Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

!Final Year > Psychiatry > Flashcards

Psychiatry Flashcards

1
Q

What is Bipolar Affective Disorder?

A

A chronic mental health disorder characterised by periods of mania/hypomania alongside episodes of depression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the epidemiology of bipolar affective disorder?

A

Typically develops in the late teen years
lifetime prevalence: 2%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the two types of bipolar affective disorder?

A

Type I disorder: mania and depression (most common)
Type II disorder: hypomania and depression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the difference between mania and hypomania?

A

Both terms mean abnormally elevated mood or irritability
Mania: severe functional impairment or psychotic symptoms (e.g.delusions of grandeur or auditory hallucinations) which suggest mania for >7 days
Hypomania: decreased or increased function for >4 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the referral guidelines for bipolar affective disorder?

A

If symptoms suggest hypomania: NICE recommend routine referral to the community mental health team
If there are features of mania or severe depression then an urgent referral to the CMHT should be made

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the management for bipolar affective disorder?

A

Psychological interventions
Medication:
lithium remains the mood stabilizer of choice
Management of mania/hypomania or depression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the management of mania/ hypermania?

A

Consider stopping antidepressant if the patient takes one
Start antipsychotic therapy e.g. olanzapine or haloperidol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the management of depression in BPAD?

A

Talking therapies
Consider SSRIs (1st = fluoxetine) but not encouraged due to risk of manic episode

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What co-morbidities are patients with BPAD at risk of getting?

A

A 2-3 times increased risk of diabetes, cardiovascular disease and COPD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the therapeutic range for lithium?

A

0.4-1.0 mmol/L

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are some of the adverse effects of Lithium?

A

Nausea/vomiting, diarrhoea
Fine tremor
Nephrotoxicity: polyuria, secondary to nephrogenic DI
Thyroid enlargement, may lead to hypothyroidism
ECG: T wave flattening/inversion
Weight gain
Idiopathic intracranial hypertension
Hyperparathyroidism and resultant hypercalcaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are some considerations regarding Lithium monitoring?

A

When checking lithium levels, the sample should be taken 12 hours post-dose
After starting lithium levels should be performed weekly and after each dose change until concentrations are stable
Once established, lithium blood level should ‘normally’ be checked every 3 months
Measure thyroid and renal function every 6 months
Patient should have an alert card and a record book

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

At what concentration does Lithium toxicity occur?

A

Concentrations > 1.5 mmol/L

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What can precipitate Lithium toxicity?

A

Dehydration
Renal failure
Drugs: diuretics (especially thiazides), ACE inhibitors/angiotensin II receptor blockers, NSAIDs and metronidazole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are some of the features of Lithium toxicity?

A

Coarse tremor (a fine tremor is seen in therapeutic levels)
Hyperreflexia
Acute confusion
Polyuria
Seizure
Coma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the management of Lithium toxicity?

A

Mild-moderate toxicity: may respond to volume resuscitation with normal saline
Severe toxicity: haemodialysis may be needed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are personality disorders?

A

A series of maladaptive personality traits that interfere with normal function in life

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are the three clusters of personality disorders?

A

Cluster A: Odd or eccentric
Custer B: Dramatic, emotional or erratic
Cluster C: Anxious and fearful

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are the three personality disorders in Cluster A (odd or eccentric)?

A
  1. Paranoid
  2. Schizoid
  3. Schizotypal
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is the difference between schizoid and schizotypal personality disorder?

A

Schizoid:
- Preference for solitary activities
- Lack of interest in sexual interactions
- Few interests and friends or confidants other than family
- Emotional coldness
Schizotypal:
- Odd beliefs and magical thinking
- Paranoid ideation and suspicion
- Odd speech

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are the four personality disorders in Cluster B?

A
  1. Antisocial
  2. EUPD
  3. Histrionic
  4. Narcissistic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are the three personality disorders in Cluster C?

A
  1. Obsessive- compulsive
  2. Avoidant
  3. Dependent
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is the main management of personality disorders?

