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Clinical Medicine > Psychiatry 🧠 > Flashcards

Psychiatry 🧠 Flashcards

1
Q

PTs with lewy body dementia are highly sensitive to what type of medication?
what happens if they take it?

A

neuroleptics

increased Parkinsonism - leading to falls

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2
Q

first line treatment for paranoia schizophrenia

A

atypical antipsychotics - risperidone

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3
Q

why would someone prefer atypical to typical antipsychotics like haloperidol

A

typical antipsychotics have higher risk of extra-pyramidal side effects

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4
Q

what are extra-pyramidal symptoms

A

inability to sit still
involuntary muscle contractions
tremors
stiff muscles
involuntary facial movements

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5
Q

classic triad of hydrocephalus

A

urinary incontinence
dementia
gait abnormality

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6
Q

if nutritional intake is resumed too rapidly after a period of low calorie intake the patient is at high risk of ?

A

refeeding syndrome

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7
Q

signs of refeeding syndrome

A

tachycardia
pedal odema
confusion

occurs 24-72 hours after refeeding begins

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8
Q

section 2 MHA

A

Admission for assessment for up to 28 days, non-renewable
The application for admission is made by an Approved Mental Health Professional (AMHP) or the patient’s nearest relative
Requires the recommendation of 2 doctors, one of whom must be ‘approved’ under Section 12(2) of the MHA

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9
Q

section 3 MHA

A

Used in emergencies where a section 2 would cause “an undesirable delay”
It requires the recommendation of only one doctor and either an AMHP or the nearest relative
Allows a person to be detained for up to 72 hours, whereby it is usually converted to a section 2

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10
Q

section 5(2) MHA

A

A voluntary patient in hospital may be legally detained by a doctor for 72 hours

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11
Q

section 5(4) MHA

A

A section 5(4) is similar to a section 5(2) but is used by nurses and only lasts for 6 hours.

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12
Q

section 17 MHA

A

A Supervised Community Treatment (also known as a Community Treatment Order)

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13
Q

section 135 MHA

A

A court order that allows the police to enter a property to remove a person to a Place of Safety (either the police station or more commonly A&E)

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14
Q

section 136 MHA

A

The police can bring someone from a public place who appears to have a mental disorder to a Place of Safety (either the police station or more commonly A&E)

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15
Q

For a patient to be treated under the Mental Health Act (MHA) what criteria must they meet?

A

They must have a mental disorder
There must be a risk to their health/safety or the safety of others
There must be a treatment (however this can include nursing care, not just drugs)

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16
Q

what is munchausens syndrome

A

patients intentionally fake signs and symptoms in order to gain attention and play the patient role

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17
Q

first line treatment for ADHD (meds)

A

methylphenidate

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18
Q

what is methylphenidate

A

first line medication for adhd in children aged 5 or over
it is a CNS stimulant which primarily acts as a dopamine/norepinephrine reuptake inhibitor

19
Q

what needs to be monitored when children are on methylphenidate

A

weight and height every 6 months

20
Q

if there is inadequate response from methylphenidate what do you do

A

switch to lisdexamfetamine
then those who can’t tolerate its side effects should switch to dexamfetamine

21
Q

clinical features of autism

A

impaired social communication and interaction
repetitive behaviours, interests and activities
often associated with intellectual or language impairment

22
Q

clinical features of anorexia nervosa

A

low BMI
hypotension
bradycardia
enlarged salivary glands
lanugo hair
amenorrhea

23
Q

typical serum chemistry results include ? for anorexia nervosa patients

A

hypokalaemia
low sex hormone levels
ketoacidosis
hypomagnesaemia
hypophosphataemia
hypocalcaemia
hypoglycaemia

24
Q

what serum chemistry would you see with an anorexic patient who purges

A

hypokalaemia
metabolic alkalosis

25
Q

what serum chemistry would you see with an anorexic patient who uses laxatives

A

hypokalaemia
hyponatraemia
metabolic acidosis

26
Q

what investigations should you perform on a patient with anorexia

A

FBC
U+E
TFTs
LFT
urinalysis
ECG - prolonged QT - hospital admission
Bone densitometry - after 1 year diagnosis

27
Q

what is fatal about a QT syndrome in anorexia patients

A

increases risk of arrhythmias such as ventricular fibrillation

28
Q

alternative causes when diagnosing anxiety

A

hyperthyroidism
cardiac disease
medication-induced anxiety

29
Q

what medications may trigger anxiety

A

salbutamol
theophylline
corticosteroids
antidepressants
caffeine

30
Q

NICE step 1 approach to GAD

A

education about GAD and active monitoring

31
Q

NICE step 2 approach to GAD

A

low intensity psychological interventions

32
Q

NICE step 3 approach to GAD

A

high intensity psychological interventions or drug treatment

33
Q

NICE step 4 approach to GAD

A

highly specialist input

34
Q

first line NICE drug treatment to GAD

A

sertraline SSRI

35
Q

after sertraline what should be offered for GAD

A

alternative SSRI or SNRI
if these aren’t tolerated then consider pregabalin
b-blockers effected for somatic anxiety symptoms
low dose anti-psychotics can also be used
Busipirone - 5HT1A agonist - is suitable for short term

36
Q

features of panic disorder

A

recurrent attacks of severe anxiety not restricted to situations/circumstances

between attacks minimal anxiety symptoms

attacks last for minutes

37
Q

clinical features of panic disorder

A

breathing difficulties
chest discomfort
palpitations
tingling or numbness in hands, feet, mouth
shaking, sweating, dizziness

38
Q

psychological management of panic disorder

A

reassurance
CBT - first line
education
cognitive restructuring

39
Q

drug management of panic disorder

A

SSRIs are first line but 2nd line to CBT
clomipramine

40
Q

What is the underlying cause of Korsakoff’s syndrome

A

Untreated Vitamin B1 (thiamine) deficiency

41
Q

Management of alcohol withdrawal

A

Long acting benzodiazepines e.g chlordiazepoxide or diazepam

42
Q

MOA of amitriptyline

A

Inhibits uptake of monoamines at the presynaptic membrane

43
Q

What is Korsakoff’s syndrome

A

Marked memory disorder often seen in alcoholics
Anterograde amnesia and retrograde amnesia that leads to confabulation

Clinical Medicine (26 decks)

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