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Psychiatry Flashcards

1
Q

What are the symptoms of depression?

A

Sustained low mood
Anhedonia
Poor concentration and memory
Poor sleep
Worthlessness, hopelessness, guilt
Suicidal ideation
Can have psychotic symptoms

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2
Q

Treatment for mild depression?

A

No medication
Counselling, CBT and self help

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3
Q

Treatment for moderate depression?

A

CBT
Medication (SSRI’s and SNIRI’s)

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4
Q

Treatment for severe depression with psychotic symptoms?

A

Antidepressant plus antipsychotic
ECT

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5
Q

Is 1 episode of mania enough to categorise as bipolar disorder?

A

No, for a diagnosis of bipolar it is 2 or more episodes of mania/hypomania

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6
Q

What is bipolar disorder type 1?

A

Patients experience mania and depression

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7
Q

What is bipolar type 2?

A

Patients experience hypomania and depression

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8
Q

What is hypomania?

A

An episode lasting longer than 4 days, less severe symptoms than mania. No psychotic symptoms

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9
Q

What is mania?

A

An episode lasting longer than 1 week. Can include psychotic symptoms

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10
Q

Which medications are used in the long term management of bipolar?

A

Lithium, valproate and carbamazepine.
Olanzapine, quetiapine, aripiprazole

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11
Q

What may you see that has changed in the thoughts of someone with bipolar disorder?

A

Inflated view of own importance
Grandiose
Chance relationships
Verbal associations
Clang association

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12
Q

What is different in the speech of those with bipolar?

A

Pressure of speech
Increase rate
Difficult to interrupt

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13
Q

What tests must be carried out on patients taking lithium?

A

Renal function as excreted by the kidney
TFT’s as can cause hypothyroidism

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14
Q

Name 3 side effects of lithium.

A

Leucocytosis (elevated WBC)
Diabetes insipidus
Tremors

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15
Q

How long does a section 2 of the MHA last?

A

28days

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16
Q

What is the purpose of a section 2?

A

For assessment of a mental disorder

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17
Q

How long is a section 3 of the MHA?

A

6 months (can be renewed)

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18
Q

What is the purpose of a section 3?

A

For treatment in the presence of a mental disorder

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19
Q

How many doctors and how many advanced medical practioners are required for a section 2 and 3 to be instigated?

A

2 doctors and 1 advanced mental health practioner

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20
Q

How long is section 4?

A

72 hours

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21
Q

What is the purpose of section 4 of the MHA?

A

For emergency when a patient needs to be detained but a second doctor is not able to be present

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22
Q

What is a section 5.2?

A

A doctors holding power, to wait for evaluation for a S2 and S3

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23
Q

What is a section 5.4?

A

A nurses holding power, to wait for medical assessment

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24
Q

How long is a section 5.2?