A

Psychological therapy = dialectical behaviour therapy
Treatment of any coexisting psychiatric conditions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What are the different options in smoking cessation?

A
  1. Nicotine replacement therapy
  2. Varenicline (a nicotinic receptor partial agonist)
  3. Bupropion (nicotine antagonist)
    2 + 3 contraindicated in pregnancy and breastfeeding
    3 also contraindicated in epilepsy (due to risk of seizure) and eating disorders (relative)
25
Q

What are the two main eating disorders?

A
  1. Anorexia nervosa
  2. Bulimia nervosa
26
Q

What is anorexia nervosa?

A

Restriction of energy intake relative to requirements leading to a significantly low body weight

27
Q

How is the diagnosis of anorexia nervosa made?

A

Based on the DSM 5 criteria
1. Restriction of energy intake relative to requirements leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health
2. Intense fear of gaining weight or becoming fat, even though underweight.
3. Disturbance in the way in which one’s body weight or shape is experienced

28
Q

What are the features of anorexia nervosa?

A

Reduced body mass index
Bradycardia
Hypotension
Enlarged salivary glands
Lanugo hair

29
Q

What are some physiological abnormalities seen in anorexia nervosa?

A

Hypokalaemia
Low FSH, LH, oestrogens and testosterone
Raised cortisol and growth hormone
Impaired glucose tolerance
Hypercholesterolaemia
Hypercarotinaemia
Low T3

30
Q

What is the management of anorexia nervosa in children and young people?

A

First line: NICE recommend ‘anorexia focused family therapy’
Second-line: cognitive behavioural therapy- eating disorder focused

31
Q

What is the management of anorexia nervosa in adults?

A
  1. Individual eating-disorder-focused cognitive behavioural therapy (CBT-ED)
  2. Maudsley Anorexia Nervosa Treatment for Adults (MANTRA)
  3. Specialist supportive clinical management (SSCM)
32
Q

What is the prognosis for people with anorexia nervosa?

A

Poor
Up to 10% of patients will eventually die because of the disorder

33
Q

What is Bulimia nervosa?

A

A type of eating disorder characterised by episodes of binge eating followed by intentional vomiting or other purgative behaviours such as the use of laxatives or diuretics or exercising

34
Q

What is the DSM 5 criteria for bulimia nervosa?

A
  1. recurrent episodes of binge eating
  2. a sense of lack of control over eating during the episode
  3. recurrent inappropriate compensatory behaviour in order to prevent weight gain, such as self-induced vomiting, misuse of laxatives, diuretics, or other medications, fasting, or excessive exercise
    These episodes occur at least once a week for 3 months
35
Q

What signs might you see in a patient with bulimia nervosa?

A

Erosion of teeth (from recurrent vomiting)
Russell’s sign - calluses on the knuckles or back of the hand due to repeated self-induced vomiting

36
Q

What is the management of bulimia nervosa?

A

Referral for specialist care is appropriate in all cases
1. Bulimia-nervosa-focused guided self-help for adults
2. If 1 is unacceptable, contraindicated, or ineffective after 4 weeks of treatment, NICE recommend individual eating-disorder-focused cognitive behavioural therapy (CBT-ED)
3. Limited role of high dose fluoxetine as a trial (long term data is lacking)
(Family therapy for children)

37
Q

What is dementia?

A

A syndrome characterised by a decline in cognition

38
Q

What is the most common cause of dementia in the UK?

A

Alzheimer’s disease

39
Q

What are the three main causes of dementia?

A

Alzheimer’s disease
Cerebrovascular disease: multi-infarct dementia (c. 10-20%)
Lewy body dementia (c. 10-20%)

40
Q

What are some important differentials in dementia?

A

Endocrine: hypothyroidism, Addison’s
Deficiency: B12/folate/thiamine
Syphilis
Brain tumour
Normal pressure hydrocephalus
Subdural haematoma
Depression
Chronic drug use e.g. Alcohol, barbiturates

41
Q

What would support a diagnosis of depression over dementia?

