Psychiatry Flashcards

Question

Psychological therapy specific to PTSD

Answer 1

Eye movement desensitising and reprocessing (EMDR) therapy

Answer 2

Congruent e.g. Nihilistic and guilty delusions 3rd person derogatory auditory hallucinations

Answer 3

Family history History of abuse Substance use Low SES Chronic disease Traumatic life event

Answer 4

Core symptoms of depression + other symptoms + suicidal ideation/marked loss of functioning

Answer 5

Possible weight loss Psychomotor retardataion (movement, speech) Decreased reactivity Avoiding eye contact Slow + quiet speech

Answer 6

MAOIs e.g. phenelzine

Answer 7

``` Presenting problem Predisposing factors Precipitating factors Perpetuating factors Protective factors ```

Answer 8

``` Appearance and behaviour Speech Emotions - mood and affect Perceptions Thoughts Insight Cognition ```

Answer 9

Isoretinoin (roaccutane) Beta-blockers

Answer 10

History of 2 mood episodes At least one of: - Hypomania (<4 days) - Mania (>7 days)

Answer 11

One episode of mania (or mixed mood); or One episode of hypomania plus a major depressive episode

Answer 12

Flamboyantly dressed Self neglect (unkempt/dehydrated) Overactivity Difficult to interview

Answer 13

Increased pressure of speech Increased rate and amount of speech Hard to interrupt Usually elated

Answer 14

Content: inflated view of own importance, grandiose Form: chance relationships, verbal associations, clang associations

Answer 15

May have delusions of persecution or grandiose - usually mood congruent Auditory hallucinations Lacking insight

Answer 16

Substance use (stimulants, hallucinogens, opiates) Schizophrenia Anxiety disorders/PTSD ADHD or conduct disorder

Answer 17

Antidepressants Benzodiazepines Antipsychotics e.g. olanzapine, risperidone Lithium (toxicity, or combined with TCAs) Many others

Answer 18

Mood stabilisers: 1. Lithium 2. Anticonvulsants e.g. sodium valproate, carbamazepine, lamotrigine 3. Anti-psychotics: used in acute mania e.g. olanzapine

Answer 19

Renal function (U+Es, Creatinine clearance): Li excreted by kidneys TFTs (hypothyroidism) Calcium

Answer 20

Leukocytosis Insipidus (diabetes) Tremor (fine) Hypothyroidism Increased Urine Mums beware (teratogenic)

Answer 21

Upper therapeutic limit = 1.2mmol/L >1.5mmol/L = some symptoms of toxicity >2.0mmol/L = definite, life-threatening toxicity

Answer 22

Bendroflumethiazide

Answer 23

Blurred vision Coarse tremor (fine tremor = early) Muscle weakness Ataxia N+V Hyperreflexia Circulatory failure Oliguria/polyuria Seizures Coma Slurred speech

Answer 24

Sertraline Citalopram Fluoxetine

Answer 25

Nausea + indigestion Worsening of sexual dysfunction Suicidal thoughts Serotonin syndrome

Answer 26

Venlafaxine | Duloxetine

Answer 27

Venlafaxine can raise BP + is c/i in heart disease | Similar to SSRIs

Answer 28

Amitriptyline | Dosulepin

Answer 29

Anticholinergic effects Dry mouth Tachycardia Constipation Sleepiness Weight gain Urinary retention

Answer 30

Phenelzine | Moclobemide

Answer 31

Raised BP if taken with tyramine: aged cheese, cured meeats, broad beans

Answer 32

Mirtazepine

Answer 33

Alpha-2 antagonist

Answer 34

Drowsiness | Weight gain

Answer 35

PHQ-9 HADS BD-II

Answer 36

Active monitoring Discuss problem + concerns Arrange follow-up around 2 weeks time

Answer 37

Low intensity psychological intervention e.g. IAPT Group-based CBT if declining above Consider antidepressants if: - History of moderate or severe depression - Subthreshold depressive symptoms lasting long period (2 years) - Symptoms persisting after other interventions - Mild depression complicating care of chronic physical health problem

