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Phase 3a > Psychiatry > Flashcards

Psychiatry Flashcards

1
Q

when is postnatal depression seen to peak

A

3m after birth

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2
Q

what is the triad for postnatal depression

A
  • low mood
  • anhedonia (lack of pleasure in activities)
  • low energy
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3
Q

how is moderate postnatal depression treated

A

SSRI + CBT

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4
Q

what is the screening tool for postnatal depression and what score is diagnostic

A

edinburgh postnatal depression scale (>10)

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5
Q

what syndrome can appear in a neonate if the mother was taking SSRI’s during pregnancy

A

neonatal abstinence syndrome (neonatal adaptation syndrome)

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6
Q

define bipolar disorder

A

extreme mood swing with combo of manic, hypomanic and depressive episodes

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7
Q

2 causes of bipolar disorder

A
  • genetic
  • medications (SSRI_
  • no trigger
  • high comorbidity with other mental illness
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8
Q

3 s/s of bipolar disorder

A
  • mood swings
  • manic episodes
  • hypomanic and depressive episodes
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9
Q

what is the criteria for bipolar diagnosis (3)

A

>1 manic episode
symptoms affect day to day
not caused by other condition or substance

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10
Q

what is the medications given for bipolar disorder (2)

A
  • atypical antipsychotics (olanzapine)
  • mood stabilizers (lithium)
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11
Q

list 3 diagnostic criteria for depressive disorder(hint: SIG ED CAPS)

A
  • sleep (up or down)
  • interest: down
  • guilt/worthlessness
  • energy (low)
  • depressed mood
  • concentration low
  • appetite and or weight increase/decrease
  • psychomotor activity up or down
  • suicidal ideation/ thought of death
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12
Q

3 symptoms of schizophrenia

A
  • hallucinations
  • delusions
  • disorganised speech
  • catatonic behaviour
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13
Q

what are the three phase cycles of schizophrenia

A
  • prodromal (withdrawn)
  • active (delusion/hallucination etc)
  • residual phase (cognitive symptoms)
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14
Q

what must be present for an official diagnosis of schizophrenia (2)

A

at least 2 of
- delusions
- hallucinations
- disorganised speech/behaviour/ catatonic
- negative symptoms
(at least 1 has to be delusion/hallucinaion/ disorganised speech)

minimum 6m

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15
Q

what medication may be considered for schizophrenia

A
  • antipsychotics (think SE)
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16
Q

2 symptoms of generalised anxiety disorder

A
  • restlessness, difficult to concentrate, irritable
  • muscle tension, fatigue, insomnia
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17
Q

how long must symptoms persist to be diagnosed as generalised anxiety disorder

A

>6m

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18
Q

3 medication choices for generalised anxiety disorder

A
  • SSRI’s
  • antidepressants
  • benzodiazepines
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19
Q

1 cardiac and 1 endo complication of trisomy 21

A

cardiac - heart valve disease

endo - hypothyroidism/obesity

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20
Q

key sign of downs syndrome

A

brushfield spots

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21
Q

How is a diagnosis of down’s syndrome made prenatally

A

Nuchal translucency (week 11-14)

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22
Q

3 lab results in prenatal diagnosis of downs syndrome

A
  1. decreased pregnancy associated plasma protein A (PAPP-A)
  2. increase serum beta human chorionic gonadotropin (B-hCG)
  3. quadruple screen
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23
Q

how long do symptoms of ADHD have to be present for diagnosis?

