Psychiatry Flashcards
Name the condition that is a non-reversible memory disorder often seen in alcoholics.
Korsakoff’s syndrome
List the 4 treatment options for mania.
Antipsychotics
Mood stabilisers
Lithium
ECT (electro convulsive therapy)
What are the 2 core features of OCD?
What is the 1st line treatment of OCD?
What is the 2nd line treatment?
What is the last treatment option if the above 2 don’t work?
1) Recurrent, obsessive thoughts
2) Compulsive acts (eg they can’t stop themselves from doing something)
1st line: CBT
2nd line: SSRI’s (fluoxetine)
Psychosurgery
What other mental health disorders are associated with eating disorders? (3)
OCD, anxiety, perfectionism
What is the first presenting symptom of:
a) Alzheimers dementia
b) Vascular dementia
c) Lewy-body dementia
d) Fronto-temporal dementia
a) Alzheimers: Loss of recent memory
b) Vascular: Step wise decrease in ADL (language affected first)
c) Lewy-body: Fluctuating confusion & visual hallucinations (+ parkinsonism symptoms)
d) Fronto-temporal: Personality change
When would baby blues typically present?
When would postnatal depression typically present?
Baby blues: Within 2 weeks of delivery
Postnatal depression: several weeks after delivery up to 1y
Which lobes of the brain are usually affected first in Alzheimers disease?
Parietal & temporal lobes
What side effects are more likely with typical antipsychotics compared to atypical antipsychotics?
Extra-pyramidal symptoms (eg, parkinsonism symptoms, tremor, slurred speech, inability to stay still)
Regarding sections from the MHA below, state a) how long they are valid for, b) who is able to use them, c) whether they include assessment/ treatment
Emergency detention certificate
Short-term detention certificate
Compulsary treatment order
Emergency detention certificate:
• Valid for 72h
• Fully registered doctor (FY2 onwards) + consent from a MHO (if available)
• ONLY detention
Short-term detention certificate:
• Valid for 28d
• Approved mental health doctor (psychiatrist!!) + MHO consent
• Detention & treatment
Compulsary treatment order:
• Valid for 6m - but can be renewed!
• MHO applies to Tribunal with 2 supporting medical reports from a AMP (psychiatrist) & GP (otherwise 2x AMPs)
• Detention & treatment
What is the name of the condition in which your face/body or both make sudden, irregular movements outwith your control?
Tardive dyskinesia
Delirium can present in 2 extremes, what are these called?
List some common features of each type.
Hyperactive & hypoactive delirium
Hyperactive delirium:
→ aggitated / aggressive
→ disorganised thoughts
→ hallucinations
→ restlessness
Hypoactive delirium:
→ abnormal drowsiness
→ fatigue
→ less reactive
→ withdrawn
What class of antidepressant’s are lethal in overdose?
Give an example of a drug in this class
TCA’s - amitriptyline
Define what dementia is.
Dementia is a syndrome (a collection of different symptoms) associated with an progressive decline in brain functioning
What antipsychotic is used in treatment resistant patients?
Clozapine
What is often the first clinical feature seen in vascular dementia?
Aphasia (problems with communication)
* Memory is often spared until advanced disease
List some clincial features seen in someone with bulimia nervosa (6)
Swollen parotid glands
Poor dentition (from the acid in the vomit)
Mouth sores
Eosophageal tears → haematemesis
Heart burn
Impulsivity: stealing, alcohol/drugs, smoking
What are the 3 main criteria of PTSD according to ICD-10? - list some symptoms that fall under each one
What is the management of sub-clinical PTSD?
What is the management of moderate+ PTSD?
~ if this doesn’t work, what medication can be used?
1) Hyper-arousal
~ persistent anxiety
~ poor concentration
~ emotional numbing
2) Flashbacks
~ intense flashbacks at night/ during day
3) Avoidance
~ activities that remind patient of trauma are avoided
Subclinical: Watch & wait approach
Moderate: Trauma focused CBT - SSRI’s
What is the management of mild- moderate depression?
What is the management of moderate- severe depression?
What do you do next if the 1st medical managent of severe depression fails?
~ If this fails, then what?
~ What do you add in next?
What is the management of severe treatment resistant depression?
~ If patient doesn’t want this, what medical management is available?
Mild-moderate: • Group CBT
Moderate-severe: • CBT PLUS SSRI (sertraline)
Add in a 2nd SSRI
~ Swap one of the SSRI’s for an SNRI
~ Use these along with lithium
** Review after 2 weeks
ECT (electro convulsive therapy)
~ Monoamine oxidase inhibitors (MAOIs)
What are the 3 pathological features seen in the brains of patients with Alzheimers disease?
