Psychiatry Flashcards
1
Q
Depression definition
A
- Persistent low mood +/- loss of pleasure in activities
- Emotional, cognitive, physical and behavioural Sx
2
Q
Core depression sx
A
- Depressed mood
- Anhedonia
- Weight change
- Insomnia
Others - Psychomotor agitation
- Low energy
- Guilt
- Reduced concentration
Mild = 2 typical +2 core
Moderate = 2 typical + 3+ core
Severe = 3 typical and 4+ other core
Severe = all
3
Q
Depression Ix
A
- Bloods
- CXR = infections
- ECG = metabolic
4
Q
Mx depression
A
Mild-moderate = CBT or psychotherapy
Moderate-severe = psychotherapy and antidepressant
1st episode = generic SSRI = citalopram, sertraline
Recurrent = antidepressant with previous good response
5
Q
GAD definition
A
Disproportionate, pervasive, uncontrollable and widespread worry
6
Q
S+S GAD
A
- Restlessness
- Fatigue
- Irritability
- Poor concentration
- Sleep disturbance
- Muscle tension
7
Q
Physical features of GAD
A
- Dry mouth
- Diarrhoea
- Chest constriction
- Palpitations
- Urinary frequency
- Libido loss
8
Q
ICD 10 GAD
A
At least 4 of
- Symptoms of autonomic arousal = palpitations, sweating, shaking, dry mouth
- Physical = breathing difficulty, choking, chest pain, nausea
- Mental state sx = dizzy, derealisation, fear of losing control
- General = hot flushes, chills, numb, tingling
- Sx tension = muscle tension, aches and pains, restlessness
- Other – exaggerated response to minor surprises
At least 6 months present most of the time
9
Q
GAD Mx
A
- active monitoring
- Psychological interventions = CBT
- = with marked functional impairenent = high intensity psychological intervention and drug treatment
10
Q
GAD drugs
A
- SSRI 1st line
- SNRI
- Pregabalin
11
Q
OCD definition
A
- Recurrent obsessional thoughts or compulsive acts
- Obsessions = unwanted intrusive thoughts
- Compulsions = behaviours that result from obsessive thoughts
12
Q
S+S OCD
A
- Often sudden onset
ICD10 - Obsessional thoughts = enter mind repeatedly, invariably distressing, own thoughts
- Compulsive = stereotyped behaviours that are repeated, not enjoyable, performed to prevent an unlikely event and recognised as pointless
13
Q
MX OCD
A
- CBT
- Supportive psychotherapy
- SSRI
- Clomipramine
- Specialist referral
14
Q
Bipolar 1
A
- Underlying depression, interspersed with mania
15
Q
Bipolar 2
A
Depression more dominant
16
Q
Bipolar Manic Sx
A
- Elevated mood
- Increased energy –> over activity, reduced sleep
- Pressured speech
- ! week
- Flight of ideas
- Grandiosity
- Reduced attention span
- Reckless
- Psychotic Sx = aud 2nd person
17
Q
Bipolar hypomanic sx
A
- 4 days
- Mildly elevated mood
- Increased energy
- Sociability
- No psychotic
18
Q
Mx bipolar
A
Acute manic
- 1st line = atypical antipsychotic = olanzapine, risperidone
- 2nd line = valproate, lamotrigine, lithium
Depressive= avoid ADs, atypical AP instead
General maintenance = lithium, mood diary, education
19
Q
Positive psychosis sx
A
- Delusions Held Firmly Think Psycho
- Delusions
- Hallucinations (3rd, auditory)
- Formal Thought disorder = form, possession, content
- Thought interference
- Passivity
- Lack of insight
20
Q
Negative Sx psychosis
A
- A6C
- Asocial
- Avolition
- Alogia
- Affect blunted
- Anhedonia
- Attention deficit
- Catatonia
21
Q
Psychosis
A
- Schizophrenia = most common form
22
Q
Schizophrenia prodrome
A
- Deterioration in social functioning + transient/attenuated psychotic Sx
23
Q
1st rank schizophrenia S+S
A
- Auditory hallucinations 3rd person
- Thought withdrawal, insertion and broadcast
- Delusional perception
- Somatic passivity (external agents imposed)
24
Q
ICD10 schizophrenia
A
At least 1 of
- thought echo, broadcasting, insertion, alienation
- delusions
- Delusions of control
- 3rd aud hall
Or at least 2 of
- persistant hall in any modality
- Irrevalent speech or neologism
- Catotonic
- neg sx
- significant and consistent change in personal behaviour
25
Schizophrenia Mx
- Early intervention = CBT or family intervention
- No 1st line AP= choice depends on personal choice, medication hx, degree of sedation required, risk of adverse effects and negative sx
- Clozapine usually offered to those who don’t respond to 2 other Aps due to SEs
- Atypical usually 1st line (risperidone, olanzapine, quietpaine, aripiprazole
26
PTSD
Following traumatic event characterised by involuntary re-experiencing of elements with Sx of hyperarousal, avoidance and emotional numbing
27
S+S PTSD
- 2 or more persistent Sx of increased psychological sensitivity and arousal = sleep, irritable, reckless
- Persistent remembering of stressor
- avoidance
- inability to recall aspects
28
PTSD Mx
- CBT
- EMDR
- SSRIs
29
Borderline personality disorder
- Act impulsively
- Intense short lived emotional attachments
- Chromic internal emptiness
- Frequent SH
- Transient pseudo psychotic featires
- FHx
30
Paranoid PD
- Extreme sensitivity
- Suspicious
- Self important
- Preoccupation with conspiracy theories
31
Schizoid PD
- Emotionally cold and detatched
- Limited capacity to express emotions
- Indifference to praise or criticism
- Preference for solitary activities
32
Antisocial PD
- Callous inconcern for feelings of others
- Incapacity to maintain enduring relationships
- Low tolerance of frustration
- Incapacity to experience guilt
- Blame others
33
Histrionic PD
- Self dramatisation, theatricality
- Shallow and liable emotions
- Continual seeking for excitement and appreciation
- Inappropriately sedutive appearance an behaviour
34
Suicide risk assessment in adolescents
Home and environment
Education
Activities
Drugs and alcohol
Sexuality
Suicide and depression
35
The dependence syndrome
- Primacy of drug seeking behaviour
- Narrowing of repertoire = preference
- Increased tolerance
- Loss of control of consumption
- Sx withdrawal on attempted abstinence
- Drug taking to avoid withdrawal Sx
- Continued use despite consequences
- Rapid reinstatement of previous pattern after abstinence
36
Screening for alcohol dependency
- CAGE
- AUDIT
- Increased MCV and GGT
37
FRAMES principles
- Feedback
- Responsibility
- Advice
- Menu
- Empathy
- Self efficacy
38
Opiates sx
- Pinpoint pupils
- Low BP
- Venepuncture marks
39
Stimulants Sx
- Rapid speech
- Large pupils
- Agitation
- Restlessness
- High BP
40
Opiate withdrawal Sx
- Dialte pupils
- High BP
- Sweaty
- Rhinorrhoea
- Cramps
- Goose bumps
41
Mx phobias
- Behavioural therapy
- Flooding
- Cognitice
- BDZ if severe
42
Serotonin syndrome
Iatrogenic syndrome resulting from excess serotonin levels in central and peripheral nervous system
43
Medications that cause serotonin syndrome
- SSRIs
- SNRIs
- MAOIs
- TCA
- Tramadol
- Stimulants
44
S+S serotonin syndrome
- Agitation and confusion
- Hypomania
- Seizures
- Tone increased
- Tremor
- Hyperreflexia and clonus
- HTN
- Diarrhoea
45
Mx serotonin syndrome
- Cease offending drugs
- Cyproheptadine
46
S+S OCPD
- Perfectionism
- Rigid mannersisms
- Extreme attention to detail
- Excessive devotion
- Doubt, indecisiveness, caution
- called anankastic
47
Sx alcohol withdrawal
- Mild = HTN, tachy, anorexia, anxiety
- Moderate = worsening mild plus agitation and coarse tremor
- Severe = delerium tremens = confusion, TC seizures, hallucinations, hyperthermia
48
Sx wernickes encephalopathy
- Confusion
- Ataxia
- Eye paralysis
- Nystagmus
- Memory disturbance
- Hypothermia and hypotension
- Caused by thiamine deficiency therefore prescribe thiamine
49
Delerium tremens
- Acute confusional state secondary to alcohol withdrawal
- Clouding consciousness
- Disorientation
- Amnesia for recent events
- Psychomotor agitation
- Hallucinations (liliputian)
50
Opiate detoxification
- Methadone
- Moderate = aches, dialted pupils, yawning = 10-20mg methadone
- Severe = vomiting, HTN = 20-30mg methadone
51
Conversion disorder
- Loss of motor or sensory function
- Doesn't consciously feign symtpoms or seek material gain
- Belle indifference
52
Somatisation
- Multiple physical symptoms present for at least 2 years
- Refuses to accept reassurance or negative test results
53
benzodiazapine used for alcohol withdrawal
chlordiazepoxide
54
ICD 10 anorexia
- Low body weight - 15% below expected BMI 17.5 or less
- Self-induced weight loss
- Body image distortion
- Endocrine
- Delayed/arrested puberty
55
Anorexia Ix
- FBC
- ESR
- U+E, phosphate, magnesium, bicarbonate, LFTs
- Glucose = hypo
- TFTs = low T3/4
- ECG = sinus brady, raised QTc
- Hypokalaemia, hyponatraemia, hypoglycaemias, hypothermia, increased cortisol
56
Anorexia Mx
- Treat psychological disorder
- Encourage weight gain
- Family therapy
57
Anorexia complication
- Cardioac = brady, hypotn, ECG changes
- CNS = impaired concentration
- Derm = brittle skin, nails and hair loss
- Haem = anaemia
- Met = hypok, hypona, hypogly
- Amenorrhoea
58
Refeeding syndrome
- Potentially fatal shift in fluids and electrolytes
- High risk = give thiamine, vit B, daily bloods
59
Metabolic consequences of refeeding syndrome
- Hypophosphataemia
- Hypokalaemia
- Hypomagnesium = torsades de points
- Abnormal fluid balance
60
NICE recommendation for refeeding
- If not eaten >5 days, refeed at no more than 50% of requirements for 2 days
61
High risk refeeding
1 or more of the following:
- BMI < 16 kg/m2
- unintentional weight loss >15% over 3-6 months
- little nutritional intake > 10 days
- hypokalaemia, hypophosphataemia or hypomagnesaemia prior to feeding (unless high)
2 or more of the following:
- BMI < 18.5 kg/m2
- unintentional weight loss > 10% over 3-6 months
- little nutritional intake > 5 days
- history of: alcohol abuse, drug therapy including insulin, chemotherapy, diuretics and antacids
62
Bulimia ICD10
- Persitent preoccupation with eating
- Irresistable craving for food
- Binges
- Attempts to counter food effects
- Morbid dread of fatness
63
Complications of purging
- Arrhythmia
- Cardiac failure
- Electrolyte disturbance
- Oesophageal erosions or gastric perforation
- Ulcers
- Pancreatitis
64
Acute dystonic reaction
- After new ATAP or and increased dose recently
- Torticollis, trismus, jaw opening
- Procyclidine given
65
Neuroleptic malignant syndrome
- Reaction to APs
- Fever, rigidity, autonomic dysfunction, confusion, tachy, tremor
- Stop AP
- BZD
- Supportive
66
Lithium toxicity
>1.5mmol/l
- Tremor (coarse), Renal failure, Hyperreflexia, convulsions, N+V, vision
- Stop lithium, fluids and NaCl, dialysis if severe
67
Opiod detox
- Methadone/buprenorphine/dihydrocoedine
- Lofexidine to relieve withdrawals
- Naltrexone to prevent relaps
- Overdose = naloxone
68
Pathophysiology alcohol abuse
- Up regulation NMDA receptors
- Downregulation GABA receptors
- Cessation causes CNS hyperexcitability
69
Alcohol wdrawal
- 6hrs = malaise, tremor, nausea
- 36hrs = seizures
- 72hrs = delirium tremens
70
Withdrawal alcohol treatment
- Chlordiazepoxide
- IV thiamine (B1) pabrinex
- Disulfiram = bad se when drink = build-up of acetaldehyde
- acamprosate = reduce cravings = enhances GABA transmission
- naltrexone = reduced pleasure = opioid antagonist
71
Delirium tremens
- 72hrs after
- Cog impairement, liliputian, paranoid delusion, sweating, dehydration
- Mx = pabrinex and lorazepam
72
Wernicke
- Delirium, nystagmus, hypothermia, ataxia
- Mx = pabrinex
73
mechanism of paracetamol overdose
- More paracetamol shunted to CP450 system so more NAPQO produced
74
Mx paracetamol OD
- within 1hr = activated charcoal
- >8hrs IV N acetylcysteine = 3 consecutive IV infusions
- 1st infusion is 1hr
75
absolute contraindication for ECT
- raised intracranial pressure
76
relatice contraindications for ect
- cerebral tumour/aneurysm
- phaeochromocytoma
- pregnancy
- recent MI
77
Indications for ECT
- catatonia
- no medication has worked
- psychotic
78
Drug induced psychosis
- cannabis
- corticosteroids
- opioids
- cocaine
- amphetamines
- levodopa
- anti-malaria
