Psychiatry🤷🏼♂️ Flashcards
1
Q
What are the points you need to assess in MSE?
A
Appearance and behaviour
Speech
Affect/Mood
Thoughts
Perceptions
Cognition
2
Q
What is confabulation?
A
Falsification of memory occuring in clear consciousness in association with organic pathology.
3
Q
What are the core symptoms of depression?
A
Low mood, loss of energy (anergia) and loss of pleasure (anhedonia)
4
Q
What are the other symptoms you might see in depression?
A
Change in sleep, typically early morning waking, change in appetite, libido, diurnal mood variation, agitation, loss of confidence/concentration, guilt, hopelessness.
5
Q
What is Bipolar affective disorder type 1?
A
Both Mania and depression (sometimes only mania)
6
Q
What is bipolar affective disorder type 2?
A
More episode of depression, and often mild hypomania
7
Q
What are the symptoms of hypomania?
A
Elevated mood, increased energy, talkativeness, poor concentration, milk reckless behaviour, sociability, overfamiliarity, sexual disinhibition, change in appetite.
8
Q
What are the symptoms of mania?
A
More than one week. Extreme elevation uncontrollable overactivity, pressure of speech, impaired judgement, extreme risk taking behaviour, social disinhibition, inflated self esteem, with psychotic symptoms.
9
Q
What are the first rank symptoms of psychosis?
A
3rd person auditory hallucination, passivity phenomena, delusional perceptions, thought alienation.
10
Q
What are the clinical features of opiate drug use?
A
Pinpoint pupils, low BP, venepuncture marks.
11
Q
What are the clinical features of benzodiazepines?
A
Gives impression of intoxication, disinhibited.
12
Q
What are the clinical features of psychostimulant drug use?
A
Rapid speech, large pupils, agitation, restlessness.
13
Q
How do you work out the number of units of alcohol?
A
Volume drunk (L) x % of alcohol = Units
14
Q
What is the ‘cheese effect’
A
Eating tyramine rich foods whilst taking a monoamine oxidase inhibitor antidepressant can lead to build up of tyramine and hypertension. Phenelzine is an example of a MAO-i
15
Q
What is the first line drug used for alcohol detox?
A
Chlordiazepoxide
16
Q
What treatment should be used in delirium tremens?
A
IV Pabrinex (Vitamin B1 to prevent the onset of Korsakoff’s syndrome) and high dose benzodiazepine.
17
Q
What are the ICD-10 criteria for delirium?
A
- Impairment of consciousness and attention
- Global disturbance in cognition
- Psychomotor disturbance
- Disturbance of sleep-wake cycle
- Emotional disturbances
18
Q
What is the definition of agoraphobia?
A
Fear of public spaces or fear of entering a public space from which immediate escape would be difficult in the event of a panic attack.
19
Q
What is the ICD-10 criteria for agoraphobia?
A
Marked and consistently manifest fear in, or avoidance of, at least 2 of: Crowds, Public spaces,
Travelling alone, Travelling away from home
● Symptoms of anxiety in the feared situation with at least 2 symptoms present together + 1 symptom
of autonomic arousal
● Significant emotional distress due to the avoidance, or anxiety symptoms.
● Recognized as excessive or unreasonable.
● Symptoms restricted to (or predominate in) feared situation
20
Q
How do benzodiazepines work?
A
They facilitate and enhance the binding of GABA to the GABA 𝛂 receptors
21
Q
What blood results would you expect in neuroleptic malignant syndrome?
A
- Raised CK –> due to muscle rigidity
- Raised WCC
- Deranged LFTs
- Acute renal failure –> Abnormal U&Es
- Metabolic acidosis –> low pH, low HCO3
22
Q
What drugs can you use in acute dystonia?
A
Procyclidine or benztropine
23
Q
What might require you to change clozapine dose?
A
Smoking cessation
24
Q
What is the SSRI of choice in children?
A
Fluoxetine
25
Where do antipsychotics mainly act?
Via dopamine D2 receptor antagonism in the mesolimbic pathway.
26
What is Knight's move thinking?
A phenomenon where a patient’s thoughts
move from one topic to another, without any logical connection between them. It is a feature that is
common in schizophrenia
Flight of ideas (B) is similar to k
27
What blood tests should you test in Lithium use and how regularly?