Amyloid plaques
Tau protein tangles
Reduced Ach
What timeframe does postnatal depression occur within?
Within 6 months of giving birth
What is the difference between mania & hypomania?
In hypomania there are no psychotic symptoms & the episode isn’t severe enough to impact on their social / occupational functioning.
What are the key clinical features in lewy body dementia? (3)
Fluctuating confusion throughout the day
Visual hallucinations
Parkinsonism symptoms (poor mobility, tremor)
What side effect is commonly associated with Olanzapine?
Weight gain
What medication is used in chronic bipolar disorder?
Lithium
What’s the difference between hallucinations & delusions?
Hallucinations are seeing/ hearing things not related to an external stimulus
~ Can affect any of the 5 senses (touch, smell, taste, hearing, sight)
Delusions are fixed, firm beliefs that are outwith the patients cultural beliefs
~ Patients will believe delusions are true, even if shown evidence against them
How is Binge Eating Disorder different from Bulimia Nervosa?
In Binge Eating Disorder, patient’s don’t purge themselves after eating
Capacity is decision specific: TRUE/FLASE?
True
What is the definition of psychosis?
The inability to distinguish between symptoms of hallucination, delusion and disordered thinking from reality - they have a lack of insight into their condition
What are the first 2 clinical features to show in Alzheimers disease?
Loss of memory
Loss of executive function
What does ‘confabulation’ mean?
Occurs when there is memory loss & the brain fills in the gap of the missing information
A 19y male is admitted to A&E following a night out with friends. He presents with rigidity, disorientation and a temperature of 39.2. He states he had taken some pills during the night out. It is suspected he has taken ectasy.
His observations are stable.
He is normally fit and well with only a PMH of depression to note.
What is the most likely diagnosis of his current symptoms?
Serotonin syndrome
PMH: depression, so he is likely taking an SSRI. As ectasy is a stimulant drug, when coupled with an SSRI it can cause serotonin syndrome!
What are the core symptoms of depression according to the ICD-10 criteria?
- A depressed mood for most of the day that has been present for 2+ weeks
- Loss of interest or pleasure (anhedonia)
- Decreased energy
Which hallucinations are most common in Schizophrenia? (3)
- 3rd person auditory
- Voices that repeat the patients thoughts
- Voices that comment on the patients thoughts/behaviour
Name the condition described:
“Episodes of binge eating with a sense of loss of control, followed by purging behaviour” - normal BMI
Bulimia nervosa
How long is an emergency detention certificate valid for?
72 hours
What is the 1st line treatment in all eating disorders?
CBT
What common side effect should all patients be advised about when starting Carbamazepine?
What 2 conditions is carbamazepine commonly used to treat?
A rash
Epilepsy & neuropathic pain
What is the difference between mania and hypomania?
Hypomania is a milder version of mania - it doesn’t include hallucinations or delusional beliefs
Name the disorder in which psychological stress is unconsciously manifested as physical, neurological symptoms (eg, weakness in an arm)
Conversion disorder
A patient with delirium does not have capacity. - T/F
Capacity is decision specific. - T/F
False, some patients may still have capacity
True, a patient may not have capacity for more complex decisions but may retain capacity for basic decisions
What is the definition of psychosis?
What 2 clinical signs fall under pschosis?
The inability to distinguish between symptoms of delusion, hallucination and disordered thinking from reality (aka, lack of insight)
Hallucinations
Delusions
What is the 1st line medication used in mild/moderate Alzheimers?
Donepezil
What is a life-threatening side effect of clozapine?
What monitoring does clozapine need for early detection of this side effect?
Agranulocytosis
Weekly FBC
What would you expect to see in the blood results of a patient diagnosed with anorexia nervosa in regards to:
- K levels
- Cholesterol levels
- Sex hormone levels (FSH, LH, Oestrogen, Testosterone)
- GH levels
- Cortisol levels
- Hypokalaemia
- Hypercholesterolaemia
- Low sex hormones
- Raised GH
- Raised cortisol
What are the 3 categories of symptoms of depression?
Psychological
Physical
Social
An elderly man has been admitted to hospital with acute onset disorientation, visual hallucinations and agitation. He has no psychiatric history and lives alone and requires no support.
What is the most likely diagnosis?
Delirium
For a diagnosis of severe depression, how many additional symptoms from the ICD-10 criteria does the patient need to have?
