Psychiatry Flashcards
1
Q
when is postnatal depression seen to peak
A
3m after birth
2
Q
what is the triad for postnatal depression
A
- low mood
- anhedonia (lack of pleasure in activities)
- low energy
3
Q
how is moderate postnatal depression treated
A
SSRI + CBT
4
Q
what is the screening tool for postnatal depression and what score is diagnostic
A
edinburgh postnatal depression scale (>10)
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)
6
Q
define bipolar disorder
A
extreme mood swing with combo of manic, hypomanic and depressive episodes
7
Q
2 causes of bipolar disorder
A
- genetic
- medications (SSRI_
- no trigger
- high comorbidity with other mental illness
8
Q
3 s/s of bipolar disorder
A
- mood swings
- manic episodes
- hypomanic and depressive episodes
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
10
Q
what is the medications given for bipolar disorder (2)
A
- atypical antipsychotics (olanzapine)
- mood stabilizers (lithium)
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
12
Q
3 symptoms of schizophrenia
A
- hallucinations
- delusions
- disorganised speech
- catatonic behaviour
13
Q
what are the three phase cycles of schizophrenia
A
- prodromal (withdrawn)
- active (delusion/hallucination etc)
- residual phase (cognitive symptoms)
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
15
Q
what medication may be considered for schizophrenia
A
- antipsychotics (think SE)
16
Q
2 symptoms of generalised anxiety disorder
A
- restlessness, difficult to concentrate, irritable
- muscle tension, fatigue, insomnia
17
Q
how long must symptoms persist to be diagnosed as generalised anxiety disorder
A
>6m
18
Q
3 medication choices for generalised anxiety disorder
A
- SSRI’s
- antidepressants
- benzodiazepines
19
Q
1 cardiac and 1 endo complication of trisomy 21
A
cardiac - heart valve disease
endo - hypothyroidism/obesity
20
Q
key sign of downs syndrome
A
brushfield spots
21
Q
How is a diagnosis of down’s syndrome made prenatally
A
Nuchal translucency (week 11-14)
22
Q
3 lab results in prenatal diagnosis of downs syndrome
A
- decreased pregnancy associated plasma protein A (PAPP-A)
- increase serum beta human chorionic gonadotropin (B-hCG)
- quadruple screen
23
Q
how long do symptoms of ADHD have to be present for diagnosis?
A
>6m
24
Q
what are the three types of ADHD
A
- inattentative
- hyperactive/impulse
- both
25
give six examples of what may beseen in inattentive ADHD
- careless mistakes
- struggles to focus
- doesnt appear to listen
- doesnt follow instruction
- poor organising
- avoids mentally engaging tasks
- loses things
- easily distracted
- forgetful
26
6 symptoms seen in hyperactive/impulsive ADHD
- fidgets
- struggles to stay sat
- restless
- struggles to keep quiet
- likes to keep moving
- doesnt like waiting
- interupts others
27
medication for ADHD
stimulants to slow release of neurotransmitter (eg amphetamines - adderall/methylphenidate = ritalin)
28
3 causes of OCD
genetic
environmental
issues with serotonin neurotransmitter
29
what is the medication option for OCD
SSRI, other antidepressants
30
3 s/s of panic disorder
- fast heartbeat
- dizziness
- trembling
- thinking about/ avoidance of public places
31
briefly define panic disorder
fear, avoidance of public places, individual refuses to leave place of safety or home
32
what type of anxiety is seen in panic disorder?
anticipatory anxiety
33
3 conditions panic disorder is associated with
- major depressive disorder
- generalised anxiety disorder
- OCD
34
3 s/s of panic disorder
- chest pain
- elevated heart rate
- sweating
- trembling
- sob
- nausea
- dizzy
35
define PTSD
memory of past traumatic event -\> recurrent mental and physical stress
36
want antidepressants are especially effective in PTSD?