● Thyroid and renal function should be checked every 6 months (A), as lithium can cause
hypothyroidism and is nephrotoxic
● Lithium has a narrow therapeutic index (D). Lithium levels are therefore checked every 3 months
28
What do the NICE guidelines recommend for mild depression?
For mild depression you should watch and wait and consider referral to IAPT for low intensity psychological interventions
29
What is Zopiclone used for?
Zopiclone can be prescribed for insomnia for short term use (up to 4 weeks)
30
What are some features of obsessive thoughts?
They are usually egodystonic (very different to the patient's normal beliefs and values). Sexual content is a relatively common theme in obsessive thoughts. They are usually intrusive and repetitive. They are usually resisted
31
What is the monitoring for clozapine?
Any patient commenced on clozapine needs to have a minimum of 1 blood test per week for the first 18 weeks.
This is reduced to fortnightly until 1 year after this monthly blood tests are needed (this is only if no abnormalities are found on blood tests
32
What is akathisia?
Defined as the inability to remain still. It is a neuropsychiatric syndrome that is associated with psychomotor restlessness. The individual with akathisia will generally experience an intense sensation of unease or an inner restlessness that usually involves the lower extremities.
33
What is pica?
Pica is a feeding disorder in which someone eats non-food substances that have no nutritional value, such as paper, soap, paint, chalk, or ice
34
What is needed for a diagnosis of pica?
- behaviour must be present for at least one month
- not part of a cultural practice
- developmentally inappropriate
35
What is rumination disorder?
Rumination disorder is an illness that involves repetitive, habitual bringing up of food that might be partly digested. It often occurs effortlessly and painlessly, and is not associated with nausea or disgust. Rumination disorder can affect anyone at any age.
36
How you can define refeeding syndrome?
Can be defined as the potentially fatal shifts in fluids and electrolytes that may occur in malnourished patients receiving artificial feeding (whether enterally or parenterally)
37
What is the gold standard medication for chronic bipolar disorder?
Lithium to act as a mood stabiliser
Valproate is a suitable second line option.
38
What is Pick's disease?
A specific cause of frontotemporal dementia where "Pick's bodies" (accumulations of TAU protein that stain with silver) are found in the neurons.
39
When is Pick's disease diagnosed?
On post mortem
40
Is hypo or hyperthyroidism a side effect of Lithium?
Hypothyroidism is a common side effect of lithium.
41
What is Ekbom syndrome?
In Ekbom syndrome, the patient believes they have been infested with parasites. The patient will complain of crawling sensations on the skin and can be due to a psychological or organic reason such as B12 deficiency.
42
What is Capgras delusion?
Capgras delusion refers to a delusion that either oneself or another person has been replaced by an exact clone. It may be part of a psychotic illness or as a result of trauma to the brain.
43
What is Cotard delusion?
Cotard delusion refers to the belief that a patient is dead, non-existent or 'rotting'. Again, it may occur in psychosis but can appear as a result of parietal lobe lesions.
44
What is Othello Syndrome?
Othello syndrome is a strong delusional belief that their spouse or partner is unfaithful with little or any proof to back up their claim. It is associated with alcohol abuse, psychosis and right frontal lobe damage.
45
What ECG change might you see in refeeding syndrome?
Prominent U waves
These are a feature of hypokalaemia
46
What area of the brain is responsible for the activation of the 'flight or fight' response?
The amygdala
47
What is splitting and when is it seen?
Splitting is a phenomenon sometimes seen in EUPD, whereby relationships alternate between idealisation and devaluation
48
What is Russell's sign?
Scarring on fingers from induced vomiting
49
What is punding?
A form of stereotyped motor behaviour in which there is an apparent fascination with repetitive, mechanical tasks such as arranging items or dismantling and assembling mechanical objects
50
What is punding?
A form of stereotyped motor behaviour in which there is an apparent fascination with repetitive, mechanical tasks such as arranging items or dismantling and assembling mechanical objects
51
What is Hoover's sign?
It is a clinical tool used to differentiate organic from non-organic leg paresis.
In non-organic paresis, pressure is felt under the paretic leg when lifting the non-paretic leg against pressure, this is due to involuntary contralateral hip extension
52
What are some common side effects of tricyclic antidepressants?
