Psychiatry Flashcards
What are the 3 core symptoms of depression?
Low mood, anergia, anhedonia
What are other biological symptoms of depression?
Changes in sleep (early morning wakening)
Changes in appetite
Change in libido
Agitation/anxiety
Diurnal mood variation
What are other cognitive symptoms of depression?
Loss of confidence
Loss of concentration
Feelings of guilt
Hopelessness
Suicidal ideation
What is the diagnostic criteria for mild depression?
Minimum 2/3 core symptoms + 2-3 other symptoms
What is the diagnostic criteria for moderate depression?
Minimum 2/3 core symptoms + 4 others
What is the diagnostic criteria for severe depression?
Core symptoms + several other symptoms + suicidal thoughts +/- psychotic symptoms
What are examples of SSRIs?
Sertraline
Fluoxetine
Paroxetine
Citalopram
For what disorders can SSRIs be used?
Depression
Generalised Anxiety Disorder
PTSD
OCD
What are the side effects of SSRIs?
Excessive stimulation of cerebral serotonin receptors (insomnia, anxiety, irritability)
Excessive stimulation of spinal serotonin receptors (sexual dysfunction)
Excessive stimulation of GI serotonin receptors (Nausea, vomiting, diarrhoea)
What are the symptoms of abrupt SSRI discontinuation?
Increased mood change
Restlessness
Difficulty sleeping
Unsteadiness
Sweating
GI symptoms
Paraesthesia and electric shock-like sensations
What are examples of SNRIs?
Duloxetine
Venlafaxine
Levomilnacipran
For what disorders can SNRIs be used?
Depression
Generalised Anxiety Disorder
Panic disorders
Fibromyalgia
Neuropathy
What are the side effects of SNRIs?
Excessive stimulation of cerebral serotonin receptors (insomnia, anxiety, irritability)
Excessive stimulation of spinal serotonin receptors (sexual dysfunction)
Excessive stimulation of GI serotonin receptors (Nausea, vomiting, diarrhoea)
PLUS - Excessive noradrenergic activity (hypertension, tachycardia)
What are examples of tricyclic antidepressants?
Amitriptyline
Clomipramine
Nortriptyline
Doxepin
Desipramine
Amoxapine
What are the uses of TCAs?
Migraine prevention
Neuropathic pain
Insomnia
What are the side effects of TCAs?
Inhibition of alpha receptors (orthostatic hypotension, dizziness)
Inhibition of histamine receptors (sedation)
Inhibition of muscarinic receptors (blurred vision, constipation, urinary retention, dry mouth (anticholinergic effects))
Block cardiac sodium channels (cardiac conduction abnormalities)
What are examples of monoamine oxidase inhibitors (MAOIs)?
Isocarboxazid
Phenelzine
Selegiline
What are the uses of MAOIs?
Last choice antidepressant due to interactions with other drugs and foods
What are the side effects of MAOIs?
Interact with tyramine (eg. in cheeses, beer, red wine, fish sauces) and can cause stroke
What are examples of atypical antidepressants?
Bupropion –> Used for depression, nicotine cravings and withdrawal symptoms
Mirtazapine –> Sedation
Nefazadone
Vilazadone
What is first line pharmaceutical management of depression?
SSRIs
What is non-pharmaceutical management of depression?
CBT
What are the two states of bipolar disorder?
Depression
Mania/hypomania
What is hypomania?
A milder form of mania
What symptoms are suggestive of mania?
Abnormally elevated mood
Increased energy
Pressure of speech
Flight of ideas or racing thoughts
Poor concentration
Increased libido/disinhibition
Extravagant plans
Psychotic symptoms –> delusions (usually grandiose), hallucinations (usually voices)
How do you diagnose a manic episode?
Symptoms of mania lasting for at least 7 days which usually begin abruptly
What symptoms are suggestive of hypomania?
Mild elevation of mood/irritability
Increased energy
Feelings of wellbeing
Increased sociability
How do you diagnose a mixed episode (in bipolar)?
Rapid alternation, within a few hours, of manic/hypomanic symptoms and depression
What symptoms may help distinguish bipolar disorder from unipolar depression?
Hypersomnia
Weight instability
Early age of onset
Abrupt onset
More frequent episodes of shorter duration
History of substance misuse
Psychosis, psychomotor retardation, catatonia
Family history of bipolar disorder
What is the diagnostic criteria for Bipolar I?
Mania + depression
What is the diagnostic criteria for Bipolar II?
Many episodes of depression + hypomania
What therapies are used to manage bipolar disorder?
CBT
Interpersonal therapy
What is first line pharmaceutical treatment of bipolar disorder?