SSRI
37
define somatic symptom disorder
extended periods of unexplainable physical symptoms
38
difference between somatic symptom disorder and factitious disorder
somatic - patient not faking symptoms
39
first line treatment for delerium tremens and preventing seizures
chlordiazepoxide
40
The treatment of acute dystonia
anti-cholinergic procyclidine
41
long term antipsychotic SE (2)
polyuria and polydipsia due to glucose dysregulation and diabetes
42
what SSRI is most likely to cause QT prolongation and torsades de pointes
Citalopram
43
risk of SSRI usage in the third trimester of pregnancy
persistant pulmonary hypertension of the newborn
44
peak incidence of delerium tremens following alcohol withdrawel
72 hrs
45
3 cardiac complications of alcohol use disorder
dilated cardiomyopathy
arrhythmia
stroke
46
3 liver related complications of alcohol use disorder
steatosis
steatohepatosis
fibrosis
cirrhosis
47
3 s/s of alcohol withdrawal
- anxiety
- depression
- irritability
- fatigue
- clammy skin
- tremor
- DELERIUM TREMENS (72HRS)
48
what is the triad of wernicke-korsakoff syndrome
Confusion
Ataxia
Nystagmus
(tip: CANs of beer)
49
what 3 medications may be used for alcohol use disorder and what is their purpose
- naltrexone (reduces cravings)
- acamprosate (stabilize withdrawal)
- disulfiram (increases ethanol sensitivity)
50
4 symptoms of wernickes encephalopathy
confusion
opthalmoplegia
ataxia
thiamine tx
51
4 symptoms of korsakoffs psychosis
retrograde amnesia
anterograde amnesia
confabulation
korsakoff psychosis
52
how does alcohol affect the medulla
affects autonomic functions
- breathing
- consciousness
- body temp
53
3 complications of cocaine dependence
- hyopthermia
- seizures
- brain haemorrhage
- heart attack
- death by overdose
54
medication used for cocaine dependence
modafinil (stimulates, reduces cravings)
55
immediate medication for cocaine overdose
give sedative
- diazepam
- lorazepam
56
3 medications used for opiod overdose
naloxone (blocks opiods)
naltrexone
methadone (opiod for maintenance/tapering consumption)
buprenorphine
57
half-life of nicotine
1-2 hours
58
treatment for acute intoxication of cocaine
benzodiazepines
59
treatment for acute intoxication of benzodiazepines
activated charcoal
flumazenil
60
briefly describe serotonin syndrome
excessive presence of serotonin overactivation of central serotonin receptors -\> clinical manifestations related to mental status, neuromusclar excitation and autonomic excitation
61
3 complications of serotonin syndrome
- ventricular dysrrhythmia
- rhabdomyolysis -\> renal failure
- metabolic acidosis
- acute respiratory distress syndrome
62
3 main signs of serotonin syndrome
1. neuromuscular excitation (hyperreflexia, tremors, clonus, rigidity)
2. autonomic nervous system hyperactivity (vomit, diarrhoea, htn, tachy)
3. altered mental status (anxiety, agitation, confusion)
63
lab results for serotonin syndrome (3)
increased wbc count
increase creatine phosphokinase
decrease serum bicarbonate
64
diagnostic criteria for serotonin syndrome
hunter serotonin toxicity criteria
65
antidote for serotonin syndrome
cyproheptadine (H1,5 HT2 antagonistic affects)
66
when do personality disorders typically arise and what clusters are they classified in to
arise in adolescence or early adulthood
cluster A,B,C
67
3 examples of type A personality disorders
(odd or eccentric thinking or behaviour)
- paranoid personality disorder
- schizoid personality disorder
- shizotypal personality disorder
68
what are cluster A personality disorders highly linked to
higher rates of schizophrenia (and visa versa)
genetic assocation between schizophrenia and Cluster A personality disorder
69
what is the immediate treatment given in delerium tremens/alcohol withdrawel
chloridazepoxide or diazepam
70
common s/e of clozapine
constipation/intestinal obstruction
71
S/E of atypical anti-psychotics
weight gain
72
risk of atypical antipsychotics in the elderly?
increased risk of VTE and stroke
73
what dementia is diagnosed via a SPECT scan
fronto-temporal dementia
74
what is pseudodementia
cognitive impairment secondary to mental illness
75
what warrant allows police to enter a home if a person is at serious risk of harming themselves or others
section 135 warrant
76
how long may a person be detained under a section 135
up to 24 hours
77
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?
under section 136
78
what detainment can a nurse use to keep a patient until doctor/deputy attend and review?