Answer 38

Antidepressant | High-intensity psychological intervention

Answer 39

Consider suicide risk + toxicity in overdose Symptoms of anxiety may initially worsen May take time to work Should be continued for at least 6 months following remission of symptoms, to prevent relapse

Answer 40

Assessment section (although treatment can be given) Allows compulsory admission for up to 28 days Cannot be renewed Can occur anywhere except prison

Answer 41

Treatment section Allows compulsory admission for up to 6 months Can be renewed idefinitely

Answer 42

``` 2 doctors (1 must be S12 approved) AMHP ```

Answer 43

Should suspect a mental disorder | Risk to individual, or ris to other people

Answer 44

2 doctors | 1 AMHP

Answer 45

Requires a diagnosis Place of treatment must be identified Treatment must be available Treatment is in their best interests (and for other people)

Answer 46

Emergency order Lasts 72 hours Used when waiting for a second doctor would lead to an undesirable delay

Answer 47

1 doctor | 1 AMHP

Answer 48

Mental disorder suspected Risk to self or others Not enough time for a 2nd doctor to attend for the assessment

Answer 49

Nurses' holding power Patients in hospital (not A+E) Lasts 6 hours (for until a doctor can attend) Cannot be treated coercively

Answer 50

``` Doctors' holding power Patients in hospital (not A+E) Lasts 72 hours Cannot be done by FY1 Cannot be treated coercively ```

Answer 51

Police section | For a person suspected of having mental disorder in a public place (not someone's home)

Answer 52

Police Section | Requires a court order to access a person's home and remove them

Answer 53

Trisomy 21 (Down's syndrome)

Answer 54

Fragile X syndrome

Answer 55

Milder symptoms | Premature ovarian failure

Answer 56

Long, narrow face Prominent jaw Big ears

Answer 57

Large hands and feet Hyperextensible joints Pes planus (flat foot) Macroorchidism

Answer 58

Mitral valve prolapse

Answer 59

X-linked inheritance >200 CGG repeats in FMR1 gene

Answer 60

Genetic abnormalities Prenatal viruses Birth complications e.g. prematurity, hypoxic brain injury, cerebral pasly Childhood illness e.g. meningitis, brain injury, severe neglect

Answer 61

Lifelong, persistent, deeply ingrained maladaptive behaviour Characterises an individual Deviates markedly from expected or accepted 'normal' Onset in late childhood or early adolescence Not explained by organic disease or other mental disorder

Answer 62

More than one of: - Cognition - Affectivity - Occupational and social performance - Impulse control and need gratification - Interpersonal function

Answer 63

'Odd/Eccentric' Schizoid - socially withdrawn Paranoid - delusional Schizotypal - distorted reality

Answer 64

'Dramatic/Erratic' EUPD Histrionic Narcissistic Dissocial

Answer 65

'Anxious/Fearful' Obsessive compulsive personality disorder (Anankastic) Dependant Avoidant