Antidepressant (fluoxetine) + antipsychotic (olanzapine, quetiapine, haloperidol, risperidone) for an acute manic episode
Lithium (mood stabiliser) or valproate for long term management
What are examples of typical antipsychotics?
Haloperidol
Fluphenazine
Chlorpromazine
Prochlorpromazine
What are the uses of typical antipsychotics?
Reduce positive schizophrenia symptoms (delusions, hallucinations)
What are the side effects of typical antipsychotics?
Worsening of negative schizophrenia symptoms (anergia, lack of motivation, social disengagement)
Extrapyramidal disorders
Increased prolactin (sexual dysfunction, gynaecomastia, galactorrhoea)
Chlorpromazine –> Orthostatic hypotension, anticholinergic symptoms (eg. dry mouth, blurred vision, constipation, urinary problems), sedation, weight gain
What can be given to prevent and treat extra-pyramidal side effects of antipsychotics?
Anti-cholinergic drugs (eg. procyclidine)
What are examples of atypical antipsychotics?
Aripiprazole
Olanzapine
Risperidone
Paliperidone
Clozapine
Quetiapine
What are the uses of atypical antipsychotics?
Reduce positive and negative schizophrenic symptoms
Reduces extrapyramidal side effects
Improves cognition compared with typical antipsychotics
What are side effects of atypical antipsychotics?
Weight gain
Sedation
Orthostatic hypotension
Hyperglycaemia/hyperlipidaemia
Constipation
Nausea/vomiting
What are the first rank symptoms of schizophrenia?
Thought alienation
Passive phenomena
3rd person auditory hallucination
Delusional perception
(Only need 1 of the above for diagnosis)
What are the secondary symptoms of schizophrenia?
Delusions
2nd person auditory hallucinations
Thought disorders
Catatonic behaviours
(Need at least 2 of the above for diagnosis)
What symptoms can be associated with Generalised Anxiety Disorder?
Excessive anxiety
Lasting for 6+ months
Tiredness
Poor concentration
Irritability
Muscle tension
Initial insomnia (difficulty falling asleep)
What are physical symptoms associated with panic disorder?
Palpitations
Chest pain
Tachypnoea
Urgency
Dizziness
What are psychological symptoms associated with panic disorder?
Feelings of impending doom
Fear of dying
Fear of losing control
Depersonalisation
Derealisation
What are examples of benzodiazepines?
Alprazolam
Diazepam
Clonazepam
Lorazepam
What are some side effects of benzodiazepines?
Drowsiness
Dizziness
Decreased concentration
What are the uses of benzodiazepines?
Insomnia
Anxiety
Muscle relaxants
Which personality disorders belong to cluster A (odd/eccentric)?
Schizoid (lack of interest in social interaction)
Paranoid (patterns of distrust and suspicion without reasonable cause)
Schizotypal (mild form of schizophrenia where someone has few, if any, close relationships and doesn’t seem to understand how relationships form and how their behaviour impacts others, also quite eccentric)
Which personality disorders belong to cluster B (dramatic/erratic)?
Emotionally unstable/Borderline
Histrionic (feel uncomfortable if not at the centre of attention)
Narcissistic (inflated sense of self importance)
Dissocial (converted from antisocial PD at 18 years old, antisocial behaviour can include impulsivity, irresponsibility and crime)
Which personality disorders belong to cluster C (anxious/fearful)?
Obsessive-Compulsive Personality Disorder/Anankastic (preoccupation with orderliness, perfection and control)
Dependent (feelings of helplessness and submissiveness and inability to take care of themselves)
Avoidant (chronic feelings of inadequacy and fear of rejection)
What are the clinical features of EUPD?
Impulsivity –> can manifest as substance abuse, eating disorders, sexual/risk taking behaviours, self-harm, overspending
Intense unstable relationships
Fear of abandonment
Unstable mood
Feelings of emptiness
Thoughts of self-harm/suicide
Uncertainty around self-image
What are the conditions of self-harm in EUPD?
Tends to not be suicidal but instead aims to relieve psychic pain
Inflict self-punishment
Reduce anxiety/re-establish control
Shout for help
What are the principles of management in EUPD?
Validating, containing, compassion
Consistency
Medication is often unreliable
Gold standard therapy is Dialectical Behavioural Therapy –> Self-soothing and distraction techniques
For which disorders is CBT approved?
Depression
Anxiety
OCD
PTSD
Eating disorders
Psychosis
For which disorders is interpersonal therapy used?
Mild/moderate depression –> helps the patient to understand how their problems are connected to their relationships
For which disorders is dialectical behavioural therapy used?
EUPD/BPD
What is involved in section 2 of the Mental Health Act?