A

>6m

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24
Q

what are the three types of ADHD

A
  • inattentative
  • hyperactive/impulse
  • both
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25
Q

give six examples of what may beseen in inattentive ADHD

A
  • careless mistakes
  • struggles to focus
  • doesnt appear to listen
  • doesnt follow instruction
  • poor organising
  • avoids mentally engaging tasks
  • loses things
  • easily distracted
  • forgetful
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26
Q

6 symptoms seen in hyperactive/impulsive ADHD

A
  • fidgets
  • struggles to stay sat
  • restless
  • struggles to keep quiet
  • likes to keep moving
  • doesnt like waiting
  • interupts others
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27
Q

medication for ADHD

A

stimulants to slow release of neurotransmitter (eg amphetamines - adderall/methylphenidate = ritalin)

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28
Q

3 causes of OCD

A

genetic

environmental

issues with serotonin neurotransmitter

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29
Q

what is the medication option for OCD

A

SSRI, other antidepressants

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30
Q

3 s/s of panic disorder

A
  • fast heartbeat
  • dizziness
  • trembling
  • thinking about/ avoidance of public places
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31
Q

briefly define panic disorder

A

fear, avoidance of public places, individual refuses to leave place of safety or home

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32
Q

what type of anxiety is seen in panic disorder?

A

anticipatory anxiety

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33
Q

3 conditions panic disorder is associated with

A
  • major depressive disorder
  • generalised anxiety disorder
  • OCD
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34
Q

3 s/s of panic disorder

A
  • chest pain
  • elevated heart rate
  • sweating
  • trembling
  • sob
  • nausea
  • dizzy
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35
Q

define PTSD

A

memory of past traumatic event -> recurrent mental and physical stress

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36
Q

want antidepressants are especially effective in PTSD?

A

SSRI

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37
Q

define somatic symptom disorder

A

extended periods of unexplainable physical symptoms

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38
Q

difference between somatic symptom disorder and factitious disorder

A

somatic - patient not faking symptoms

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39
Q

first line treatment for delerium tremens and preventing seizures

A

chlordiazepoxide

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40
Q

The treatment of acute dystonia

A

anti-cholinergic procyclidine

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41
Q

long term antipsychotic SE (2)

A

polyuria and polydipsia due to glucose dysregulation and diabetes

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42
Q

what SSRI is most likely to cause QT prolongation and torsades de pointes

A

Citalopram

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43
Q

risk of SSRI usage in the third trimester of pregnancy

A

persistant pulmonary hypertension of the newborn

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44
Q

peak incidence of delerium tremens following alcohol withdrawel

A

72 hrs

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45
Q

3 cardiac complications of alcohol use disorder

A

dilated cardiomyopathy

arrhythmia

stroke

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46
Q

3 liver related complications of alcohol use disorder

A

steatosis

steatohepatosis

fibrosis

cirrhosis

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47
Q

3 s/s of alcohol withdrawal

A
  • anxiety
  • depression
  • irritability
  • fatigue
  • clammy skin
  • tremor
  • DELERIUM TREMENS (72HRS)
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48
Q

what is the triad of wernicke-korsakoff syndrome

A

Confusion

Ataxia

Nystagmus

(tip: CANs of beer)

49
Q

what 3 medications may be used for alcohol use disorder and what is their purpose

A
  • naltrexone (reduces cravings)
  • acamprosate (stabilize withdrawal)
  • disulfiram (increases ethanol sensitivity)
50
Q

4 symptoms of wernickes encephalopathy

A

confusion

opthalmoplegia

ataxia

thiamine tx

51
Q

4 symptoms of korsakoffs psychosis

A

retrograde amnesia

anterograde amnesia

confabulation

korsakoff psychosis

52
Q

how does alcohol affect the medulla

A

affects autonomic functions

  • breathing
  • consciousness
  • body temp
53
Q

3 complications of cocaine dependence

A
  • hyopthermia
  • seizures
  • brain haemorrhage
  • heart attack
  • death by overdose
54
Q

medication used for cocaine dependence

A

modafinil (stimulates, reduces cravings)

55
Q

immediate medication for cocaine overdose

A

give sedative

  • diazepam
  • lorazepam
56
Q

3 medications used for opiod overdose

A

naloxone (blocks opiods)

naltrexone

methadone (opiod for maintenance/tapering consumption)

buprenorphine

57
Q

half-life of nicotine

A

1-2 hours

58
Q

treatment for acute intoxication of cocaine

A

benzodiazepines

59
Q

treatment for acute intoxication of benzodiazepines

A

activated charcoal

flumazenil

60
Q

briefly describe serotonin syndrome

A

excessive presence of serotonin overactivation of central serotonin receptors -> clinical manifestations related to mental status, neuromusclar excitation and autonomic excitation