Answer 66

``` Emotional instability Lack of impulse control Outbursts of violence or threatening behaviour are common - especially in response to criticism Low self-esteem/self-image uncertaining Feelings of emptiness Intense and unstable relationships Avoids abandonment Self harm/suicide Engage in dangerous, risky behaviour ```

Answer 67

DBT (dialectical behaviour therapy)

Answer 68

Insecure attachment Domestic violence Childhood sexual abuse

Answer 69

Certainty held with absolute conviction Incorrigibility Impossibility or falseity of content

Answer 70

Mood congruent vs incongruent Themes: persecutory, grandiose, erotomania, jealousy, poverty Specific delusions e.g. delusions of reference (believing insignificant things have a personal meaning or significance)

Answer 71

Form of delusional misidentification - person believes another person has been replaced by an exact double Similar to: - Intermetamorphosis (person transformed into different person) - Fregoli syndrome (stranger is someone familiar) - Syndrome of subjective doubles (another person been transferred into your own self)

Answer 72

Where a delusional belief is transferred form a psychotic person to another inidividual, usually close to them The associate is often socially, intellectually or physically deprived or disadvantaged

Answer 73

A recurrent thought, impulse or image that enters the subject's mind despite resistance

Answer 74

A form of haptic or tactile hallucination where the person feels insects crawling in, on, or underneath the skin. Associated with intoxication or withdrawal from alcohol and drugs (particularly cocaine) Can also occur in psychosis

Answer 75

A belief not held quite as strongly as a delusion, and is typically more understandable

Answer 76

Feeling as if they are being taken over/not in control of own thoughts and actions

Answer 77

Insertion Withdrawal Broadcasting

Answer 78

Irrelevant details and digressions overwhelm the direction of the thought process Cannot provide an answer without excess, unnecessary detail Question will still be answered in the end Seen in mania and anankastic personality disorder

Answer 79

Patient goes off on a tangent and will not answer the question

Answer 80

Repeating ideas or words despite an attempt to change the topic

Answer 81

Speech pattern where sounds rather than meaning govern the use of words May occur during flight of ideas

Answer 82

Use of made up words

Answer 83

Repetition of someone else's speech, including the question that was asked Occurs in schizophrenia and intellectual disabilities

Answer 84

Patients leap from one topic to another with minimal links between them Ideas may be linked by puns, rhymes etc. Seen in hypomania/mania

Answer 85

Lack of connection between ideas | Seen in schizophrenia

Answer 86

Complete jumble of words

Answer 87

Sounds/words repeated in a senseless way

Answer 88

Unexpected and complete illogical leaps from one topic to another

Answer 89

Abrupt and complete interruption in stream of thought Seen in schizophrenia Often accompanies thought withdrawal

Answer 90

The feeling of unreality or detachment with respect to surroundings or external world

Answer 91

Subjective feeling of altered reality of the self Alteration in the perception or experience of the self so that one feels detached from and as if one is an outside observer of one's mental procceses or body

Answer 92

Subjective sense of an uncomfortable desire to move, relieved by repeated movement of the affected part (typically legs) Side-effect of neuroleptic drugs

Answer 93

A primary delusion which appears to arise fully formed in a patient's mind without explanation

Answer 94

Behaviour which is apparently conscious in nature that appears in the absence of full consciousness e.g. in a seizure

Answer 95

Loss of the normal degree of emotional sensitivity and sense of the appropriate emotional response to events Negative symptoms of schizophrenia

Answer 96

Surprising lack of concern for, or denial of, apparently severe functional disability

Answer 97

Increased resting muscle tone which is not present on active or passive movement Motor symptom of schizophrenia

Answer 98

Level between full consciousness and coma

Answer 99

Process of describing plausibly false memories for a period for which the patient has amnesia Seen in Korsakoff psychosis and dementia

Answer 100

Development of features suggestive of a physical illness which are instead attributed to psychiatric illness or emotional disturbance

Answer 101

Psychotic depressive illness seen in eldery people in particular Severely depressed mood with nihilistic delusions and/or hypochondriacal delusions

Answer 102

Personality characteristic of cyclical mood variation to a lesser degree than bipolar disorder

Answer 103

Separation of unpleasant emotions and memories from consciousness awareness with subsequent disruption to the normal integrated function of consciousness and memory

Answer 104

Auditory hallucinations : - Third person auditory hallucinations - Thought echo - Running commentary Delusions of thought interference: - Thought insertion - Thought withdrawal - Thought broadcasting Delusions of control - Passivity of affect - Passivity of impulse - Passivity of volitions - Somatic passivity Delusional perception: a primary delusion of any content that is reported by the patient as having arisen following the experience of a normal perception

Answer 105

Experience of bodily sensations being imposed by external agency

Answer 106

Dimunition of the normal range of emotional experience | Negative symptom of schizophrenia

Answer 107

Used to refer to three different groups of psychiatric symptoms: - All pathological disturbances in the form of thought - Synonym for schizophrenic thought disorder - The group of first-rank symptoms which are delusions regarding thought interference (insertions, withdrawal, and broadcasting)

Answer 108

Loss of ability to understand abstract concepts and metaphorical ideas leading to a strictly literal form of speech and inability to comprehend allusive language Seen in schizophrenia and dementing illness

Answer 109

An internal perception without a corresponding external object

Answer 110

Lacks one or all of the characteristics of a true hallucination: - Perceived in external space - Distinct from imagined images - Outside concious control - Possessing relative permanence

Answer 111

A primary delusion which is recalled as having arisen as a result of a perception Percept is a real, external object, and not a result of hallucination

Answer 112

A type of false perception in which the perception of a real world object is combined with internal imagery to produce a false internal percept

Answer 113

Objective impression that the displayed affect is not consistent with the current thoguths or actions Occurs in schizophrenia

Answer 114

Abnormal and occasionally bizarre performance of a voluntary, goal-directed activity

Answer 115

Delusions Hallucinations Passivity phenomena Thought alienation Lack of insight Disturbance of mood

Answer 116

Blunting of affect Amotivation Poverty of speech + thought Poor non-verbal communication Deterioration in functioning Self-neglect lack of insight

Answer 117

Other delusions/hallucinations Breaks in thought fluency: incoherence, irrelevant speech, neologisms Catatonic behaviour e.g. excitement, stupor, mutism, posturing, wavy flexibility, negativism Negative symptoms

Answer 118

One 1st rank symptom, or two 2nd rank, acutely for 1 month | With evidence of disturbance of functioning for 6 months

Answer 119

Akathisia | Decreased prolactin

Answer 120

Anticholinergic symptoms Diabetes/dysglycaemia Hyperlipidaemia/hypercholesterolaemia Orthostasis Sedation Weight gain

Answer 121

Acute parkinsonism Elevated prolactin Weight gain

Answer 122

Diabetes Orthostasis Sedation Weight gain

Answer 123

Acute parkinsonism Elevated prolactin Weight gain

Answer 124

Prolonged QTc interval

Answer 125

Occur when an individual is falling asleep | Mostly auditory

Answer 126

Occurs as a person awakes | Experience continues once the individual's eyes open from sleep

Answer 127

Noradrenergic and specific serotonergic antidepressant Sedation Weight gain

Answer 128

Cervical dystonia - an acute dystonic reaction | Commonly caused by antipsychotic medications

Answer 129

Low weight: 85% or less of expected weight and/or less than 3rd percentile for BMI Lack of any weight gain Significant oedema Physiological decompensation e.g. - Severe electrolyte imbalance - Cardiac disturbances - Altered mental status - Orthostatic differential > 30/min Temperature less than 36 degrees Pulse <45 bpm Psychosis or high risk of suicide Symptoms refractory to outpatient treatment

Answer 130