Drowsiness, dry mouth, blurred vision, constipation, urinary retention (can lead to overflow incontinence), lengthening of QT interval
53
How long should you continue antidepressants after remission of symptoms?
at least 6 months to decrease the risk of relapse
54
What is recommended as first-line treatment for children and young people with anorexia nervosa?
Anorexia focused family therapy.
The second-line treatment is CBT
55
What are some indications for ECT?
-Treatment resistant severe depression
-Manic episodes
-An episode of moderate depression known to response to ECT in the past
-Life threatening catatonia
56
What are some indications for ECT?
-Treatment resistant severe depression
-Manic episodes
-An episode of moderate depression known to response to ECT in the past
-Life threatening catatonia
57
When is the peak incidence of seizures following alcohol withdrawal?
symptoms: 6-12 hours
seizures: 36 hours
delirium tremens: 72 hours
58
How do you differentiate between Knight's move and flight of ideas?
Knight's move thinking there are illogical leaps from one idea to another, flight of ideas there are discernable links between ideas
59
What may be used to treat moderate/severe tardive dyskinesia?
Tetrabenazine
60
What is the strongest risk factor for developing a psychotic disorder?
Family history - RR of 7.5
61
What is the first line treatment of Alzheimer's dementia?
Donepezil (Acetylcholinesterase inhibitor)
62
Over what length of time do you give acetylcysteine?
1 hour
63
What are some risk factors for ADHD?
Prematurity, Low birth weight, low paternal education, prenatal smoking, maternal depression
64
What is the first-line medication for ADHD?
Methylphenidate
65
What are the four stages to a care programme approach (CPA)?
- Assessing health and social needs
- Creating a care plan
- Appointing a key worker to be the first point of contact
- Reviewing treatment
66
What are some risk factors for developing Bipolar disorder?
Genetic factors: combined effect of many single nucleotide polymorphisms (SNPs)
Prenatal exposure to Toxoplasma gondii (the parasite that causes toxoplasmosis)
Premature birth <32 weeks gestation
Childhood maltreatment
Postpartum period
Cannabis use
67
What are some of the key neurophysiological changes which underpin anxiety?
- Reduced functional connectivity between the prefrontal cortex and the limbic system
- Single nucleotide polymorphism variations in 5-HT transporter, resulting in diminished 5-HT signalling
- Dysregulation of the hypothalamic-pituitary-adrenal axis
68
What drug is not usually detected by a urine drug screen?
LSD (it is rapidly removed by the body and very difficult to detect in the urine)
69
What is Fugue state?
Patients with fugue state lose their memory (including personal identity) and wander away from home - sometimes travelling huge distances. Despite their amnesia for personal information, they are usually able to function very well.
70
What is enmeshment?
It describes the situation whereby family boundaries are unclear and relationships are over-involved. This can make it difficult for children to develop a sense of autonomy and self-identity
71
What is the drug of choice for alcohol deterrence and how does it work?
this results in an increase in serum acetaldehyde if alcohol is consumed which causes diaphoresis, palpitations, facial flushing, nausea, vertigo, headache, hypotension and tachycardia
72
What do NICE guidelines recommend for inpatient assisted withdrawal?
If a service user meets one or more of the following criteria:
- They drink over 30 units of alcohol per day
- Have a score of more than 30 on the SADQ
- Have a history of epilepsy
- Past-experience of withdrawal-related seizures or delirium tremes
- Need concurrent withdrawal from alcohol and benzos
- Regularly drink between 15-30 U/Day AND have significiant psych or physical comorbidities§
73
What is the Edwards and Gross Criteria?
Alcohol dependance can be identified using this criteria:
- Narrowing of Repertoire
- Salience of drink-seeking behaviour
- Increased tolerance to alcohol
- Repeated withdrawal symptoms
- Relief or avoidance of withdrawal symptoms by further drinking
- Subjective awareness of compulsion to drink
- Reinstatement after abstinence
74
How does Acamprosate work in alcohol dependence?
It reduces cravings by inhibiting GABA transmission
75
What is the ONE absolute contraindication for ECT?
Raised Intracranial pressure
76
What is the first line drug treatment for delirium?
Haloperidol 0.5mg PO
77
In which conditions is Haloperidol contraindicated in delirium?
Parkinsons disease
Lewy body dementia
78
What is an illusion?
Stimuli from a perceived object are combined with a mental image to produce a false perception
79
What is an extracampine hallucination?
hallucination that is outside the limits of sensory field.