Used for detainment for assessment of a patient
Maximum 28 days and cannot be renewed
Requires 1 section 12 registered doctor and any other registered practitioner
What is involved in section 3 of the Mental Health Act?
Used for detainment for treatment of a patient
6 months and can be renewed
Requires 1 section 12 registered doctor and any other registered practitioner
What is involved in section 4 of the Mental Health Act?
Used for urgent necessity for when a second doctor is unavailable
Maximum 72 hours for assessment
1 doctor + 1AMHP
What is involved in section 5 (2) of the Mental Health Act?
Used as a doctor’s holding power for admitted patients to allow for assessment for sections 2 or 3
Maximum 72 hours
Does not allow treatment
What is involved in section 5 (4) of the Mental Health Act?
Used as a nurse’s holding power for an admitted patient who wants to leave, until a doctor can arrive
Maximum 6 hours
Does not allow for treatment
What is involved in section 12 of the Mental Health Act?
The ability of a doctor to make decisions about detainment of a patient in sections 2 or 3
What is involved in section 135 of the Mental Health Act?
Allows for the police to access a person’s home and remove them on the basis of poor mental health and transport them to a place of safety to allow for further assessment
What is involved in section 136 of the Mental Health Act?
Allows for the police to detain an individual suspected of having a mental disorder in a public place and transport them to a place of safety to allow for further assessment
What are the symptoms of alcohol withdrawal?
Anxiousness/nervousness
Irritability
Depression
Fatigue
Tremor
Mood swings
Loss of concentration
Night sweats
Headache
Difficulty sleeping
Nausea/vomiting
Loss of appetite
What are the clinical signs of alcohol withdrawal?
Tremor
Tachycardia
Hypertension
Dilated pupils
Fever
Tachypnoea
What is the management of mild/moderate alcohol withdrawal?
Often able to withdraw at home with help
Benzodiazepine sedative (eg. chlordiazepoxide)
Test for other comorbidities associated with alcohol use
Counselling for alcohol use
What is the management of moderate/severe alcohol withdrawal?
Often hospitalised for monitoring
IV fluids
IV sedatives
Treat seizures or any other complication
Supportive to stop drinking
What are the symptoms of delirium tremens?
Fever
Extreme agitation
Seizures
Extreme confusion
Hallucinations
Hypertension
Tachycardia
Hyperthermia
Extreme sweating
What are the risk factors for delirium tremens?
Past history of delirium tremens
Past history of seizures
Concurrent illness
History of detoxification
Prolonged period prior to last drink
What is the cause of delirium tremens?
Severe alcohol withdrawal
What is the treatment of delirium tremens?
IV benzodiazepines
IV Pabrinex (Vitamin B1) –> Prevent Korsakoff’s syndrome
Control and treat symptoms
What is Wernicke’s encephalopathy?
Thiamine deficiency
What are the signs of Wernicke’s encephalopathy?
Altered mental state
Ophthalmoplegia (extraocular muscle paralysis)
Ataxic gait
Delirium
Hypotension
Nystagmus
What are the risk factors of Wernicke’s encephalopathy?
Chronic alcohol abuse
Chronic malnutrition
What are the causes of Wernicke’s encephalopathy?
Severe alcohol use
Severe malnutrition
Hyperemesis gravidarum (severe vomiting in pregnancy)
Malignancy
Liver disease
Hyperthyroidism
How can you diagnose Wernicke’s encephalopathy?
Clinical triad of altered mental state, ophthalmoplegia and ataxic gait
What is the treatment of Wernicke’s encephalopathy?
IV thiamine
What are the symptoms of severe lithium toxicity?
Hyperreflexia
Seizures
Agitation
Slurred speech
Kidney failure
Tachycardia
Hyperthermia
Nystagmus
Hypotension
Confusion
What is the treatment of lithium toxicity?
Decontamination –> Charcoal, gastric lavage, whole bowel irrigation
Elimination –> Haemodialysis
What is the difference between illusion and hallucination?
Both are false perceptions, but whereas illusions are due to a misinterpretation of a stimulus arising from an object, hallucinations do not involve an object
What is a hypnagogic hallucination?
A hallucination that occurs when falling asleep
What is a hypnopompic hallucination?
A hallucination that occurs when waking up
What is the definition of a over-valued idea?
A false belief that is maintained despite strong evidence that it is untrue (eg. an anorexic patient believing that they are fat)
What is the definition of a delusion?
A belief held with unshakeable conviction that cannot be altered by rational arguement and is outside the person’s normal cultural belief system
What is delusional perception?
Belief that a normal event has a special meaning for them
What is thought alienation?
Feelings that an individual’s thoughts are no longer in their control
What is thought insertion?