``` Tachycardia Drowsiness Dry mouth N+V Urinary retention Confusion Agitation Headache Hypotension Hyperreflecia Dilated pupils Hyperthermia ```

Answer 131

Calluses on knuckles, causing by being scraped across teeth | Seen in bulimia nervosa

Answer 132

The potentially fatal shifts in fluids and electrolytes that may occur in malnourished patients receiving artificial refeeding

Answer 133

Hypophosphataemia

Answer 134

``` Low phosphate Abnormal sodium Abnormal fluid balance Changes in glucose, fat and protein metabolism Thiamine deficiency Low potassium Low magnesium ```

Answer 135

Eating disorders Chronic alcoholism Malabsorption conditions e.g. IBD Chronic malnutrition Poorly contrólele diabetes Oncological conditions Post-operative state

Answer 136

Glycaemia leads to increased insulin, decreased glucagon —> glycogen, protein and fat synthesis which requires phosphate, magnesium and thiamine Insulin —> absorption of potassium into cells Magnesium and phosphate also taken up into cells Water follows by osmosis

Answer 137

Wernicke’s encephalopathy | Korsakoff’s syndrome

Answer 138

Introduction of CHO into diet —> decreased renal sodium and water excretion If fluid depletion instituted —> fluid overload —> congestive cardiac failure, pulmonary oedema, cardiac arrhythmia

Answer 139

Potassium: arrhythmias, cardiac arrest Magnesium: cardiac dysfunction, neuromuscular complications Glucose: excess glucose, fatty liver, increased CO2, hypercapnoea, respiratory failure Thiamine deficiency Heart failure Pulmonary oedema Arrhythmia

Answer 140

Distinguished by a pattern of exaggerated emotionality and attention-seeking behaviours Shallow affect Egocentricity Craving attention and excitement Manipulative behaviour Seductive or provocative behaviour Easily influenced Preoccupied with physical attractiveness

Answer 141

Psychodynamic/CBT/Group therapy

Answer 142

Emotionally cold/flattened affect Detachment Lack of interest in others Excessive introspection and fantasy Solitary Little interest in sexual experiences Indifferent to praise or criticism

Answer 143

Psychodynamic and/or group therapy

Answer 144

Sensitive Suspicious Consipiratorial explanations Self-referential attitude Distrust of others Holds grudges

Answer 145

Interpersonal discomfort Magical thinking/peculiar ideas Unusual perceptions Odd appearance and behaviour Inappropriate affect Vague + circumstantial Delusions of reference (but may be persuadeable)

Answer 146

Impaired level of consciousness Impairment of cognition - disorientation, recent memory + abstract thinking Disturbance in sleep - nocturnal worsening of symptons Psychomotor agitation Emotional lability Perceptual abnormalities - typically visual Speech disorder - rambling, incoherent + thought disordered Paranoid delusions Rapid onset with fluctuations in severity

Answer 147

Treat precipitating cause + exacerbating factors Environmental + supportive measures e.g. reduce noise, incude clock, correct sensory impairments Avoid sedation unless absolutely necessary Regular clinical review + follow-up

Answer 148

Atypical antipsychotic e.g. olanzapine, quetiapine, risperidone, clozapine Then valproate, lamotrigine or lithium

Answer 149

Psychological interventiom Avoid antidepressants alone - can cause rapid cycling of mood Atypical antipsychotic e.g. quetiapine or olanzapine +/- fluoxetine Add anticonvulsant lamotrigine, or lithium adjunct

Answer 150

First line = lithium If ineffective, add valproate Avoid in women of chidbearing age where possible

Answer 151

Benzodiazepine (likely chlordiazepoxide) or Carbamazepine Alternative = clomethiazole Give thiamine to replenish low B1 stores

Answer 152

Acamprosate Disulfiram Started 6-12 months after abstinence, to prevent relapse

Answer 153

Aversive drug in maintenance of alcohol abstinence Causes flushing, headache, N+V and tachycardia Inhibits conversion of alcohol to CO2 and water --> build up of acetaldehyde S/E = halitosis and headache

Answer 154

Anti-craving drug in maintenance of alcohol abstinence | S/E = GI upset, pruritiss, rash, altered libido

Answer 155

Acute confusional state secondary to alcohol withdrawal Onset 1-7 days after last drink (peak at 48-72 hours) Clouding of consciousness, disorientation, amnesia, psychomotor agitation, hallucinations, terror-stricken face Tachycardia, sweating etc. Tremor

Answer 156

High dose benzodiazepine e.g. chlordiazepoxide (lorazepam also used) May also give IV Pabrinex (high dose vitamin B1) Fluid replacement Dextrose

Answer 157

Neuromuscular excitability Autonomic dysfunction (hypo or hypertension) Altered mental state

Answer 158

Autonomic effects: hyper/hypotension, tachycardia, fever, diarrhoea Psychiatric effects: agitation, confusion, hypomania, seizures Muscle/peripheral neurological effects: increased tone, tremor, shaking, hyperreflexia, clonus

Answer 159

Increased WCC Increased CK | Increased CK

Answer 160

Stop causative medications Manage complications Oral cyproheptadine - serotonin-antagnostic effects

Answer 161

Hyperthermia Rhabdomyolysis ARDS DIC Hypertension Seizures Renal failure

Answer 162

Fear of public spaces/fear of entering a public space from which immediate escape would be difficult int he event of a panic attack Fear in, or avoidance of at least 2 of: crowds, public spaces, travelling alone, travelling away from home Symptoms of anxiety

Answer 163

Tense Self-conscious Fear of negative evaluation by others Timid Insecure Avoidance of social or occupational activities

Answer 164

Psychodynamic/CBT/group therapy | Social skills training

Answer 165

Recurrent panic attacks not consistently associated with a specific situation or object, often spontaenous >4 attacks in one month Sudden onset with somatic symptoms, and cognitive deficits Often believe some large misfortune is about to happen e.g. heart attack Sweating, tachycardia, palpitations, tremor, hyperventiliation Minutes-hours

Answer 166

Psychoeducation Breathing/relaxation techniques CBT SSRIs may reduce frequency and severity of attacks e.g. citalopram

Answer 167

Facilitate and enhance binding of GABA to GABA-A receptors

Answer 168

Block postsynaptic dopamine D2 receptors --> blocks dopaminergic pathways of CNS

Answer 169

``` Raised CK due to muscle rigidity Raised WCC Deranged LFTs Acute renal failure --> abnormal U+Es Metabolic acidosis --> low pH, low HCO3 ```

Answer 170

Adverse reaction to antipsychotic (and other) medication e.g. anti-parkinsonian agents (often withdrawal), anti-depressants and others

Answer 171

Rigidity Hyperthermia Delirium Fluctuating BP Tachycardia Sweating Extrapyramidal side effects

Answer 172

Stop drug/restart anti-parkinsonian if relevant Treat hyperthermia aggressively Circulatory +ventilatory support where necessary Benzos to control agitation

Answer 173

Autonomic overactivity due to withdrawal of alcohol's inhibition Tremor Nausea Sweating Agitation Tachycardia/palpitations Raised BP Often features early in the morning, where a drink will relieve the symptoms

Answer 174

Delusions COnfusion Diarrhoea Epileptic seizures/convulsions (peak incidence at 36 hours) Auditory hallucinations After 48-72 hours --> delirium tremens

Answer 175

GABA agonist GABA neurones are inhibitory --> alcohol suppresses brain activity

Answer 176

A hallucination of the feeling of insects crawling in, on, or under your skin Seen in many conditions, but associated with alcohol withdrawal/delirium tremens

Answer 177

Altered mental status Ataxic gait Ophthalmoplegia (often abducens nerve) Nystagmus Nausea Occurs in any type of thiamine deficiency e.g. diet, gastric carcinoma, pernicious anaemia

Answer 178

Anterograde memory disorder - old memories can be accessed, but new memories cannot be consolidated Distorted sense of time Confabulation No clouding of consciousness Peripheral neuropathy

Answer 179

Thiamine! Usally in conjunction with other B vitamins. Given IV or IM Sedation if necessary Fluid/electrolytes

Answer 180

Life-long chronic illness Thiamine supplements may have some role

Answer 181

Memory loss = most important - Retrograde amnesia is more common Immediate: - Drowsiness - Confusion - Headache - Nausea - Aching muscles - Loss of appetite Long-term: - Apathy - Anhedonia - Difficulty concentrating - Loss of emotional responses - Difficulty learning new info

Answer 182

Triptans MAOIs TCAs SNRIs Carbamazepine Many types of analgesia e.g. opiod medications Lithium

Answer 183

Increased risk of stroke Increased risk of VTE

Answer 184

Weigh up benefits + risk Use during first trimester gives small increased risk of congenital heart defects (paroxetine especially) Use during third trimester can result in persistent pulmonary hypertension of the newborn

Answer 185

QT prolongation and/or ventricular arrhythmias including torsade de pointes --> take an ECG in patients with history of cardiac disease

Answer 186

U+Es to look for hyponatraemia High risk: measure level before starting treatment, 2-4 weeks after starting treatment and every 3 months after

Answer 187

Weekly after initiation, and after each dose change Done until concentrations are stables --> then in 3 months time, then every 3 months for the first year --> then can go to every 6 months in low-risk patients, or continue on 3 months indefinitely TFTs should be monitored 6-monlty

Answer 188

Consider stopping the antidepressant Offer an antipsychotic regardless: - Haloperidol - Olanzapine - Quetiapine - Risperidone If one of these fails at top dose/not tolerated --> try an alternative from the list 3rd line = lithium 4th line = sodium valproate

Answer 189

Multiple physical SYMPTOMS Present for at least 2 years Patient refuses to accept reasurrance or negative test results