80
What are some risk factors for depression?
Genetic susceptibility, life factors, alcohol/drug dependence. abuse, unemployment, previous psych diagnosis, chronic disease, post natal
81
What is a typical regimen for ECT?
1-3 sessions per week for 8-12 weeks
82
How is ECT thought to work?
Increases the activity of 5-HT cell and increases the number of post-synaptic 5-HT receptors, it also enhances dopaminergic activity
83
What is another name for obsessive-compulsive personality disorder?
Anankastic personality disorder
84
Define depression
A pervasive lowering of mood
85
What drugs do SSRIs interact with?
NSAIDs - Add a PPI if giving SSRI
Warfarin/heparin - avoid SSRI consider mirtazipine
Aspirin- Give PPI
Triptans - Avoid SSRI
86
Define dysthymia?
Chronic, mildly depressed mood and diminished enjoyment
Not severe enough to be considered depressive illness
87
Name some risk factors for postpartum depression?
Past psychiatric history
Conflicting feelings about the pregnancy
History of abuse as a child
USS showing fetal abnormalities
Low socioeconomic status
Lack of supportive relationships
88
Briefly describe the pathophysiology behind schizophrenia?
Seems to involved dopamine excess
Over activity in the mesolimbic dopaminergic pathways
Stimulant drugs which release dopamine can precipitate psychosis
89
What is schizoaffective disorder?
Where mood symptoms and schizophrenia occur in equal prominence
90
Who is most at risk for an episode of post-partum psychosis?
- Those with a previous episode of psychosis
- First time mothers
- After instrumental delivery
- Those with an FH of affective disorder
91
Risk factors for GAD?
- Alcohol use
- Benzodiazepine use
- Stimulants - Particularly withdrawal from them
- Coexisting depression
- FH
- Child abuse/neglect
- Excessively pushy parents during childhood
- Life stressors/events
92
What are the causes or risk factors for OCD?
Genetics - FH of OCD or tick like disorder
Parental over-protection
PANDAS Subtype
93
What is PANDAS?
Paediatric neuropsychiatic disorders associated with streptococci
94
What are the stages of change steps in alcohol misuse?
Pre-contemplation
Contemplation
Planning/preparation
Action
Maintenance
Sustained maintenance or potential for relapse
95
What else can cause Korsakoff's (other than alcohol abuse)
- Head injury
- Post-anaesthesia
- Basal/temporal lobe encephalitis
- Carbon monoxide poisoning
- Other causes of thiamine deficiency such as anorexia, starvation or hyperemesis
96
What tool is used to screen for delirium?
4AT
97
Define insomnia?
Persistent problems with:
- Falling asleep
- Maintaining sleep
- Poor quality of sleep
For at least 3 days a week for one month
98
What is the definition of a learning disability?
A reduced intellectual ability and difficulty with everyday activities which affects someone for their whole life
99
What is an adjustment disorder?
An abnormal and excessive reaction to an identifiable life stressor
100
What causes tourettes?
Genetic association
Environmental factors – stress, gestational/perinatal insults, fatigue, PANDAS (associated with streptococcal infection)
Often comorbid with – OCD, ADHD, depression, anxiety, learning difficulties, ASD, migraines
101
What are some of the theories of attachment?
Bowlby - humans and animals are attached to the caregiver that feeds them
Lorenz 1952 - Goslings follow their parent not for food
Harlow 1958 - Monkeys' bond to the cuddly pole with food rather than the wire pole
102
What are the four types of attachment?
- Secure
- Anxious
- Ambivalent
- Avoidant
103
What is a secure attachment?
- Able to internally self-regulate the emotional neural systems and responded to environmental stimuli
- Able to respond in an appropriate way to emotional stimuli from age of 5
- Able to develop reciprocal social bonds
104
What is an anxious attachment?
- Occurs when the care giver is emotionally unavailable
- Individuals with this form of attachment appear clingy
105
What is an ambivalent attachment?
- Occurs when the care giver regularly uses drugs/alcohol
- Individuals with this form of attachment alternate between clinging with excessive submissiveness and no trust
- Dysregulation of fear and anger
106
What is an avoidant attachment?
- Occurs when the caregiver is abusive or neglectful
- Child tends to minimise the need for attachment to avoid abuse/neglect
- If the avoidance is severe they can freeze when reunited with their parent