8
Amitriptyline is used to treat which 2 clinical conditions?
Depression Mild pain (neuropathic)
What are the 3 criteria needed for a diagnosis of learning difficulty?
What are the 3 main causes of learning difficulty?
1) Intellectual impairment (IQ < 70)
2) Social/ adaptive dysfunction
(eg deficits in communication/ self-care, social skills etc)
3) Onset before 18y (whilst brain is still developing)
1) Head injury
2) Chromosomal abnormalities (eg Downs)
3) Congenital abnormalities (eg infection/ abnormal brain development)
A 39 year old woman presents with a complaint that she is fearful that something bad may happen to her. This fear occurs where-ever she goes and she cannot describe what might happen. She also complains of pains in her chest, a tremor and sweating at times.
What is the most likely diagnosis?
Generalised anxiety disorder
Refeeding syndrome can occur in people who havent eaten for how many days?
What happens to K, phosphate & Mg2+ if food is reintroduced too fast to someone with anorexia?
What are 3 common symptoms/ signs seen in refeeding syndrome?
5+ days
Levels fall resulting in depletion of all 3 electrolytes!
- Arrhythmia’s
- Confusion
- Death
What are the 1st and 2nd line drug classes used for depression?
1st line: SSRI’s
2nd line: SNRI’s
What 2 tests can be performed to assess the level of cognitive impairment/ ability?
MMSE (mini mental state exam)
MOCA
What are some common side effects of Valproic acid? (3)
Which 2 conditions is valproic acid (sodium valproate) used to treat?
Nausea
Vomiting
Weight gain
1) Epilepsy
2) Bipolar disorder
Roughly how long after stopping alcohol intake does delirium tremens present?
72 hours
What condition does the following statement indicate a diagnosis of?
” 50y with gradual change in behaviour over past 2 years. Clear personality change & quite withdrawn “
Frontotemporal dementia
What is mixed state delirium?
It’s when someone fluctuates between hyperactive delirium & hypoactive delirium
What type of antipsychotic is Risperidone?
Atypical antipsychotic
What is the medical word that describes the inability to feel pleasure?
What condition is this a key feature of?
Anhedonia
Depression
What drug class are used as the 1st line treatment for depression?
SSRI’s
Which 2 antipsychotics are associated with weight gain?
Olanzapine & Clozapine
Can clozapine be used whilst actively breastfeeding?
No
To be diagnosed with dementia, what type of imaging is required?
None. Dementia is a clinical diagnosis - imaging is done occasionally to confirm the diagnosis
What is the antedote to a paracetemol overdose?
NAC (N-acetylcysteine)
Someone with autism may have defecits in what 3 things?
What does the management of autism involve?
What congenital condition is autism commonly seen in?
1) Social interaction
2) Communiation
3) Behaviour
Management: MDT team, no medications
Down syndrome
What medication would you start someone on if they present with their 1st episode of mania?
What contraindications are there to this medicine?
Lithium
Not ideal for women of child bearing age - discuss contraception with them
Which antidepressant class should be avoided in patients with suicidal ideation?
Tricyclic antidepressants - they are lethal in overdose
What are the 2 mechanisms underlying addiction?
~ State whether they underpin physical/ psychological dependence
- Tolerance - physical dependence
- Activation of the reward pathway - psychological dependence
Name the most commonly used SSRI.
Sertraline
What questionairre is used in general practice to grade the severity of a patient’s depression?
PHQ-9 questionairre
Name the condition described:
“Episodes of binge eating with a sense of loss of control, followed by purging behaviour” - BMI less than 17.5
Anorexia nervosa: binge purge subtype
Which neurotransmitter is most implicated in developing Schizophrenia?
~ Name the 4 pathways in which this neurotransmitter is released:
Dopamine
- Nigrostriatal pathway
- Meso-limbic pathway
- Meso-cortical pathway
- Tuberoinfundibular pathway
There are 2 extremes of delirum. What are they called? List some symptoms seen in each: (3, 3)
Hyperactive delirium:
→ Aggression/ aggitation
→ Hallucinations
→ Restlessness
Hypoactive delirium:
→ Sleepiness/ fatigue
→ Withdrawn
→ Memory problems (temporary dementia)
What type of hallucinations are common in lewy body dementia?
Visual hallucinations:
→ animals in the house
→ faces in the wallpaper
What is the ICD10 classification of mild depression?
What is the ICD10 classification of moderate depression?
