Psychiatry Flashcards
What is a pseudohallucination?
Common after bereavement
The patient is aware that they are hallucinating
Define perseveration
Repeating the same words/answers
Define echolalia
Repeating exactly what someone has said
Define neologism
Making up new words
Define word salad
Disorganised speech, sentences that do not make sense
Define expressive dysphagia
Difficulty putting together words
Often develops following a stroke
First line treatment for children and young people with anorexia nervosa
Family based therapy
Define torticollis
Twisting of the neck (extrapyramidal side effect)
Which are the typical/atypical antipsychotics?
How can SSRIs cause confusion?
Increase the risk of hyponatremia
Measure U+E
What should be monitored at baseline and on dose titration
Blood pressure
What should be monitored before starting citalopram
ECG in people with heart disease risk
Prolongs Q-T interval
Define thought withdrawal
Belief of having the removal of a thought by an external force = thought withdrawal
3 features of a schizoid personality disorder
Prefers to be alone
Doesn’t like relationships
Low libido
(negative symptoms of schizophrenia)
Poor prognostic indicator for schizophrenia
Gradual onset
Low IQ
Prodromal phase of social withdrawal
Define catatonia
Stopping of voluntary movement or staying still in an unusual position
Side effect of antipsychotic medications
Acute dystonic reactions
Give 2 examples of typical antipsychotics
HALOPERIDOL
CHLOPROMAZINE
Give 3 examples of atypical antipsychotics
CLOZAPINE
RISPERIDONE
OLANZAPINE
Define akathisia
Sense of inner restlessness and inability to keep still
What happens in conversion disorder and what can it be caused by
Typically involves loss of motor or sensory function
Can be caused by stress
Treatment of delirium tremens/alcohol withdrawal
Chlordiazepoxide or Diazepam
Pabrinex administered to prevent the development of Wernicke’s, it does not have a role in treating acute withdrawal
Which gender is affected by antisocial personality disorder
Men
Common side effect in atypical antipsychotics
Weight gain e.g. olanzapine
Unexplained physical symptoms
Somatisation = Symptoms
hypoChondria = Cancer (underlying diagnosis)
Munchausen’s (intentional production of sx)
How long should antidepressants be continued for depression
6 months
A man asks for help with social anxiety. He prefers to be alone and doesn’t like to share his beliefs, which other people think are odd. He has a strong interest in the paranormal and talks in an high-pitched voice when talking about his ‘spirit-guide’
Schizotypal personality disorder
Short term side effects of ECT
headache nausea short term memory impairment memory loss of events prior to ECT (retrograde amnesia) cardiac arrhythmia
3 timeframes in alcohol withdrawal
symptoms: 6-12 hours
seizures: 36 hours
delirium tremens: 72 hours
4 first rank schizophrenia sx
auditory hallucinations
thought disorders
passivity phenomena
delusional perceptions
Initial management of OCD
Exposure and response prevention or CBT
Schizophrenia conservative management
CBT
What class of drug is lorazepam
Benzo
Side effect of benzos
Anterograde amnesia
What is flight of ideas a feature of?
