffective disorder

A

Presence of schizophrenia symptoms concurrent with mood symptoms (depression or mania)

197
Q

Give 3 psychotic features

A

Hallucinations
Delusions
thoughts disorganisation

198
Q

Give 4 associated features of psychosis

A

-Agitation / aggression
-Neurocognitive impairment (memory, attention or executive functioning)
-Depression
-Thoughts of self harm

199
Q

-multiple physical SYMPTOMS present for at least 2 yrs
-patient refuses to accept reassurance or negative test results

A

somatisation disorder

200
Q

Persistent belief in the presence of an underlying serious DISEASE (e.g. cancer)
Patient refuses to accept reassurance or negative test results

A

Hypochondriasis

201
Q

Loss of motor or sensory function (NEUROLOGICAL SYMPTOMS)
La belle indifference

A

Conversion disorder

202
Q

Intentional production of physical or psychological symptoms

A

Factitious disorder / Munchausen’s syndrome

203
Q

Fradulent simulation or exaggeration of symptoms for financial or other gain

A

Malingering

204
Q

what is capgras syndrome

A

false belief that an identical duplicate has replaced someone significant to the patient

205
Q

What is neuroleptic malignant syndrome

A

Life threatening reaction to antipyschotics

206
Q

What are the 6 signs and symptoms of neuroleptic malignant syndrome

A

-High fever
-Muscle rigidity
-Altered mental status
-Autonomic nervous system dysfunction
-Tachycardia
-Tachypnoea

207
Q

How does serotonin syndrome present ?

A

-Within 2 wks of starting medication : SSRI/SSNRI, opioid, MAOI, lithium
-Psychiatric : confusion, hallucinations
-Peripheral : tremor, shaking, hyperreflexia,
-Autonomic : HTN, tachycardia, hyperthermia, swaeting, shivers

208
Q

define echolalia

A

repetition of someone else’s speech, including the question that was asked

209
Q

define copropraxia

A

involuntary performing of obscene or forbidden gestures or inappropriate touching

210
Q

define echopraxia

A

meaningless repetition or imitation of the movements of others

211
Q

define palilalia

A

automatic repetition of one’s own words, phrases or sentances

212
Q

what can cause a rise in clozapine levels

A

smoking cessation

213
Q

if clozapine doses are missed for more than 48hrs what is the best course of action to address the missed doses?

A

re-titrate the doses again slowly

214
Q

what does zopiclone increase the risk of in the elderly

A

falls

215
Q

what medication will cause facial flushing, N&V if alcohol is drank

A

Disulfiram

216
Q

what medication reduces alcohol cravings

A

acamprosate

217
Q

what medication is given as a sublingual tablet as an alternative to methadone in opioid dependence

A

buprenorphine

218
Q

what are the management options for ADHD

A

-Conservative : healthy diet and exercise
-Medication : CNS stimulants
1st : methyphenidate
2nd : dexamfetamine
3rd : atomexetine

219
Q

what is the treatment for deliriumn tremens

A

IV pabrinex or Lorazepam
Long acting benzo (chlordiazepoxide)

If psychotic features : IM haloperidol (CI in LBD or PD)

220
Q

what can be used in SSRI overdose

A

-> activated charcoal

221
Q

what is the difference in WBC count between SS and NMS

A

SS : normal
NMS : high

222
Q

what medication reduces pleasure in alcohol

A

Naltrexone

3a (45 decks)

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