section 5(4)
79
how long can a person be detained under a sectio 5(4)
up to 6hrs
80
what sectioning gives doctors right to detain someone for up to 72hrs
section 5 (2)
81
how long can a person be detained for under a section 2 and a section 3
section 2 up to 28 days
section 3 up to six months with further renewals
82
can you be treated against your will if detained under the mental health act
yes, MHA deems you not to have capacity
83
if a patient is able to leave hospital for a period of time whilst detained under the mental health act what is this called
section 17 leave
84
3 conditions where lithium is contraindicated
- cardiac disease associated with rhythm disorders
- clinically significant renal impairment
- untreated or untreatable hypothyroidism
- low sodium levels
- addisons disease
85
3 S/E of lithium
- diarrhoea
- nausea
- vertigo
- muscle weakness
86
3 signs of lithium toxicity
- diarrhoea
- anorexia
- muscle weakness
- ataxia
- blurred vision
- drowsiness
87
what to do if lithium toxicity suspect
- immediate lithium levels
- secondary care
- supportive treatment and checking lithium every 6-12hrs
88
briefly describe Neuroleptic Malignant Syndrome
- reaction to antipsychotics that is life-threatening
muscle rigidity
fevers
altered mental status
autonomic dysfunction
89
3 most common medications to cause Neuroleptic Malignant Syndrome
first gen neuroleptic
- haloperidol
- fluphenazine
- chlorpromazine
90
3 complications of Neuroleptic Malignant Syndrome
- rhabdomyolysis, renal failure
- seizures
- encephalopathy, coma
- cardiac arrhythmia
- disseminated intravascular coagulation
91
3 main s/s of Neuroleptic Malignant Syndrome
altered mental status (confusion)
muscular abnormalities (leadpipe rigidity)
hyperthermia
92
lab results in Neuroleptic Malignant Syndrome
- severe increase creatinine kinase
- decrease calcium/magnesium/increase pottasium
- increase wcc
- decrease serum iron
93
2 medications that may be administered in Neuroleptic Malignant Syndrome
dantrolene (muscle relaxant)
bromocriptine (dopamine agonist)
94
what are the 4 dopamine pathways
1. mesolimbic (motivation and desire)
2. mesocortical (emotions)
3. nigrostriatal (invol movement and co-ordination)
4. tuberofundibular (releases dopamine to limit orolactin)
95
3 high potency typical antipsychotics
- haloperidol
- trifluoperazine
- fluphenazine
96
3 lower potency typical antipsychotics
- thioridazine
- chlorpromazine
- tiotixine
97
3 SE of antipsychotics
stimulate release of prolactin -\> oligomenorrhea, galactorrhoea and gynaecomastia
98
what is dystonia and how long after starting anti-psychotic medication may this symptom occur
few hours to days
muscle spasms of the tongue, face, neck and back
99
define an oculogyric crisis and what medication may cause this
spasm of the extraocular muscles, caused by anti-psychotics
100
what is akathisia and what medication may cause this
restlessness and urge to move limbs typically caused by anti-psychotics
101
antipsychotics may cause tardive dyskinisia - what is this?
constant involuntary rhymic movement
102
what is the most dangerous SE of antipsychotic medication and what are the symptoms
NMS
confusion, coma, agitation, muscle rigidity, seizures, and hyperthermia.
103
what does NMS present almost identically too and what causes that condition
serotonin syndrome - caused by SSRI
104
differentiates between NMS and serotonin syndrome
serotonin syndrome - hyperreflexia and dilated pupils
105
treatment of neuroleptic malignant syndrome?
dantrolene (muscle relaxant)
106
how may antipsychotics affect an ECG
prolongation of the QT interval
107
specific SE of chlorpromazine
corneal deposits
108
3 conditions which may be treated by ECT
mod-severe depression last resort
catatonia
severe/long-lasting episode of mania
109
when is ECT not recommended (x2)
- ongoing management of schizophrenia
- routine treatment of mild-mod depression
110
key potential SE of ECT
memory loss
usually short term but can be long term
111
define anhedonia - what is it a typical symptom of
inability to feel pleasure - depression
112
define belle indifference
absence of psychological distress despite having serious mental illness/symptoms related to a health condition
113
define catatonia
lack of mobility, erratic and extreme movement
114
define flight of ideas and two times where this may be seen
someone talking rapidly and erratically jumping between ideas ans thoughts
seen in mania, psychosis and some neurodevelopmental conditions
115
what is seen in a patient with Vascular dementia post-mortem?
widespread infarcts
116
what type of medication can cause ED in a psychiatric Hx
SSRI (e.g. citalopram)
117
first line treatment of autoimmune encephalitis
steroids and IV immunoglobulins (if doesnt work add rituximab)
118
rare but life-threatening SE of Clozapine
Agranulocytosis - get an FBC
119