Mania (bipolar)
Define flight of ideas
when a patient speaks very quickly and rapidly jumps between different topics
Sleep in schizophrenia
Insomnia
Which type of incontinence is caused by TCA
Overflow
Clozapine dose missed for more than 48 hours
Titrate the dose again slowly
To diagnose chronic insomnia
Trouble falling asleep for 3 nights a week for 3 months
Medication to abstain from alcohol that makes you violently vomit
Dusulfiram (Antabuse)
Alternative to methadone
Tablet that goes under your tongue
Buprenorphine
Anti-craving medication for alcoholics that is safe to use with alcohol
Acamprosate
First line medication for PTSD
Venlafaxine or SSRI
When is ECT indicated
in life-threatening major depressive disorder, where catatonia in present
Strongest risk factor for psychotic disorders
FHx
First line drug for panic disorder and GAD
SSRI
What class is duloxetine
SNRI
Minimum time for depressive symptoms
2 weeks
Define torticollis
A type of acute dystonia with unilateral pain and deviation of the neck with pain on palpation and restricted range of motion
What is delusional parasitosis
Patient with a fixed, false belief (delusion) that they are infested by ‘bugs’
Conservative treatment for borderline personality disorder
dialectical behaviour therapy (DBT)
risk of developing schizophrenia if one monozygotic twin is affected
50%
When should lithium levels be measured
12 hours post dose
poor oral compliance to antipsychotics
Once monthly IM injections
Side effect of clozapine
Constipation/Intestinal obstruction
Agranulocytosis/neutropenia (monitor FBC)
Reduces seizure threshold
SSRI decontinuation syndrome sx
GI side effects (diarrhoea), restless, mood change, insomnia, dizzy, anxiety, electric shock
side effects of clomipramine (TCAs)
Dry mouth (anticholinergic) and weight gain (antihistaminic)
What do you do with antidepressant mediation prior to starting ECT treatment
Reduce the dose
Risk factor for Charles Bonnet
Visual impairment
When does sleep paralysis most often occur
When waking from sleep
Difference between mania and hypomania
Mania = psychotic symptoms
Citalopram ECG
QT
3 common features of PTSD
re-experiencing e.g. flashbacks, nightmares
avoidance e.g. avoiding people or situations
hyperarousal e.g.hypervigilance, sleep problems
3 features of korsakoff
anterograde amnesia, retrograde amnesia, and confabulation
Management of hypomania
Routine referral to CMHT
Most tolerable antipsychotic medication with the least side effects
Aripiprazole
Define tardive dyskinesia
Involuntary chewing/pouting of the jaw
SE antipsychotics
SSRI of choice in paeds
Fluoxetine
Sleep in mania/hypomania
Decreased need for sleep without feeling tired
Define circumstantiality
circuitous and non-direct thinking or speech that digresses from the main point of a conversation
inability to answer a question without giving excessive and unnecessary detail
in anxiety/hypomania
What medication interacts with SSRIs
Triptan
Lithium side effect
Hyperparathyroidism and hypercalcaemia (back pain, constipation, headache, low mood, reduced concentration)
Hypothyroidism
Timeframe of acute stress reaction to PTSD
4 weeks
SSRI of choice post-MI
Sertraline
Define othello syndrome
delusional jealously, usually believing their partner is unfaithful
Side effects of mirtazapine
Sedation and increased appetite
What factor increases the risk of suicide
Self harm
What condition is Cotards associated with
Severe depression
Side effect of zopiclone in the elderly
Increased risk of fall
First line conservative treatment for acute stress disorder
Trauma-focused cognitive-behavioural therapy (CBT)
Somatic symptoms in depression
early morning waking and changes in appetite and weight
Management of acute dystonia secondary to antipsychotics
Procyclidine
Trauma in post concussion syndrome may be trivial
Metabolic side effects of antipsychotics
dysglycaemia, dyslipidaemia, and diabetes mellitus
Scale used to assess alcohol withdrawal severity
Revised Clinical Institute Withdrawal Assessment for Alcohol (CIWA)
Management of moderate/severe tardive dyskinesia
Tetrabenazine
What endocrine abnormality can anorexia cause
Hypothyroidism
What class is venlafaxine
SNRI
Sudden onset psychosis following course of corticosteroids
Steroid induced psychosis
How should you stop an SSRI
Withdraw the dose gradually over 4 weeks
Define Erotomania (De Clerambault’s syndrome)
the presence of a delusion that a famous is in love with them, with the absence of other psychotic symptoms
What abnormality can lithium cause on bloods