What is the ICD10 classification of severe depression?
Mild depression, need 2 of the general criteria PLUS 1 additional sympotms
Moderate depression, need 2 of the general criteria PLUS 3 additional symptoms
Severe depression, need all 3 of the general criteria PLUS 5 additonal symptoms
General criteria for depression:
- Low mood for most of the day almost everyday for 2+ weeks
- Loss of interest or pleasure (anhedonia)
- Decreased energy (fatigue)
Additonal symptoms:
- Loss of confidence
- Feelings of guilt
- Suicidal ideation
- Decreased concentration
- Agitation/ psychomotor retardation
- Sleep disturbance
- Change in appetite
What medication is used for treatment resistant Schizophrenia?
Clozapine
After starting an antipsychotic, roughly how long does it take for the patient to notice it start working?
Up to 8 weeks
What is the management of all personality disorders?
CBT
Before starting someone on an antipsychotic, which bloods would you want to do? (4)
FBC
LFT
Lipid profile
Fasting blood sugar
When starting someone on an SSRI, what should you warn them about?
What is the name given to this?
They may feel worse for the first 10 days, but after this they should feel better
Activation syndrome
What ilicit drugs are capable of causing with serotonin syndrome? (4)
- Cocaine
- MDMA (ectasy)
- LSD
- Amphetamine
What is the antedote to an opioid overdose?
IV naloxone!
Below which BMI is considered as anorexic?
Below BMI of 17.5
What drug is given to rapidly reverse an opioid overdose?
Naloxone
What is the treatment of mild-moderate Alzheimers disease? (Drug & drug class)
~ Name a common S/E of this.
What is the treatment of severe Alzheimers disease/ if previous treatment has failed?
What is the treatment of Vascular dementia?
What is the treatment of Lewy-Body dementia? (Drug & drug class)
~ Name a common S/E of this.
What is the treatment of Fronto-temporal dementia?
Anticholinesterase inhibitors: donepezil
S/E = GI upset (nausea, vomiting, diarrhoea)
Memantine
Management of underlying vascular risk factors
Anticholinesterase inhibitors: donepezil
S/E = GI upset (nausea, vomiting, diarrhoea)
No current treatment..
List some clincial features seen in someone with bulimia nervosa (6)
Swollen parotid glands
Poor dentition (from the acid in the vomit)
Mouth sores
Eosophageal tears → haematemesis
Heart burn
Cuts on knuckles from induced vomiting (Russell’s sign)
Which neurotransmitter do antipsychotics decrease?
Dopamine
What drug class are used to manage the somatic symptoms of anxiety? Eg sweating, palpitations & hand tremors.
Name a contraindication to this drug class.
Beta blockers
Asthma & heart block
After starting an antidepressant, roughly how long does it take for the patient to notice it start working?
2-4 weeks
What are the 3 core symptoms of depression?
- Low mood (for more than half of the day, 2+ weeks)
- Anhedonia
- Low energy levels
How is Binge Eating Disorder different from Bulimia Nervosa?
What is an effective treatment in Binge Eating Disorder?
In Binge Eating Disorder, patient’s don’t purge themselves after eating
Treatment BED: CBT
What type of antipsychotic is Chlopromazine?
Typical antipsychotic
What neuropathological features would be seen on imaging of someone with Alzheimer’s disease? (2)
Amyloid plaques
Tau protein tangles
What is the medical word used to describe: ‘a loss of interest/motivation’
Apathy
What does ‘dystonia’ mean?
What psychiatric drug class can cause dystonia?
Involuntary muscle spasms/contractions (hypertonia)
Antipsychotics
What is delirium?
What is a screening tool for delirium?
What is the management of delirium? (5)
An acute confusional state
4AT
Non-pharmacological management !!!!!
~ Stop/ treat any precipitating factors (eg medications, infection)
~ Mobilise patient asap
~ Make patient familiar with their surroundings
~ Normalise sleep-wake cycle
~ Discharge from hospital ASAP
Give 3 examples of foods/drinks patients on MAOI’s should avoid.
Cheese
Beer
Red wine
For a diagnosis of mild depression, how many additional symptoms from the ICD-10 criteria does the patient need to have?
4
What is the difference between mania and hypomania?
For a diagnosis of either, how long do symptoms need to be present for?
Mania: Elated/ irritable mood PLUS:
• psychotic features (halluctination/ delusions)
• impacts on ADL
Hypomania: Elated/ irritable mood PLUS:
• NO psychotic features
• NO impact on ADL
Diagnosis requires symptoms for 1 week+
Hyperprolactinaemia is a potential side effect of which class of psychiatric drugs?
