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Psychiatry Flashcards

1
Q

Section 2

A

4 weeks (28 days)

2 doctors make recommendation, AMHP arranges assessment
Can be for safety

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2
Q

Section 3

A

6 months
can be renewed
for TREATMENT only
2 doctors + AMHP

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3
Q

Section 5(2)

A

gives doctors the ability to detain in hospital for 72 hours

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4
Q

Section 5(4)

A

gives nurses the ability to detain in hospital for 6 hours

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5
Q

Section 136

A

Police can take you (or keep you at) a place of safety

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6
Q

Section 4

A

72 hour assessment order
used as emergency when a section 2 would involve unacceptable delay e.g. outpatients inc. emergency department
a GP/doctor + AMHP or NR

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7
Q

Grandiose delusions

A

delusions with a strong positive affect where patients believe they have highly positive traits e.g “I’m rich” “I’m the Prime Minister”. Associated with mania.

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8
Q

Delusions of control

A

to a sensation that an external party is controlling an individuals thoughts or actions.
Seen in psychosis.

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9
Q

Persecutory delusions

A

a set of delusional conditions in which the patient believes they are being persecuted.
May be seen in psychosis.

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10
Q

Capgras delusion

A

A delusion that either oneself or another person has been replaced by an exact clone.
May be part of a psychotic illness or as a result of trauma to the brain.

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11
Q

Ekbom’s syndrome

A

A delusional belief where a patient feels that they are infested with parasites.
They often complain of feeling “crawling” in the skin.
It can appear as part of a psychotic illness or a secondary organic disease such as B12 deficiency, hypothyroidism and neurological disorders.

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12
Q

Cotard Delusion

A

A belief that a patient is dead, non-existent or ‘rotting’
may occur in psychosis but can appear as a result of parietal lobe lesions.

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13
Q

Othello syndrome

A

strong delusional belief that their spouse or partner is unfaithful with little or any proof to back up their claim.
associated with alcohol abuse, psychosis and right frontal lobe damage.

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14
Q

Preferred SSRIs in breastfeeding women w/ postpartum depression

A

Sertraline or Paroxetine

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15
Q

What is Bipolar Affective Disorder?

A

A mental disorder characterised by periods of depression and periods of elevated mood (mania)

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16
Q

Clinical Features of Bipolar Affective Disorder

A

Periods of depression: withdrawn, tearful, low mood, poor sleep, anhedonia, may experience suicidal thoughts or make attempts

Manic episodes: elevated modd or irritability, make impulsive and dangerous decisions, need for sleep reduced, often have pressured speech and exhibit flight of ideas. Mood congruent delusions may be present.

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17
Q

Dx of Bipolar Affective Disorder

A

diagnosed when a person has at least one episode of a manic or a hypomanic state, and one major depressive episode

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18
Q

symptoms needed to diagnose mania

A

At least three of the following:
Elevated self-esteem
Reduced need for sleep
Increased rate of speech
Flight of ideas
Easily distracted
An increased interest in goals or activities
Psychomotor agitation (pacing, hand wringing etc.)
Increased pursuit of activities with a high risk of danger

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19
Q

Hypomania diagnostic definition

A

“the episode (should not be) severe enough to cause marked impairment in social or occupational functioning, or to necessitate hospitalisation, and there are no psychotic features”

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20
Q

Diagnostic criteria for depressive episode in Bipolar Affective Disorder

A

At least four of the following, should be new or suddenly worse, and must last for at least 2 weeks:

Changes in appetite or weight, sleep, or psychomotor activity
Decreased energy
Feelings of worthlessness or guilt
Trouble thinking, concentrating, or making decisions
Thoughts of death or suicidal plans or attempts

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21
Q

Chronic Mx Bipolar Affective Disorder

A

Lithium: acts as mood stabiliser
Valproate: 2nd line

Access to CBT, interpersonal therapy or couples/family therapy.

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22
Q

Acute Mx Bipolar Affective Disorder

1) Acute mania
2) Acute depression

A

1) Acute mania w/ agitation: IM benzodiazepine or a neuroleptic, may need urgent admission to a secure unit.
Acute mania w/o agitation: oral antipsychotic, if necessary, sedation and a mood stabiliser such as lithium.

2) Acute depression: mood stabilizer and/or atypical antipsychotic and/or antidepressant w/ appropriate psychosocial support

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23
Q

What is Munchausen syndrome?

A

Patients fake illnesses to receive attention
e.g. adding blood to urine, not taking medications or faking pain.

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24
Q

What is Malingering?

A

Patients intentionally fake or induce illness for secondary gain e.g. drug seeking, disability benefits, avoiding work or prison time

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25
What is a conversion disorder?
Psychiatric condition that results in a presentation of neurological symptoms w/o any underlying neurological cause (e.g. paralysis, pseudoseizures, sensory changes) Not an intentional process and symptoms are very 'real' to the patient. Linked to emotional stress
26
What is a somatoform disorder?
The presence of physical symptoms that cannot be explained by a medical condition, drug or other MH disorder. Unconscious process
27
Features of opiate intoxication (e.g. heroin)
drowsiness confusion decreased resp rate decreased HR constricted pupils If heroin: needle marks
28
Features of cannabis intoxication
drowsiness impaired memory slowed reflexes & motor skills bloodshot eyes increased appetite dry mouth ^ HR paranoia
29
What receptors do opiates act on?
Opioid receptors
30
What receptors does cannabis act on?
Cannabinoid receptors
31
Features of LSD intoxication
labile mood hallucinations ^ BP ^ HR ^ temp sweating insomnia dry mouth
32
What receptors does LSD act on?
Dopamine receptors
33
Features of stimulant intoxication? (e.g. cocaine, methamphetamine)
euphoria ^ BP ^ HR ^ temp low doses: increased concentration and focus
34
What receptor does cocaine act on?
dopamine receptors
35
What receptors does methamphetamine act on?
TAAR1 receptors (Trace Amine-Associated Receptor 1)
36
Opiate withdrawal features
agitation anxiety muscle aches or cramps chills runny eyes runny nose sweating yawning insomnia gastro disturbance e.g. abdo cramps, N&V, diarrhoea dilated pupils 'goose bump' skin ^ HR & BP
37
Features of normal-pressure hydrocephalus
Urinary incontinence Dementia Gait abnormality (can cause falls)
38
Treatment for normal pressure hydrocephalus
Ventriculo-peritoneal shunting
39
What part of the brain is responsible for the activation of the 'fight or flight' response?
The amygdala
40
What term is used to describe a phenomenon in which the patient has a fascination with repetitive mechanical tasks or with the ordering of objects?
Punding
41
De Clerambault's Syndrome
Delusional disorder in which the patient has a specific, fixed, false belief that someone is in love with them otherwise known as erotomania
42
First line treatment for PTSD?
Trauma-focused psychological treatments (e.g. trauma-focused CBT)
43
Low levels of which neurotransmitter are associated with the development of anxiety?
Gamma-aminobutyric acid (GABA)
44
When not to use an SSRI?
Increased risk of bleeding when prescribed with anticoagulants: especially in elderly ?alongside pill?
45
Physical Features of Bulimia Nervosa
Dental Erosion Parotid gland swelling Russell's sign (scarring on fingers from induced vomiting)
46
What is the correct length and quantity of symptoms needed for a diagnosis of mild depression to be made?
5 or more symptoms, occurring nearly every day for 2 weeks
47
Clinical Features of Frontotemporal Dementia
- younger age than other forms - early personality change and frequently become disinhibited - language can also be affected early on