61
Q

3 complications of serotonin syndrome

A
  • ventricular dysrrhythmia
  • rhabdomyolysis -> renal failure
  • metabolic acidosis
  • acute respiratory distress syndrome
62
Q

3 main signs of serotonin syndrome

A
  1. neuromuscular excitation (hyperreflexia, tremors, clonus, rigidity)
  2. autonomic nervous system hyperactivity (vomit, diarrhoea, htn, tachy)
  3. altered mental status (anxiety, agitation, confusion)
63
Q

lab results for serotonin syndrome (3)

A

increased wbc count

increase creatine phosphokinase

decrease serum bicarbonate

64
Q

diagnostic criteria for serotonin syndrome

A

hunter serotonin toxicity criteria

65
Q

antidote for serotonin syndrome

A

cyproheptadine (H1,5 HT2 antagonistic affects)

66
Q

when do personality disorders typically arise and what clusters are they classified in to

A

arise in adolescence or early adulthood

cluster A,B,C

67
Q

3 examples of type A personality disorders

(odd or eccentric thinking or behaviour)

A
  • paranoid personality disorder
  • schizoid personality disorder
  • shizotypal personality disorder
68
Q

what are cluster A personality disorders highly linked to

A

higher rates of schizophrenia (and visa versa)

genetic assocation between schizophrenia and Cluster A personality disorder

69
Q

what is the immediate treatment given in delerium tremens/alcohol withdrawel

A

chloridazepoxide or diazepam

70
Q

common s/e of clozapine

A

constipation/intestinal obstruction

71
Q

S/E of atypical anti-psychotics

A

weight gain

72
Q

risk of atypical antipsychotics in the elderly?

A

increased risk of VTE and stroke

73
Q

what dementia is diagnosed via a SPECT scan

A

fronto-temporal dementia

74
Q

what is pseudodementia

A

cognitive impairment secondary to mental illness

75
Q

what warrant allows police to enter a home if a person is at serious risk of harming themselves or others

A

section 135 warrant

76
Q

how long may a person be detained under a section 135

A

up to 24 hours

77
Q

If the police find you in a public place and you appear to have a mental disorder and are in need of immediate care or control, they can take you to a place of safety and detain you. this is what sectioning?

A

under section 136

78
Q

what detainment can a nurse use to keep a patient until doctor/deputy attend and review?

A

section 5(4)

79
Q

how long can a person be detained under a sectio 5(4)

A

up to 6hrs

80
Q

what sectioning gives doctors right to detain someone for up to 72hrs

A

section 5 (2)

81
Q

how long can a person be detained for under a section 2 and a section 3

A

section 2 up to 28 days

section 3 up to six months with further renewals

82
Q

can you be treated against your will if detained under the mental health act

A

yes, MHA deems you not to have capacity

83
Q

if a patient is able to leave hospital for a period of time whilst detained under the mental health act what is this called

A

section 17 leave

84
Q

3 conditions where lithium is contraindicated

A
  • cardiac disease associated with rhythm disorders
  • clinically significant renal impairment
  • untreated or untreatable hypothyroidism
  • low sodium levels
  • addisons disease
85
Q

3 S/E of lithium

A
  • diarrhoea
  • nausea
  • vertigo
  • muscle weakness
86
Q

3 signs of lithium toxicity

A
  • diarrhoea
  • anorexia
  • muscle weakness
  • ataxia
  • blurred vision
  • drowsiness
87
Q

what to do if lithium toxicity suspect

A
  • immediate lithium levels
  • secondary care
  • supportive treatment and checking lithium every 6-12hrs
88
Q

briefly describe Neuroleptic Malignant Syndrome

A
  • reaction to antipsychotics that is life-threatening

muscle rigidity

fevers

altered mental status

autonomic dysfunction

89
Q

3 most common medications to cause Neuroleptic Malignant Syndrome

A

first gen neuroleptic

  • haloperidol
  • fluphenazine
  • chlorpromazine
90
Q

3 complications of Neuroleptic Malignant Syndrome

A
  • rhabdomyolysis, renal failure
  • seizures
  • encephalopathy, coma
  • cardiac arrhythmia
  • disseminated intravascular coagulation
91
Q