Where an individual believes that a thought has been inserting into their head
What is thought withdrawal?
Where an individual believes that their thoughts have been taken out of their head by an external source
What is thought broadcast?
Belief that the individual’s life story is being told to everyone
What is thought echo?
A form of hallucination where the individual hears their own thoughts out loud after they have thought them
What is thought block?
A sudden halting of thoughts, causing the individual to stop speaking mid sentence
What is loosening of association?
Where an individual jumps between unrelated ideas when talking
What is circumstanitality?
Where an individual talks irrelevantly around the point
What is perseveration?
Where an individual repeats a word/theme/action beyond the point of relevance
What is confabulation?
Where a gap in the memory is filled with false content
What is somatic passivity?
Where the individual passively receives bodily sensations that are imposed from outside forces
What is the definition of delirium?
A serious mental disturbance causing confusion and reduced awareness of the surroundings
What is the definition of catatonia?
A state of excited motor activity in the absence of mood or neurological disorder
What is flight of ideas?
Where thoughts are formed quickly, causing the individual to talk quickly and jittery
What is poverty of speech?
Where speech is difficult to form and only comes in order to answer a question
What is poverty of thought?
Where speech is adequate in quantity but is vague and lacks meaningful content
What is pressure of speech
A tendency to speak rapidly and frenziedly
What is anhedonia?
The inability to experience emotion
What is apathy?
A lack of interest
What is flattening of affect?
No emotional expression
What is blunting of affect?
Significantly reduced emotional expression
What is incongruity of affect?
Emotional response out of time with the scenario
What is Belle indifference (“Beautiful ignorance”)?
A lack of concern by an individual to their symptoms
What is depersonalisation?
A feeling of being outside oneself and passively observing ones actions
What is derealisation?
A feeling that the world around an individual is unreal
What is the definition of an obsession?
An intrusive thought that intrudes into consciousness and cannot be easily removed
What is the definition of a compulsion?
A repetitive behaviour that an individual feels the need to do to temporarily relieve an unpleasant feeling brought on by an obsessive thought
What is Othello syndrome?
Delusional jealousy, usually believing that their partner is being unfaithful
What is Fregoli syndrome?
Delusional belief that one or more familiar people are repeatedly changing their appearance
What is Folie a deux?
A mental disorder shared by two people at the same time
What is factitious disorder/Munchausen disorder?
Where someone deceives others by appearing sick or purposely getting sick or self harming
Can also happen by presenting others, such as children, as being ill
What is Cotard syndrome?
When a patient believes that they are dead or non-existent
What is Capgras syndrome?
When the patient believes that a relative or friend has been replaced by an identical imposter
What is Charles Bonnet syndrome?
Where patients with vision loss have vivid, recurrent visual hallucinations
What is De Clerambault syndrome/erotomania?
When a patient believes that another individual is infatuated with them, often with the other person being imaginary, deceased or unknown
What is somatisation disorder?
Significant focus on a physical symptoms that causes significant distress and/or problems functioning
What is hypochondrial disorder?
An exaggeration of present symptoms and belief that there is an underlying serious disease eg. cancer
What is conversion disorder?
Where a patient experiences motor or sensory neurological symptoms that cannot be explained with medical evaluation
What is malingering?
Feigning or exaggeration of symptoms for financial/material gain
What is dissociative disorder?
Where the patient feels disconnected from the world around them
What is tangentiality?
Where a patient talks around the point without ever answering the question asked
What drugs should be avoided when taking SSRIs?
Triptans –> cause Serotonin Syndrome
What are the signs and symptoms of serotonin syndrome?
Agitation/restlessness
Insomnia
Confusion
Hypertension
Tachycardia
Pupil dilation
Muscle rigidity
Twitching
Sweating
Diarrhoea
Headache
Shivering
What is the cause of serotonin syndrome?
Excess serotonin build up
What is the management of serotonin syndrome?
Stop causative drug
Activated charcoal if caused by overdose
Supportive measures
Benzodiazepines to control agitation
What are the causes of neuroleptic malignant syndrome?
Adverse reaction to antipsychotics
Abrupt dopaminergic withdrawal
What is the presentation of neuroleptic malignant syndrome?
Change in mental state
Rigidity
Fever
Autonomic dysfunction (tachycardia, hyper/hypotension)
What is the ICD-10 criteria for delirium?
Impairment of consciousness and attention
Global disturbance in cognition
Psychomotor disturbance
Disturbance of sleep-wake cycle
Emotional disturbance
What is the mechanism of action of benzodiazepines?
They facilitate and enhance the bonding of GABA to the GABA receptors
What are side effects of lithium?