48
Symptoms of hyperprolactinaemia
women: amenorrhoea & oligomenorrhoea men: gynaecomastia, erectile dysfunction both: decreased libido galactorrhoea infertility osteoporosis
49
Side effects of antipsychotics
Hyperprolactinaemia - prolactin production can be stimulated by dopamine receptor antagonists such as risperidone and other antipsychotic medications
50
What monitoring parameter is needed after starting a patient on Venlafaxine?
Blood Pressure - can cause increase in BP and HR
51
Biochemistry results for Anorexia Nervosa
Hypokalemia Low sex hormone levels (FSH, LH, oestrogen, testosterone) Raised growth hormone and cortisol levels Hypercholesterolaemia
52
Features of Lithium Toxicity
Coarse tremor CNS disturbance inc. seizures, impaired coordination, dysarthria Arrhythmias Visual disturbance Confusion
53
Which specific ECG change can be associated with haloperidol use?
Prolongation of the QT interval
54
What term is used to describe a phenomenon in Parkinson's disease where a patient may get stuck on a word in a sentence and repeat it over again?
Logoclonia
55
Side effects of SSRIs
GI upset Anxiety and agitation QT interval prolongation (esp. associated w/ citalopram) Sexual dysfunction Hyponatraemia Gastric ulcer
56
Side effects of Tricyclic antidepressants (e.g. amitriptyline, clomipramine)
Urinary retention Drowsiness Blurred vision Constipation Dry mouth
57
Cautions with SSRIs
Omitted in mania Used w/ caution in children and adolescents Sertraline best for patients w/ ischaemic heart disease
58
Cautions w/ Tricyclic antidepressants
Contraindicated w/ previous heart disease Can exacerbate schizophrenia Exacerbate long QT syndrome Use w/ caution in pregnancy and breastfeeding
59
Cautions with SNRIs
Contraindicated in those with a history of heart disease and high BP
60
What is autoimmune encephalitis?
A form of non-infectious neuroinflammation that causes acute/subacute progressive mental status change
61
Clinical features of Autoimmune Encephalitis
Wide range of symptoms: confusion, seizures, movement disorders, behavioural changes, emotional lability, psychosis, cognitive impairment, reduced consciousness level
62
Ix for autoimmune encephalitis
Full neuro exam Blood tests: - Low sodium associated w/ LG1 encephalitis - Antibodies: LGI1, NMDA receptor, CASPR2 MRI Lumbar puncture: ^ levels of lymphocytes in CSF
63
Treatment for autoimmune encephalitis
1st line: steroids, IV immunoglobulin 2nd line: not responding within 2 weeks --> immunosuppressant therapy e.g. Rituximab, Cyclophosphamide Plasma exchange can be used as an adjunctive treatment in those that are not fully responding to treatment
64
What does the term 'pica' describe?
eating non-food items or food items in obscene quantities
65
CT appearance for Normal Pressure Hydrocephalus
Enlarged ventricles and absent sulci seen on CT brain scan
66
What is Wernicke's encephalopathy?
Acute neurological condition due to thiamine/vitamin B1 deficiency (alcoholics)
67
Wernicke's encephalopathy triad
confusion, ataxia and ophthalmoplegia (weakness or paralysis of the eye muscles)
68
Features of Serotonin Syndrome
Restlessness, diaphoresis, clonus, hyperthermia, rigidity, hyperreflexia
69
Side effects of clozapine
Most common: constipation Most serious: Agranulocytosis (regular full blood count monitoring)
70
Which ECG change may be seen in refeeding syndrome?
QT prolongation Flattened and inverted T waves Prominent U waves Mild ST depression (hypokalaemia)
71
What is neuroleptic malignant syndrome? (NMS)
A rare but potentially life-threatening adverse reaction to antipsychotics, e.g. haloperidol
72
Symptoms of haloperidol
^ sweating, fever, rigidity, confusion, fluctuating consciousness, fluctuating BP, tachycardia
73
Dx for neuroleptic malignant syndrome (NMS)
Raised creatine kinase

Medicine (13 decks)

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