3 main s/s of Neuroleptic Malignant Syndrome

A

altered mental status (confusion)

muscular abnormalities (leadpipe rigidity)

hyperthermia

92
Q

lab results in Neuroleptic Malignant Syndrome

A
  • severe increase creatinine kinase
  • decrease calcium/magnesium/increase pottasium
  • increase wcc
  • decrease serum iron
93
Q

2 medications that may be administered in Neuroleptic Malignant Syndrome

A

dantrolene (muscle relaxant)

bromocriptine (dopamine agonist)

94
Q

what are the 4 dopamine pathways

A
  1. mesolimbic (motivation and desire)
  2. mesocortical (emotions)
  3. nigrostriatal (invol movement and co-ordination)
  4. tuberofundibular (releases dopamine to limit orolactin)
95
Q

3 high potency typical antipsychotics

A
  • haloperidol
  • trifluoperazine
  • fluphenazine
96
Q

3 lower potency typical antipsychotics

A
  • thioridazine
  • chlorpromazine
  • tiotixine
97
Q

3 SE of antipsychotics

A

stimulate release of prolactin -> oligomenorrhea, galactorrhoea and gynaecomastia

98
Q

what is dystonia and how long after starting anti-psychotic medication may this symptom occur

A

few hours to days

muscle spasms of the tongue, face, neck and back

99
Q

define an oculogyric crisis and what medication may cause this

A

spasm of the extraocular muscles, caused by anti-psychotics

100
Q

what is akathisia and what medication may cause this

A

restlessness and urge to move limbs typically caused by anti-psychotics

101
Q

antipsychotics may cause tardive dyskinisia - what is this?

A

constant involuntary rhymic movement

102
Q

what is the most dangerous SE of antipsychotic medication and what are the symptoms

A

NMS

confusion, coma, agitation, muscle rigidity, seizures, and hyperthermia.

103
Q

what does NMS present almost identically too and what causes that condition

A

serotonin syndrome - caused by SSRI

104
Q

differentiates between NMS and serotonin syndrome

A

serotonin syndrome - hyperreflexia and dilated pupils

105
Q

treatment of neuroleptic malignant syndrome?

A

dantrolene (muscle relaxant)

106
Q

how may antipsychotics affect an ECG

A

prolongation of the QT interval

107
Q

specific SE of chlorpromazine

A

corneal deposits

108
Q

3 conditions which may be treated by ECT

A

mod-severe depression last resort

catatonia

severe/long-lasting episode of mania

109
Q

when is ECT not recommended (x2)

A
  • ongoing management of schizophrenia
  • routine treatment of mild-mod depression
110
Q

key potential SE of ECT

A

memory loss

usually short term but can be long term

111
Q

define anhedonia - what is it a typical symptom of

A

inability to feel pleasure - depression

112
Q

define belle indifference

A

absence of psychological distress despite having serious mental illness/symptoms related to a health condition

113
Q

define catatonia

A

lack of mobility, erratic and extreme movement

114
Q

define flight of ideas and two times where this may be seen

A

someone talking rapidly and erratically jumping between ideas ans thoughts

seen in mania, psychosis and some neurodevelopmental conditions

115
Q

what is seen in a patient with Vascular dementia post-mortem?

A

widespread infarcts

116
Q

what type of medication can cause ED in a psychiatric Hx

A

SSRI (e.g. citalopram)

117
Q

first line treatment of autoimmune encephalitis

A

steroids and IV immunoglobulins (if doesnt work add rituximab)

118
Q

rare but life-threatening SE of Clozapine

A

Agranulocytosis - get an FBC

119
Q
A

Phase 3a (4 decks)

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