Answer 190

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

Answer 191

Education about GAD + active monitoring

Answer 192

Low-intensity psychological interventions e.g. individual non-facilitated self-help, or individual guided self-help, or psychoeducational groups

Answer 193

High-intensity psychological interventions eg. CBT or applied relaxation And/or drug treatment

Answer 194

Highly specialist input e.g. mutli-agency teams

Answer 195

Sertraline as first-line SSRI If sertraline ineffective, offer an alternative SSRI or SNRI If these are not tolerated, consider offering pregabalin

Answer 196

Minimum 4 weeks/1 month Less than this time = acute stress reaction

Answer 197

Procyclidine

Answer 198

Stopping of voluntary movement or staying still in an unusual position

Answer 199

Aripiprazole

Answer 200

Fluoxetine

Answer 201

Dose should be gradually reduced over a 4 week period (not necessary for fluoxetine)

Answer 202

FIRM STOP Flu like sx Insomnia Restlessness Mood swings Sweating Tummy problems (pain, cramps, D+V) Off balance Paraesthesia

Answer 203

Strong family history Gradual onset of symptoms Low IQ Prodromal phase of social withdrawal Lack of obvious precipitant Younger age at diagnosis Predominant negative symptoms

Answer 204

Anti-cholinergic medication e.g. procyclidine In tardive dyskineisa, given tetrabenazine instead

Answer 205

Flumazenil

Answer 206

1st line = methadone, or buprenorphine May consider lofexidine

Answer 207

Ranges from 0-27 5-9 = mild 10-14 = moderate 15-19 = moderately severe 20+ = severe depression

Answer 208

Ranges from 021 0-4 = minimal anxiety 5-9 = mild anxiety 10-14 = moderate anxiety 15+ = severe anxiety

Answer 209

Typically egodystonic i.e. very different to patient's normal beliefs and values Sexual content is relatively common Usually resisted Usually intrusive + repetitive Can occur in depressive disorders as well as obsessive disorders

Answer 210

Family History

Answer 211

Gs and Cs Growth hormone Glucose salivary Glands Cortisol Cholesterol Carotinaemia

Answer 212

Hypokalaemia FSH, LH, oestrogen + testosterone T3

Answer 213

Hyperparathyroidism --> hypercalcaemia 'Stones, bones, abdominal moans + psychic groans'

Answer 214

Clozapine - reduces seizure threshold

Answer 215

GI bleeding risk --> give PPI protection

Answer 216

Weight gain Hyperprolactinaemia Increased risk of stroke/VTE in the elderly

Answer 217

Sertraline

Answer 218

Aripiprazole - most tolerable side effect profile of atypical antipsychotics

Answer 219

EPSE of typical antipsychotics Late onset of abnormal, involuntary choreoathetoid movements in patients Often irreversible Can involve chewing, pouting or ecessive blinking

Answer 220

Treatment resistant severe depression Manic episodes An episode of moderate depression known to respond to ECT in the past Life threatening catatonia

Answer 221

Raised intracranial pressure

Answer 222

Aged 35-54 Being divorced or separated Living alone Being a lone parent

Answer 223

Aged 16-24 Being marred or cohabiting

Answer 224

Within 1 hour of ingestion: activated charcoal Within 8 hours of ingestion, above treatment line: N-acetylcysteine. Total dose divided into 3 consecutive IV infusions. First infusion done over an hour

Answer 225

First 24 hours after a period of high-intensity use (first phase) = - Increased hunger + cravings - Anxiety - Fatigue - Irritability - Lack of motivation Second phase lasts up to 10 weeks Final phase shows decrease in most withdrawal symptoms, but low mood can persist (up to 6 months)

Answer 226

Wernicke's (acute phase) --> - Confusion - Ophthalmoplegia - Ataxia - Thiamine treatment Korsakoff's (chronic phase) --> - Retrograde amnesia - Anterograde amnesia - Confabulation - Korsakoff's psychosis

Answer 227

Liliputian i.e. seeing lots of small people

Answer 228

Hallucinations outside the realm of physical possibility Seen in schizophrenia and other psychotic illnesses