What clinical features might males & females present with?
Antipsychotics
Males:
→ Erectile dysfunction
→ Gynaecomastia
→ Galactorrhoea
Females:
→ Galactorrhoea
→ Menstrual dysfunction
Someone with autism may have defecits in what 3 things?
What does the management of autism involve?
What congenital condition is autism commonly seen in?
- *1)** Social interaction
- *2)** Communiation
- *3)** Behaviour
Management: MDT team, no medications
Down syndrome
What drug class are extrapyramidal side effects associated with?
List some common ones: (4)
Typical antipsychotics
• Akathisia (restlessness)
• Parkinsonism features (bradykinesia, tremor, rigidity)
• Dystonia (involuntary muscle twitching)
• Tardive dyskinesia (involuntary facial movements)
What is a delusional perception?
When someone see’s/hear’s something and associates it with something unrelated.
Eg, someone see’s a street lamp flicker and then believes that they are destined to be the next king
List the 3 main features of delirium:
1) Fluctuating consciousness
~ hypoactive
~ hyperactive
~ disrupted REM sleep
2) Change in cognition
~ confusion
~ memory impairment
3) Acute onset
What are 2 serious side effects of MAOI’s? - How can these be avoided?
1) Hypertensive crisis (cheese reaction)
~ avoid tyramine rich foods as they cause huge increase in BP
~ eg, beer, wine, cheese
2) Serotonin syndrome
~ occurs when MAOI’s are taken alongisde drugs that increase serotonin (eg SSRI’s)
~ wait 2 weeks after stopping SSRI before starting MAOI
What type of antipsychotic is Olanzapine?
Atypical antipsychotic
You are asked to see a 29-year-old woman in clinic who has recently found out she is pregnant. She has a history of type 1 bipolar affective disorder, for which she takes lithium. Despite treatment she suffered an episode of mania 9 months previously. How should this patient’s psychiatric medication be managed during the antenatal period?
Gradually switch the lithium to an atypical antipsychotic
What is the classic traid of clinical features seen in Wernicke’s encephalopathy?
Ataxia (lack of coordination of movements)
Ophthalmoplegia (paralysis of the eye muscles)
Encephalopathy (brain damage)
For a diagnosis of moderate depression, how many additional symptoms from the ICD-10 criteria does the patient need to have?
6
List some symptoms of anorexia (7)
Lanugo hair
Cold intolerance
Blue hands / feet
Amenorrhoea
Dry skin
Hypotension
Weakness / fatigue
Which class of antidepressants are used in treatment resistant depression?
MAOI’s
A 19 year old student presents to his GP with a three month history of hearing a voice commenting on what he is doing and making derogatory comments about him. It has recently started telling him to do things. He has started to believe that his flatmates are against him and wish to harm him. He uses no illicit drugs.
What is the most likely diagnosis?
Schizophrenia
What are the negative symptoms of schizophrenia? (4)
Apathy (lack of interest/ motivation)
Social withdrawal
Emotional blunting
Poverty of speech/ psychomotor retardation
List some characteristics seen in Borderline Personality Disorder: (5)
What treatment options are available for personality disorders? (2)
- Impulsive behaviour
- Inability to control emotions
- Unstable relationships
- Self harm
- Feelings of paranoia/ anxiety
Treatment options:
• CBT
• Antipsychotics/ antidepressants/ mood stabilisers - to treat underlying mental health condition!
What does ‘akathisia’ mean?
Unpleasant sensation of restlessness
Name the condition described:
“Episodes of binge eating with a sense of loss of control, followed by purging behaviour” - normal BMI
Bulimia nervosa
The drugs below are antidotes to overdoses of what substances?
a) Naloxone
b) Flumazenil
c) N-acetyecysteine
a) Opioids
b) Benzodiazepines
c) Paracetemol
What common hallucination is associated with delirium tremens?
Visual hallucinations involving insects
Which electrolyte imbalance is seen in anorexia nervosa?
Hypokalaemia (low K)
A deficiency in which vitamin can result in Korsakoff’s syndrome?
Thiamine - B1
What type of medication is used 1st line if someone presents with an acute manic episode with no aggitation?
An antipsychotic
What is the medical word for the inability to experience pleasure in things that you used to enjoy?