A

72 hours

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25
How long is a section 5.4?
6 hours
26
What is a section 135 used for?
Police section Go into a patients home and remove them to a place of safety
27
What is a section 136 used for?
Police section Person suspected to have a mental disorder in a public place
28
Which questionnaire is used to assist the diagnosis of depression?
PHQ-9
29
What is the definition of dysthymic disorder?
Subthreshold depressive symptoms lasting between 2-5 years
30
What are the 4 classic symptoms of PTSD?
HEAR Hyperarousal Emotional numbing Avoidance Reliving the situation
31
What are the diagnostic criteria for PTSD?
Traumatic event Symptoms 1-6 months after the event Lasts more than 4 weeks
32
What is the first line treatment for PTSD?
EMDR or trauma focused CBT
33
Which disorder presents within a month of a traumatic event?
Acute stress disorder
34
Which medications are most effective in treating PTSD?
Venlafaxine and sertraline +/- zopiclone for sleep
35
What is OCD?
Chronic anxiety with obsessions and/or compulsions
36
What is an obsession?
Pts own idea/ impulse repetative and intrusive
37
What is a compulsion?
Patient recognises that the behaviour is a problem but is unable to stop doing it
38
What is the treatment for OCD?
Psychological therapy with ERP (exposure and response therapy) SSRI first line pharmacological treatment.
39
What are positive symptoms of schizophrenia?
Things that might start happening
40
Name 5 positive symptoms of schizophrenia.
Delusions Hallucinations Formal thought disorder Thought interference Passivity
41
What are negative symptoms of schizophrenia?
Things that might stop happening
42
Name 5 negative symptoms of schizophrenia.
Anhedonia Affect blunting Asocial Alogia (poverty of speech) Attention deficit
43
Name 4 1st rank symptoms of schizophrenia.
Auditory hallucinations Thought disorder (thought broadcasting) Passivity phenomena (bodily sensations being controlled by external influence Delusional perceptions
44
What is believed to be the cause of Alzheimer's disease?
Senile plaques, neurofibrillary tangles and neuronal loss
45
What is believed to be the cause of vascular dementia?
Micro infarcts in cerebral blood vessels, due to HTN
46
What is lewy body dementia?
Abnormal deposits of alpha synuclein
47
Name 5 risk factors for developing dementia?
Age FHx Down's syndrome Cerebral vascular disease Hyperlipidaemia Lifestyle Poor education
48
What type of memory is lost first in dementia?
Recent memory is lost first
49
What is nominal dysphasia?
Inability to recall the names of people or objects
50
How does the progression of Alzheimer's and vascular dementia differ?
Alzheimer's is gradual, whereas vascular shows a stepwise progression.
51
What is the mneumonic to remember the causes of delirium?
PINCH ME
52
What does the mneumonic PINCH ME stand for?
Pain Infection Nutrition Constipation Hydration Medication Environment
53
What is the class of drugs used to slow the progression of dementia called?
Acetylcholinesterase inhibitors
54
Name 3 acetylcholinesterase inhibitors?
Donepezil Galantamine Rivastigmine
55
What is the definition of delirium?
An acute, fluctuating change in mental state
56
What tests are used in the confusion screen?
Bloods Urinalysis Imaging (CT head and CXR)
57
What cognitive screening tools are used in dementia?
MMSE ACEII MoCA
58
What are the characteristic signs of Lewy body dementia?
Hallucinations Parkinsonian symptoms (stiffness, tremors and slow movements) Along with other dementia symptoms such as memory problems etc.
59
What age does frontotemporal dementia typically present?
45-65
60
What are the characteristic symptoms seen in frontotemporal dementia?
Personality and behaviour changes Language problems (slow speech, struggle with pronounciation) Memory changes come later on
61
What is mild cognitive impairment?
Cognitive changes that are serious enough to be noticed by family members but do not affect the individuals ability to carry out everyday activities.
62
What are the types of side effects associated with typical antipsychotics?
Extrapyramidal SE's
63
What are extrapyramidal symptoms, give 5 examples?
Dystonia (continuous spasms/muscle contractions) Akathisia (restlessness) Parkinsonism's (rigidity) Bradykinesia (slowing of movement) Tardive dyskinesia (irregular jerky movements)
64
What is the mechanism of action of antipsychotics?
Type 2 dopamine receptor antagonists
65
Name 2 typical antipsychotics.
Haloperidol and fluphenazine
66
Which symptoms are antipsychotics used to treat?
Positive symptoms such as hallucinations and dellusions.
67
What is neuroleptic malignant syndrome?
A severe consequence of taking antipsychotic medications. Causing fever, altered mental state, rigidity and autonomic dysfunction.
68
Name 4 atypical antipsychotics.
Quetiapine Olanzapine Risperidone Aripiprazole Clozapine
69
What are the clinical indications for atypical antipsychotics?
Schizophrenia (both positive and negative symptoms) Adjunctive therapy in depression OCD
70
What must be closely monitored for in patients taking clozapine?
Agranulocytosis Lowers seizure threshold Constipation
71
What is the definition of a personality disorder?
An enduring pattern of inner experience and behaviour that deviated markedly from the expectations of the individuals culture.
72
What do patients present like with a cluster A personality disorder?
Odd or eccentric
73
What is a cluster B personality disorder?
Patients tend to appear dramatic, emotional or erratic
74
What is a cluster C personality disorder?
Patients tend to appear anxious or fearful
75
What are the characteristic features of EUPD?
Impulsive, poor response to criticism Self image and chronic feelings of emptiness Intense and unstable relationships Self harm Suicide attempts profound
76
What is histrionic PD?
Self dramatization, Shallow affect egocentricity Craving attention Maniuplative behaviour
77
What is avoidant PD?
Tension Self-consciousness Fear of negative evaluation by others Timid Social inhibition Insecure
78
What is dependant PD?
Reassurance required Expressing disagreement is difficult Lack of self confidence Abandonment fears
79
What is the management of personality disorders?
DBT Crisis team
80
What is the recommended alcohol limit per week?
14 units
81
What are the symptoms of alcohol withdrawal?
Malaise, tremor, nausea, insomnia, transient hallucinations, autonomic hypersensitivity.
82
How long does it take for alcohol withdrawal symptoms to show?
6-12 hours after last drink
83
What are some of the more severe side effects of alcohol withdrawal?
Seizures Delirium tremens
84
What is Wernicke's encephalopathy?
Thiamine deficiency Caused by alcohol misuse
85
What is the presentation of patients with wernickes?
Ataxia Delirium Hypothermia Nystagmus
86
What is the treatment for wernicke's?
IV Pabrinex (thiamine
87
What is Korsakoff's syndrome?
Inability to lay down new memories Amnesia Disorientation to time
88
What is the SADQ questionnaire?
Severity of alcohol dependence questionnaire
89
What is Chlordiazepoxide used for?
A medication used to treat the symptoms of anxiety and agitation caused by alcohol withdrawal.
90
Which medications can be given to help maintain alcohol remission and reduce relapse?
Acamprosate, naltrexone or disulfiram
91
What can affect blood clozapine levels?
Smoking lower blood clozapine levels. Therefore smoking cesation will cause them to rise
92
What is the name of the delusional disorder where people feel they are dead, and which psychiatric condition is this most commonly associated with?
Cotard syndrome and major depressive disorder

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