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Phase 3a > Psychiatry > Flashcards

Psychiatry Flashcards

1
Q

Depression definition

A
  • Persistent low mood +/- loss of pleasure in activities
  • Emotional, cognitive, physical and behavioural Sx
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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
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3
Q

Depression Ix

A
  • Bloods
  • CXR = infections
  • ECG = metabolic
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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

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5
Q

GAD definition

A

Disproportionate, pervasive, uncontrollable and widespread worry

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6
Q

S+S GAD

A
  • Restlessness
  • Fatigue
  • Irritability
  • Poor concentration
  • Sleep disturbance
  • Muscle tension
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7
Q

Physical features of GAD

A
  • Dry mouth
  • Diarrhoea
  • Chest constriction
  • Palpitations
  • Urinary frequency
  • Libido loss
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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

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9
Q

GAD Mx

A
  1. active monitoring
  2. Psychological interventions = CBT
  3. = with marked functional impairenent = high intensity psychological intervention and drug treatment
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10
Q

GAD drugs

A
  • SSRI 1st line
  • SNRI
  • Pregabalin
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11
Q

OCD definition

A
  • Recurrent obsessional thoughts or compulsive acts
  • Obsessions = unwanted intrusive thoughts
  • Compulsions = behaviours that result from obsessive thoughts
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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
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13
Q

MX OCD

A
  • CBT
  • Supportive psychotherapy
  • SSRI
  • Clomipramine
  • Specialist referral
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14
Q

Bipolar 1

A
  • Underlying depression, interspersed with mania
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15
Q

Bipolar 2

A

Depression more dominant

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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
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17
Q

Bipolar hypomanic sx

A
  • 4 days
  • Mildly elevated mood
  • Increased energy
  • Sociability
  • No psychotic
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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

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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
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20
Q

Negative Sx psychosis

A
  • A6C
  • Asocial
  • Avolition
  • Alogia
  • Affect blunted
  • Anhedonia
  • Attention deficit
  • Catatonia
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21
Q

Psychosis

A
  • Schizophrenia = most common form
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22
Q

Schizophrenia prodrome

A
  • Deterioration in social functioning + transient/attenuated psychotic Sx
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23
Q

1st rank schizophrenia S+S

A
  • Auditory hallucinations 3rd person
  • Thought withdrawal, insertion and broadcast
  • Delusional perception
  • Somatic passivity (external agents imposed)
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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

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25
Q

Schizophrenia Mx

A
  • 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
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26
Q

PTSD

A

Following traumatic event characterised by involuntary re-experiencing of elements with Sx of hyperarousal, avoidance and emotional numbing

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27
Q

S+S PTSD

A
  • 2 or more persistent Sx of increased psychological sensitivity and arousal = sleep, irritable, reckless
  • Persistent remembering of stressor
  • avoidance
  • inability to recall aspects
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28
Q

PTSD Mx

A
  • CBT
  • EMDR
  • SSRIs
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29
Q

Borderline personality disorder

A
  • Act impulsively
  • Intense short lived emotional attachments
  • Chromic internal emptiness
  • Frequent SH
  • Transient pseudo psychotic featires
  • FHx
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30
Q

Paranoid PD

A
  • Extreme sensitivity
  • Suspicious
  • Self important
  • Preoccupation with conspiracy theories
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31
Q

Schizoid PD

A
  • Emotionally cold and detatched
  • Limited capacity to express emotions
  • Indifference to praise or criticism
  • Preference for solitary activities
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32
Q

Antisocial PD

A
  • Callous inconcern for feelings of others
  • Incapacity to maintain enduring relationships
  • Low tolerance of frustration
  • Incapacity to experience guilt
  • Blame others
33
Q

Histrionic PD

A
  • Self dramatisation, theatricality
  • Shallow and liable emotions
  • Continual seeking for excitement and appreciation
  • Inappropriately sedutive appearance an behaviour
34
Q

Suicide risk assessment in adolescents

A

Home and environment
Education
Activities
Drugs and alcohol
Sexuality
Suicide and depression

35
Q

The dependence syndrome

A
  • 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
Q

Screening for alcohol dependency

A
  • CAGE
  • AUDIT
  • Increased MCV and GGT
37
Q

FRAMES principles

A
  • Feedback
  • Responsibility
  • Advice
  • Menu
  • Empathy
  • Self efficacy
38
Q

Opiates sx

A
  • Pinpoint pupils
  • Low BP
  • Venepuncture marks
39
Q

Stimulants Sx

A
  • Rapid speech
  • Large pupils
  • Agitation
  • Restlessness
  • High BP
40
Q

Opiate withdrawal Sx

A
  • Dialte pupils
  • High BP
  • Sweaty
  • Rhinorrhoea
  • Cramps
  • Goose bumps
41
Q

Mx phobias

A
  • Behavioural therapy
  • Flooding
  • Cognitice
  • BDZ if severe
42
Q

Serotonin syndrome

A

Iatrogenic syndrome resulting from excess serotonin levels in central and peripheral nervous system

43
Q

Medications that cause serotonin syndrome

A
  • SSRIs
  • SNRIs
  • MAOIs
  • TCA
  • Tramadol
  • Stimulants
44
Q

S+S serotonin syndrome

A
  • Agitation and confusion
  • Hypomania
  • Seizures
  • Tone increased
  • Tremor
  • Hyperreflexia and clonus
  • HTN
  • Diarrhoea
45
Q