Anhedonia
- *Aspirin** overdose causes what type of abnormality seen on an ABG:
- 1*. Initially
2. Later on (in the second phase of it’s toxicity)?
(eg, metabolic alkalosis etc)
1. Respiratory alkalosis
Aspirin has a direct stimulatory effect on the respiratory centres within the medulla, increasing RR (and thus blowing off more CO2)
2. Metabolic acidosis
Aspirin interfere’s with aerobic respiration within cells, resulting in production of lactate (which is acidic!)
What is the management of Schizophrenia? - Name the drug class & 2 examples
What are some common contraindictations of atypical antipsychotics?
What can also be given if patient is aggitated in an acute episode of Schizophrenia?
What medication is used in treatment resistant Schizophrenia?
~ Name an important S/E of this
Atypical antipsychotics - eg olanzapine/ risperidone**
Atypical’s:
• Weight gain & hyperlipidaemia/ hypercholesterolaemia (olanzapine)
• Hyperprolactinaemia (risperidone)
Aggitation: Benzodiazepam, eg lorazepam
Clozapine - agranulocytosis (weekly blood tests needed)
** CBT may aslo be used
List the positive & negative symptoms of schizophrenia: (3, 3)
Having more of which type of symptoms indicates a better prognosis?
How long do symptoms need to be present for an ICD-10 diagnosis?
Positive symptoms: - better prognosis!
• Hallucinations
• Delusions
• Disordered thinking
Negative symptoms:
• Anhedonia
• Lack of emotions (emotional blunting)
• Apathy (lack of motivation)
Schizophrenia = symptoms present for 1 month +
What are the 1st rank symptoms of Schizophrenia? (ABCD)
A - Auditory Hallucinations
B - Broadcasting of Thought
C - Controlled Thought (delusions of control)
D - Delusional Perception
What drug class is used for the treatment of Alzheimers disease & Lewy Body dementia?
Give an example of a medication from this class.
Acetylcholinesterase inhibitors
Donepezil
What type of antipsychotic is Clozapine?
Atypical antipsychotic
What is the acute management of a manic episode? - give an example
What is the chronic management of bipolar disorder?
Antipsychotic (eg, Olanzapine)
Lithium (or sodium valproate)
+ antipsychotic (eg olanzapine) - if uncontrolled with lithium
What is the difference between type 1 and type 2 bipolar affective disorder?
BPAD 1 - associated with mania (manic highs) = hallucinations/ delusions
BPAD 2 - associated with hypomania (hypomanic highs) = no hallucinations/ delusions
What screening tool is used to assess the likelihood of anorexia nervosa?
A score of what would suggest an eating disorder?
SCOFF questionairre
2+
What’s a common side effect of SSRI’s that causes poor patient compliance?
Sexual dysfunction
What tool is used to assess for alcohol use & problems?
FAST (fast alcohol screening tool)
Give an example of a commonly used tricyclic antidepressant.
Amitriptyline
What is the screening tool for delirium?
A score of what indicates possible delirium?
Who should be screened for delirium upon admission to hospital?
4AT
4 or more
Anyone over 65y!
Why does the dose of Lamotrigine have to be titrated up SLOWLY?
High risk of developing Stevens Johnson’s syndrome (nasty, necrolysing rash)
What actually is delirium?
An acute confusional state
List the 5 most prevelant types of dementia:
Alzheimers disease
Vascular dementia
Lewy body dementia
Mixed dementia (when someone has a mixture of 2 dementia’s)
Frontotemporal dementia
What are the common side effects after starting Lithium?
GI upset: nausea / vomiting, diarrhoea, decreased appetite
What are the 3 criteria needed for a diagnosis of learning difficulty?
What are the 3 main causes of learning difficulty?
1) Intellectual impairment (IQ < 70)
2) Social/ adaptive dysfunction
(eg deficits in communication/ self-care, social skills etc)
3) Onset before 18y (whilst brain is still developing)
1) Head injury
2) Chromosomal abnormalities (eg Downs)
3) Congenital abnormalities (eg infection/ abnormal brain development)
What type of medication is used for the maintenance of someone that has mania / bipolar disorder?
Mood stabilisers
Lithium
What illegal drug is associated with increased risk of developing Schizophrenia?
Cannabis
A patient taking MAOI’s should be told to avoid what, & why?
Avoid tyramine-rich foods as tyramine reacts with the MAOI’s causing a hypertensive crisis
= cheese reaction
What is the 1st line medication for Parkinson’s disease?
What is this medication usually given with & why?