Benign leucocytosis
ECG shows first-degree heart block, tall P-waves and flattened T-waves
Hypokalaemia
Bulimia
What is pseudodementia
Severe depression can mimic dementia but gives a pattern of global memory loss rather than short-term memory loss
Patient in a public place and threatening violent behaviour
Call the police
Why should SSRIs and MAOIs never be combined
Risk of serotonin syndrome
What class of drug is rasagiline
MAOIs
Antipsychotics in the elderly
Increased risk of stroke and VTE
Paroxetine in pregnancy
Risk of congenital malformations
Another term for hypochondriasis
Illness anxiety disorder
Type 1 vs 2 bipolar
Type 1: Mania
Type 2: Hypomania
What side effect of antipsychotic medication is oculogyric crisis an example of
Acute dystonia
Define clang associations
ideas related only by rhyme or being similar sounding
What class is mirtazapine
oradrenergic and specific serotonergic antidepressant which increases release of neurotramsitters by blocking alpha2 adrenoreceptors
Paranoid personality disorder
patients who are overly sensitive and can be unforgiving if insulted, question loyalty of those around them and are reluctant to confide in others
Investigation in elderly patients with new sudden onset psychosis to rule out other causes
CT Head
Which side-effect is more common with atypical than conventional anti-psychotics
Weight gain
After a change in lithium dose when should levels me taken
Weekly until stable then 3 monthly
Common side effect in depot antipsychotics
Parkinsonian symptoms
What is Hoover’s sign
a quick and useful clinical tool to differentiate organic from non-organic leg paresis. In non-organic paresis, pressure is felt under the paretic leg when lifting the non-paretic leg against pressure, this is due to involuntary contralateral hip extension
Symptoms of mania in primary care…
Urgent referral to CMHT
OCD vs Psychosis
Obsessive-compulsive disorder can be differentiated from psychosis by the level of insight into their actions
Borderline (emotionally unstable) personality disorder
associated with a history of recurrent self-harm and intense interpersonal relationships that alternate between idealization and devaluation
Define malingering
Lying or exaggerating for financial gain is malingering, for example someone who fakes whiplash after a road traffic accident for an insurance payment
How long do you continue antidepressants after remission of symptoms
Antidepressants should be continued for at least 6 months after remission of symptoms to decrease risk of relapse
Avoidant personality disorder
fearful of criticism, being unliked, rejection and ridicule
Blood results in anorexia
most things low
G’s and C’s raised: growth hormone, glucose, salivary glands, cortisol, cholesterol, carotinaemia
Risk of SSRI use during third trimester
Persistent pulmonary hypertension of the newborn
Management of severe or unresponsive OCD
Sertraline
What class of drug is escitalopram
SSRI
What can cause a rise in clozapine blood levels?
Smoking cessation
obsessive-compulsive personality disorder
rigid with respect to morals, ethics and values and often are reluctant to surrender work to others
Differentiating between Knight’s move and flight of ideas
Knight’s move thinking there are illogical leaps from one idea to another, flight of ideas there are discernible links between ideas
Munchausen’s syndrome
Purposefully causing symptoms, for example a diabetic taking too much insulin to cause hypos
What condition is important to rule out in anxiety
Thyroid disease
MOA of benzos
enhance the effect of GABA, the main inhibitory neurotransmitter
MOI - avoid which foods and why
Tyramine containing foods (e.g. cheese)
Risk of hypertensive crisis
risk factor for generalised anxiety disorder
being divorced or separated
Severe restlesness with antipsychotics
Akathisia
What age do you need to be to diagnose a personality disorder?
18
Pervasive undesirable personality traits
Management of mania/hypomania in patients taking antidepressants
consider stopping the antidepressant and start antipsychotic therapy
First line for acute stress disorders
Trauma focused CBT
Side effect of long-term atypical antipsychotics
glucose dysregulation and diabetes
Common side effects with imipramine
Blurred vision and dry mouth (TCA)
SSRI use in first trimester
small increased chance of congenital heart defects
Physical finding in anorexia
Lanugo hair
Which antidepressant medication would increase the GI bleeding risk and warrant a PPI
SSRI e.g. citalopram