Mx serotonin syndrome

A
  • Cease offending drugs
  • Cyproheptadine
46
Q

S+S OCPD

A
  • Perfectionism
  • Rigid mannersisms
  • Extreme attention to detail
  • Excessive devotion
  • Doubt, indecisiveness, caution
  • called anankastic
47
Q

Sx alcohol withdrawal

A
  • Mild = HTN, tachy, anorexia, anxiety
  • Moderate = worsening mild plus agitation and coarse tremor
  • Severe = delerium tremens = confusion, TC seizures, hallucinations, hyperthermia
48
Q

Sx wernickes encephalopathy

A
  • Confusion
  • Ataxia
  • Eye paralysis
  • Nystagmus
  • Memory disturbance
  • Hypothermia and hypotension
  • Caused by thiamine deficiency therefore prescribe thiamine
49
Q

Delerium tremens

A
  • Acute confusional state secondary to alcohol withdrawal
  • Clouding consciousness
  • Disorientation
  • Amnesia for recent events
  • Psychomotor agitation
  • Hallucinations (liliputian)
50
Q

Opiate detoxification

A
  • Methadone
  • Moderate = aches, dialted pupils, yawning = 10-20mg methadone
  • Severe = vomiting, HTN = 20-30mg methadone
51
Q

Conversion disorder

A
  • Loss of motor or sensory function
  • Doesn’t consciously feign symtpoms or seek material gain
  • Belle indifference
52
Q

Somatisation

A
  • Multiple physical symptoms present for at least 2 years
  • Refuses to accept reassurance or negative test results
53
Q

benzodiazapine used for alcohol withdrawal

A

chlordiazepoxide

54
Q

ICD 10 anorexia

A
  • Low body weight - 15% below expected BMI 17.5 or less
  • Self-induced weight loss
  • Body image distortion
  • Endocrine
  • Delayed/arrested puberty
55
Q

Anorexia Ix

A
  • 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
Q

Anorexia Mx

A
  • Treat psychological disorder
  • Encourage weight gain
  • Family therapy
57
Q

Anorexia complication

A
  • Cardioac = brady, hypotn, ECG changes
  • CNS = impaired concentration
  • Derm = brittle skin, nails and hair loss
  • Haem = anaemia
  • Met = hypok, hypona, hypogly
  • Amenorrhoea
58
Q

Refeeding syndrome

A
  • Potentially fatal shift in fluids and electrolytes
  • High risk = give thiamine, vit B, daily bloods
59
Q

Metabolic consequences of refeeding syndrome

A
  • Hypophosphataemia
  • Hypokalaemia
  • Hypomagnesium = torsades de points
  • Abnormal fluid balance
60
Q

NICE recommendation for refeeding

A
  • If not eaten >5 days, refeed at no more than 50% of requirements for 2 days
61
Q

High risk refeeding

A

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
Q

Bulimia ICD10

A
  • Persitent preoccupation with eating
  • Irresistable craving for food
  • Binges
  • Attempts to counter food effects
  • Morbid dread of fatness
63
Q

Complications of purging

A
  • Arrhythmia
  • Cardiac failure
  • Electrolyte disturbance
  • Oesophageal erosions or gastric perforation
  • Ulcers
  • Pancreatitis
64
Q

Acute dystonic reaction

A
  • After new ATAP or and increased dose recently
  • Torticollis, trismus, jaw opening
  • Procyclidine given
65
Q

Neuroleptic malignant syndrome

A
  • Reaction to APs
  • Fever, rigidity, autonomic dysfunction, confusion, tachy, tremor
  • Stop AP
  • BZD
  • Supportive
66
Q

Lithium toxicity

A

> 1.5mmol/l
- Tremor (coarse), Renal failure, Hyperreflexia, convulsions, N+V, vision
- Stop lithium, fluids and NaCl, dialysis if severe

67
Q

Opiod detox

A
  • Methadone/buprenorphine/dihydrocoedine
  • Lofexidine to relieve withdrawals
  • Naltrexone to prevent relaps
  • Overdose = naloxone
68
Q

Pathophysiology alcohol abuse

A
  • Up regulation NMDA receptors
  • Downregulation GABA receptors
  • Cessation causes CNS hyperexcitability
69
Q

Alcohol wdrawal

A
  • 6hrs = malaise, tremor, nausea
  • 36hrs = seizures
  • 72hrs = delirium tremens
70
Q

Withdrawal alcohol treatment

A
  • 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
Q

Delirium tremens

A
  • 72hrs after
  • Cog impairement, liliputian, paranoid delusion, sweating, dehydration
  • Mx = pabrinex and lorazepam
72
Q

Wernicke

A
  • Delirium, nystagmus, hypothermia, ataxia
  • Mx = pabrinex
73
Q

mechanism of paracetamol overdose

A
  • More paracetamol shunted to CP450 system so more NAPQO produced
74
Q

Mx paracetamol OD

A
  • within 1hr = activated charcoal
  • > 8hrs IV N acetylcysteine = 3 consecutive IV infusions
  • 1st infusion is 1hr
75
Q

absolute contraindication for ECT

A
  • raised intracranial pressure
76
Q

relatice contraindications for ect

A
  • cerebral tumour/aneurysm
  • phaeochromocytoma
  • pregnancy
  • recent MI
77
Q

Indications for ECT

A
  • catatonia
  • no medication has worked
  • psychotic
78
Q

Drug induced psychosis

A
  • cannabis
  • corticosteroids
  • opioids
  • cocaine
  • amphetamines
  • levodopa
  • anti-malaria

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