Levodopa
Co-administered with Carbidopa - prevents L-dopa being converted into it’s active form in the systemic circulation thus more reaches the brain
If someone presents to A&E with a psychotic episode (with no previous psychiatric diagnosis), what investigation should you do immediately & why?
Urinary toxicology - to rule out the use of illicit drugs as the cause
What type of dementia is most common in the under 65’s age group?
Alcohol related brain damage (ARBD)
What screening tool is used to assess the likelihood of anorexia nervosa?
A score of what would suggest an eating disorder?
SCOFF questionairre
2+
What are ‘neologisms’? - what condition might they be featured in?
Neologisms = made up words - indicates a thought disorder
~ common in Schizophrenia
Define what dementia is:
Dementia is a syndrome (a collection of different symptoms) associated with an progressive decline in brain functioning
What monitoring does Clozapine require & why?
Weekly blood tests - associated with agranulocytosis
What is metabolic syndrome?
A syndrome involving:
- Obesity
- Hypertension
- Dyslipidaemia
- Abnormal glucose metabolism (diabetes)
What condition is associated with alcohol withdrawal?
~ How long after withdrawing alcohol does this usually present?
List some clinical features associated with this condition: (5)
What class of drugs are used to help prevent withdrawal symptoms? - Name the main drug used.
Delirium tremens
~ Presents 72h after stopping alcohol
- Confusion
- Hallucinations (visual & tactile (insects crawling under skin))
- Sweating
- Hypertension
- Seizures
Benzodiazepines (eg Chlordiazepoxide)
What drug can be given to help someone withdraw from opiates?
Methadone
Name a criteria used to diagnose depression.
ICD-10
What is the difference between generalised anxiety disorder & phobic anxiety disorders?
What is agoraphobia?
What is the available treatment of GAD?
GAD - anxiety symptoms occur all the time & are not restricted to certain circumstances
Phobias - anxiety symptoms only occur in particular circumstances
Agoraphobia: A fear of crowded spaces
1) Counselling
2) SSRI’s (sometimes TCA’s)
What condition presents with rapid onset confusion that is precipitated by alcohol withdrawal?
Delirium tremens
What are the positive symptoms of schizophrenia? (3)
Hallucinations
Delusion
Disordered thinking
List some common causes of delirium (12)
(CHIMPS PHONED)
C - Constipation / urinary retention
H - Hypoxia
I - Infection
M - Metabolic disturbance
P - Pain
S - Sleeplessness (lack of sleep)
P - Prescriptions (anti-cholinergics, opiates)
H - Hypothermia/pyrexia
O - Organ dysfunction (hepatic or renal impairment)
N - Nutrition (poor)
E - Environmental changes
D - Drugs (over the counter, illicit, alcohol and smoking)
A 25-year-old woman presents with an inability to use her right arm, for 3 days. The patient has been living with her mother for the past 5 days after being a victim of domestic abuse from her husband. She is unable to move her right arm from her shoulder to her fingers. She denies any trauma. The patient admits to feeling very stressed currently.
Examination shows normal tone and reflexes but 0/5 power in all muscle groups of the right upper limb. When the affected arm is held above the patient’s face and released, the arm misses the face and falls at the patient’s side.
What is the likely diagnosis?
Conversion disorder
Which class of drugs can be used to treat extra-pyramidal side effects of antipsychotics?
Anti-cholinergics
Which 2 neurotransmitters do atypical antipsychotics affect?
Dopamine & serotonin
What is the 1st line treatment of mild OCD?
CBT
How long should someone continue their antidepressants for if they presented with their third+ episode of depression?
Life long
What type of antipsychotic is Haloperidol?
Typical antipsychotic
List some symptoms of anorexia (7)
Lanugo hair
Cold intolerance
Blue hands / feet
Amenorrhoea
Dry skin
Hypotension
Weakness / fatigue
Explain what tolerance (in regards to addiction) means:
Name the 2 types of tolerance & explain the physiological process behind each type:
How can tolerance result in dependence?
Tolerance: Reduced responsiveness to a drug caused by the body adapting to previous physiological effects of the drug
~ body tries to maintain homeostasis
Dispositional tolerance
~ less drug reaches the drug receptors
Pharmacodynamic tolerance
~ drug has less action on the drug receptors
Tolerance = body physiologically adapts each time drug is taken → stopping drug causes withdrawal symtpoms which are often unpleasant → drug is repeatedly taken to avoid withdrawal symptoms
In a psychotic patient, too much dopamine results in what?
Positive symptoms: hallucinations, delusions, thought disorders
How long is a short term detention certificate valid for?