A

Short history, rapid onset
Biological symptoms e.g. weight loss, sleep disturbance
Patient worried about poor memory
Reluctant to take tests, disappointed with results
Mini-mental test score: variable
Global memory loss (dementia characteristically causes recent memory loss)

42
Q

What are the risk factors for Alzheimer’s disease?

A

Increasing age
FH of Alzheimer’s disease
5% of cases are inherited as an autosomal dominant trait
Mutations in the amyloid precursor protein (chromosome 21) and others
Caucasian ethnicity
Down’s syndrome

43
Q

What are the macroscopic pathological changes in Alzheimer’s?

A

Widespread cerebral atrophy, particularly involving the cortex and hippocampus (temporal lobe)

44
Q

What are the microscopic pathological changes in Alzheimer’s?

A
  1. Cortical plaques due to deposition of type A-Beta-amyloid protein
  2. Intraneuronal neurofibrillary tangles caused by abnormal aggregation of the tau protein
45
Q

What are the medical management options for Alzheimer’s?

A

Mild to moderate = acetylcholinesterase inhibitors (donepezil, galantamine and rivastigmine)
Severe or moderate and tolerant to AChEi = memantine (an NMDA receptor antagonist)

46
Q

What is the management for the non-cognitive symptoms in Alzheimer’s?

A

For mild to moderate depression = NICE does not recommend antidepressants
Antipsychotics should only be used for patients at risk of harming themselves or others, or when the agitation, hallucinations or delusions are causing them severe distress

47
Q

What is vascular dementia?

A

A group of syndromes of cognitive impairment caused by different mechanisms causing ischaemia or haemorrhage secondary to cerebrovascular disease

48
Q

What are the three main subtypes of vascular dementia?

A
  1. Stroke-related VD – multi-infarct or single-infarct dementia
  2. Subcortical VD – caused by small vessel disease
  3. Mixed dementia – the presence of both VD and Alzheimer’s disease
49
Q

What are the risk factors for vascular dementia?

A

History of stroke or transient ischaemic attack (TIA)
AF
HTN
DM
Hyperlipidaemia
Smoking
Obesity
Coronary heart disease
FH of stroke or cardiovascular disease

50
Q

What are the main symptoms of vascular dementia?

A

‘Stepwise’ progression
Focal neurological abnormalities e.g. visual disturbance, sensory or motor symptoms
Difficulty with attention and concentration
Seizures
Memory disturbance
Gait disturbance
Speech disturbance
Emotional disturbance

51
Q

What imaging may be done for vascular dementia?

A

MRI scan – may show infarcts and extensive white matter changes

52
Q

What is the management for vascular dementia?

A

Mainly symptomatic
Important to detect and address cardiovascular risk factors – for slowing down the progression

53
Q

What is Lewy body dementia?

A

A common cause (20%) of dementia

54
Q

What is the pathology of Lewy body dementia?

A

Alpha-synuclein cytoplasmic inclusions (Lewy bodies) in the substantia nigra, paralimbic and neocortical areas

55
Q

What two diseases are associated with Lewy body dementia?

A

Parkinson’s disease
Alzheimer’s: up to 40% of patients will also have Lewy bodies

56
Q

What are the features of Lewy body dementia?

A

Progressive cognitive impairment (typically occurs before parkinsonism, but both features occur within a year of each other) - early impairments in attention and executive function
Parkinsonism
Visual hallucinations (lilliputian)

57
Q

What are the investigations for Lewy body dementia?

A

Usually clinical
single-photon emission computed tomography (SPECT)- also known as DaTscan

58
Q

What is the management for Lewy body dementia?

A

If co-existent Alzheimers: acetylcholinesterase inhibitors (e.g. donepezil, rivastigmine) and memantine
Neuroleptics should be avoided in Lewy body dementia as patients are extremely sensitive and may develop irreversible parkinsonism

59
Q

What factors would suggest delirium over dementia?

A

Acute onset
Impairment of consciousness
Fluctuation of symptoms: worse at night, periods of normality
Abnormal perception (e.g. illusions and hallucinations)
Agitation, fear
Delusions

!Final Year (26 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions