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Phase 3a > Psychiatry > Flashcards

Psychiatry Flashcards

1
Q

What organic disorder can look a lot like mania?

A

Frontal lobe syndrome

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2
Q

What are features of temporal lobe epilepsy?

A

Depersonalisation
Deja vu
Smell auras
Staring
Lip smacking
Finger movements
Can look like schizophrenia

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3
Q

What systemic diseases and drugs can cause organic mental disorders?

A

Carcinoma of the pancreas
SLE
Porphyria
Hyperthyroidism
Steroids: mania
Antihypertensives: depression

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4
Q

What are the top 3 drug classes which can cause delirium?

A

Benzodiazepines
Anticholinergics
Opiates

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5
Q

Examples of tyramine-rich foods (that can precipitate a hypertensive crisis in combo with MAOIs)

A

Cheese - especially mature
Degraded protein: pickled herring, smoked fish, chicken liver, hung game
Yeast and protein extract: Bovril, Oxo, Marmite
Chianti wine, beer
Broad bean pods
Soya bean extarct
Overripe or unfresh food

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6
Q

Drugs that may precipitate a hypertensive crisis in combination with MAOIs

A

Adrenaline or noradrenaline
Amphetamines
Cocaine
Ephedrine, pseudoephedrine, phenylpropanolamine (cough mixtures, decongestants)
L-dopa, dopamine
Local anaesthetics containing adrenaline

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7
Q

What is an early warning sign of a hypertensive crisis (e.g. in MAOIs)

A

throbbing headache

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8
Q

What are some examples of mood stabiliser drugs

A

Lithium
Valproate
Carbamazepine
Lamotrigine

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9
Q

What can precipitate lithium toxicity

A

Dehydration
Renal impairment
Diuretics, NSAIDs, ACE inhibitors

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10
Q

Which mood stabiliser can rarely be associated with Stevens-Johnson syndrome?

A

Lamotrigine
Particularly in the first 8 weeks of use

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11
Q

Which mood stabiliser can interact with lots of drugs

A

Carbemazepine
It is a potent CYP450 enzyme inducer

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12
Q

What are the main sedative drugs

A

Benzodiazepines
‘Z’ drugs (zopiclone, zolpidem, zaleplon)

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13
Q

How do benzodiazepines work?

A

Potentiate the action of GABA (the main inhibitory neurotransmitter in the grain)
Increase the flow of chloride ions into the cell, hyper polarising the post-synaptic membrane, reducing neuronal excitability

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14
Q

In what patients should you use caution with benzodiazepines

A

Older adults
Patients with chronic respiratory disease (e.g. chronic obstructive pulmonary disease, sleep apnoea)

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15
Q

How does pregabalin and gabapentin work

A

Reduces the release of a range of neurotransmitters through binding to an auxiliary subunit of voltage-gated calcium channels

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16
Q

How do stimulants like amphetamines work?

A

Increase the activity of dopamine and norepinephrine

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17
Q

Causes of delirium

A

D - Drugs and alcohol (Anti-cholinergics, opiates, anti-convulsants, recreational)
E - Eyes, ears and emotional
L - Low Output state (MI, ARDS, PE, CHF, COPD)
I - Infection
R - Retention (of urine or stool)
I - Ictal
U - Under-hydration/Under-nutrition
M - Metabolic (Electrolyte imbalance, thyroid, wernickes)
(S) - Subdural, Sleep deprivation

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18
Q

What reversible causes of reduced cognitive function should be ruled out?

A

B12
Folate
Thyroid function
Urine dip

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19
Q

What should you use in an agitated patient with Parkinson’s?

A

Lorazepam
NOT haloperidol (promotes dopamine blockade causing deterioration)

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20
Q

What syndrome do patients often describe seeing tiny versions of real life objects, often faces or cartoons (visual hallucinations)

A

Charles Bonet Syndrome

21
Q

What causes Charles Bonnet syndrome?

A

Vision loss

22
Q

Is Charles Bonnet syndrome a psychiatric condition?

A

No - they often have insight - due to their vision loss not a mental health condition

23
Q

How do you assess muscle wasting in patients with anorexia?

A

SUSS (sit up-squat-stand) without using hands

24
Q

What is the first-line pharmacological therapy for ADHD?

A

Methylphenidate

25
Q

What are the most common and important side effects of Methylphenidate?

A

Appetite suppression and subsequent growth suppression
May also be associated weight loss

26
Q

What are is the difference in time onset between neuroleptic malignant syndrome and serotonin syndrome?

A

NMS comes on gradually over weeks whereas serotonin syndrome comes on rapidly in hours

27
Q

What are some similarities in symptoms in neuroleptic malignant syndrome and serotonin syndrome?

A

Altered mental state
Diaphoresis
Tachycardia
Rigidity
Hyperthermia

28
Q

What are some differences in symptoms in neuroleptic malignant syndrome and serotonin syndrome?

A

Serotonin: dilated pupils, hyperreflexia, clonus
NMS: normal pupils, no clonus, hyporeflexia

29
Q

What is the difference between Section 135 and 136 of the Mental Health Act?

A

Section 135 allows the police the enter a person’s home to move them to a Place of Safety, whereas 136 is when they are in a public place to move them to a Place of Safety.

30
Q

What antidepressants are allowed in a woman who is breastfeeding?

A

Sertraline or Paroxetine

31
Q

What is the only SSRI licensed for use in under 18s?

A

Fluoxetine

32
Q

What class of drug is Amitriptyline?

A

Tricyclic antidepressant

33
Q

What side effects can tricyclic antidepressants such as Amitriptyline cause?

A

Urinary retention and dry mouth
Blurred vision

34
Q

How long can a patient be detained under a section 5(2) of the Mental Health Act?

A

72 hrs - this is done by a doctor

35
Q

How long can a patient be detained under a section 5(4) of the Mental Health Act?

A

6 hrs - this can be done by a nurse

36
Q

What is Section 4 of the mental health act

A

Detainment in outpatient services (e.g. Emergency department) for up to 72 hrs

37
Q

Which cardiac arrhythmia is most commonly seen in sever anorexia nervosa?

A

Prolonged QT
Bradycardia

38
Q

What type of dementia has recurrent well-formed visual hallucinations?

A

Dementia with Lewy Bodies

39
Q

How does heroin withdrawal present?

A

GI upset (abdo pain and diarrhoea)
Sympathetic hyperactivity (tachycardia and hypertension)
CNS stimulation

40
Q

What class of drug is ketamine?

A

NMDA receptor antagonist

41
Q

What can ketamine cause in your bladder?

A

Bladder fibrosis, leading to episodes of incontinence

42
Q

What is chlorpromazine?

A

Typical anti-psychotic
Often causes akathisia (extra-pyramidal symptoms)

43
Q

What is Ekbom syndrome?

A

The delusion that you are infested with parasites

44
Q

What class of antidepressant can cause gastric ulcers?

A

SSRIs

45
Q

What is the prognosis of schizophrenia relapse and response to treatment?

A

25% will never have another episode
25% will substantially improve on treatment but have rare relapses
25% have some improvement with frequent relapses
25% are resistant to treatment

46
Q

What is the most common side effect of Clozapine?

A

Constipation secondary to intestinal peristalsis

47
Q

Which antihistamine can cause delirium?

A

Chlorphenamine (a first gen H1 antagonist which has anticholinergic activity)

48
Q

What is the difference between Fregoli delusion and Capgras delusion?

A

Fregoli: patient believes that everyone they meet is the same person but with different disguises
Capgras: patient believes that someone close to them has been replaced by a clone

Phase 3a (12 decks)

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