Who is able to undertake this detention certificate?
28 days
ONLY an approved medical practitioner (eg, consultant psychiatrist!)
Name the reversible neurological condition commonly seen in alcoholics:
~ What causes this condition?
List the triad of presenting features seen in this condition:
What is the treatment of it?
If left untreated, what can it progress into?
Wernicke’s encephalopathy
~ Thiamine (B1) deficiency
1) Ataxia (problems with coorindation, balance & speech)
2) Confusion
3) Opthalmoplegia/ nystagmus
Treatment: IV thiamine (usually given as pabrinex)
Korsakoff’s syndrome (irreversible brain damage)
An 8 year old boy is referred with behavioural problems to the child Psychiatry Department. He is always active at home and moves from task to task. He finds it difficult to concentrate to read or watch TV. He often puts himself into dangerous situations like climbing onto high roofs. His performance at school is poor where he is distractible and causes distractions to others.
What is the most likely diagnosis?
ADHD
What symptoms are seen in lithium toxicity? (4)
Coarse tremor
Arrhythmias
Visual disturbances
CNS disturbances: seizures, slurred speech, confusion
What is a nihilistic delusion?
What condition is it usually a feature of?
A negative delusion (belief) of something decaying/missing - commonly people think they are rotting internally/ their organs are missing
Severe depression
Activated charcoal can be used as an antedote to drug overdoses, however it can only be used if the drug was ingested within a certain timeframe.
What is this timeframe?
Within 1 hour of presentation!
Treatment of delirium is mainly managed pharmacologically: TRUE/FALSE
What does the management of delirium involve?
False - mainly non-pharmacological management:
→ Re-orientate the patient
→ Help them mobilise as much as possible
→ Normalise sleep-wake cycle
→ Discharge asap !!
Name the condition described:
“Episodes of binge eating with a sense of loss of control, followed by purging behaviour” - BMI less than 17.5
Anorexia nervosa: binge purge subtype
List some symptoms of opiate withdrawl: (8)
Aggitation
Anxiety
Runny nose
Runny eyes
Sweating
Diarrhoea
Insomnia
Uncontrollable yawning!
Increased BP & HR
Name the 3 commonest drug classes to treat depression.
SSRI;s
SNRI’s
Tricyclic antidepressants
List some common symptoms of depression.
Low mood - often worse in the morning
Poor sleep (difficulty falling asleep, EMW, excessive sleep)
Fatigue
Changes in appetite & weight
Poor concentration / focus
Suicidal thoughts & planning
Anxiousness
Low libido
Psychomotor retardation
Social withdrawal
Name 2 serious complications with the use of MAOI’s:
What are MAOIs mainly used to treat?
Hypertensive crisis (cheese reaction) Serotonin syndrome
Depression
What is the effect of opioid’s on someone’s pupils?
Pin prick pupils
A 43-year-old man is reviewed on the mental health ward following a deterioration of his psychiatric condition. The patient was originally admitted with a major depressive disorder associated with psychiatric hallucinations.
Recently the patient has been consistently reporting that he believes he is dead. As a result, the patient has stopped eating and has clear evidence of self-neglect. The patient is not known to have any other medical conditions other than his mental health issues.
What syndrome is this patient suffering from?
Cotard Syndrome
Name the syndrome in which a depressed patient believes that they are dead:
Cotard syndrome
What is the thought disorder: echolalia?
Echolia: when a patient repeats someone elses speech, including the questions that they are asked
What is Othello’s Syndrome?
“Delusional jealousy” - people usually believe that their partner is being unfaithful (without any good reason to believe so)
A patient with Capgras Syndrome would believe what?
They believe that someone significant in their life (eg, friend/ spouse) has been replaced by an identical imposter
A patient with Fregoli Syndrome believes what?
They believe that multiple people are in fact the same person who is just changing their appearance!
What class of antidepressants is associated with urinary retention? (eg SSRIs, SNRIs, tricyclics, MAOIs..)
Tricyclic antidepressants (eg amitriptyline)
When checking lithium levels, how long after the lithium was taken should the bloods be taken?
12 hours post lithium dose
If a patient is about to start ECT, what, if any, changes need to be made to their current antidepressants?
The dose needs to be decreased!
~ (the antidepressant shouldnt be stopped though)
What is the difference between the thought disorders: tangentiality and circumstantiality?
Tangentiality: wanders off topic and never answers the question they were asked.
Circumstantiality: wanders off topic but does eventually answer the question they were asked.
