Psychiatry Flashcards

Question

Give some side effects of SSRIs?

Answer 1

GI Symptoms GI Bleeding risk- prescribe PPI if also taking a NSAID

Answer 2

Noradrenergic and specific serotonergic antidepressant

Answer 3

Fewer side effects than other antidepressants so used in older people however Sedation Increased appetite Useful for insomnia and low appetite

Answer 4

Smoking cessation. Starting smoking can reduce clozapine levels. Alcohol binges can increase the levels

Answer 5

Weight gain Clozapine is associated with agranulocytosis Hyperprolactinaemia In elderly patients: Increased risk of stroke Increased risk of venous thromboembolism

Answer 6

Aripiprazole- good side effect profile particularly for prolactin elevation

Answer 7

* Agranulocytosis (1%), neutropaenia (3%) *Reduced seizure threshold - can induce seizures in up to 3% of patients * Constipation * Myocarditis: a baseline ECG should be taken before starting treatment * Hypersalivation

Answer 8

Lorazepam (Benzodiazepines)

Answer 9

Hyperthyroidism Cardiac disease Medication-induced anxiety

Answer 10

Sertraline

Answer 11

Auditory hallucinations Thought disorders Passivity phenomena Delusional perceptions

Answer 12

Fraudulent simulation or exaggeration of symptoms with the intention of financial or other gain

Answer 13

The intentional production of physical or psychological symptom

Answer 14

Typically involves loss of motor or sensory function- not faking it or doing it for gain but no explanation

Answer 15

Multiple physical SYMPTOMS present for at least 2 years. Patient refuses to accept reassurance or negative test results.

Answer 16

Persistent believe of an underlying DISEASE. Patient refuses to accept reassurance or negative test results.

Answer 17

Guided self help

Answer 18

Less than 16

Answer 19

16 or over

Answer 20

0.4-1.0 mmol/L

Answer 21

Thyroid and renal function every 6 months

Answer 22

GI Symptoms- pain, cramping, diahorroea, vomiting Increased mood change Restlessness Difficulty sleeping Unsteadiness Sweating paraesthesia

Answer 23

Delirium tremens

Answer 24

Long acting benzodiazepines- chlordiazepoxide or diazepam. Also lorazepam. Replace B vitamins

Answer 25

Mental disorder in which patients believe they or part of their body is dead and does not exist

Answer 26

Borderline (emotionally unstable) personality disorder is associated with a history of recurrent self-harm and intense interpersonal relationships that alternate between idealization and devaluation

Answer 27

Dialectical behaviour therapy

Answer 28

Derailment

Answer 29

Giving the same answer repeatedly

Answer 30

Pre-morbid social withdrawal Low IQ FH Schizophrenia Gradual onset symptoms Lack of obvious precipitant

Answer 31

Confusion Ataxia (Broad based gate) Oculomotor dysfunction (for example CN 6 palsies and nystagmus)

Answer 32

Korsakoff's syndrome

Answer 33

Anterograde amnesia, retrograde amnesia and confabulation

Answer 34

Sertraline

Answer 35

Reduce the dose

Answer 36

Pregabalin

Answer 37

Antipsychotic

Answer 38

Benzodiazepines

Answer 39

SNRIs NICE recommend that all patients have their blood pressure monitored at initiation and each dose titration of venlafaxine

Answer 40

SSRIs BNF observe all people taking antidepressants for signs of hyponatraemia. For people at high risk, measure the serum sodium level before starting treatment, 2–4 weeks after starting treatment and every 3 months thereafter

Answer 41

Hospital Anxiety and Depression (HAD) scale Patient Health Questionnaire (PHQ-9) DSM-IV- used by NICE

Answer 42

Start them on it again slowly

Answer 43

The intentional production of symptoms

Answer 44

Aripiprazole

Answer 45

Schizoid don't want and relations whereas avoidant do

Answer 46

Alcohol withdrawal symptoms: 6-12 hours seizures: 36 hours delirium tremens: 72 hours

Answer 47

Most things low G's and C's raised: growth hormone, glucose, salivary glands, cortisol, cholesterol, carotinaemia

Answer 48

Long acting benzodiazepines such as chlordiazepoxide or diazepam

Answer 49

Family history Also: Black Caribbean Migration Urban environment Cannabis use

Answer 50

Tranylcypromine Phenelzine

Answer 51

Atypical depression eg hyperphagia Non frequently used due to side effects

Answer 52

Hypertensive reactions with tyramine containing foods- cheese, picked herring, bovril Anticholinergic effects

Answer 53

Symptoms start 6-12 hours- tremor, sweating, tachycardia, anxiety Peak incidence of seizures at 36 hours Peak incidence of delerium tremens at 48-72 hours- coarse tremor, confusion, delusions, auditory and visual hallucinations, fever, tachycardia

Answer 54

Patients with complex history admitted until withdrawls stabilised 1st- long acting benzodiazepines- chlordiazepoxide or diazepam. Lorazepam may be preffered in hepatic failure Carbamazepine also effective Phenytoin not as effective

Answer 55

Agranulocytosis, neutropenia Reduced seizure threshold Constipation Myocarditis- baseline ECG before starting treatment Hypersalivation Dose adjustment might be necessary if smoking started or stopped

Answer 56

False perception in the absence of external stimuli- affected is aware they are hallucinating

Answer 57

CBT and antidepressant

Answer 58

A PHQ-9 score of < 16

Answer 59

A PHQ-9 score of ≥ 16

Answer 60

Antidepressant not first line unless person's preference guided self-help group cognitive behavioural therapy (CBT) group behavioural activation (BA) individual CBT individual BA group exercise group mindfulness and meditation interpersonal psychotherapy (IPT) selective serotonin reuptake inhibitors (SSRIs) counselling short-term psychodynamic psychotherapy (STPP)

Answer 61

a combination of individual cognitive behavioural therapy (CBT) and an antidepressant individual CBT individual behavioural activation (BA) antidepressant medication selective serotonin reuptake inhibitor (SSRI), or serotonin-norepinephrine reuptake inhibitor (SNRI), or another antidepressant if indicated based on previous clinical and treatment history individual problem-solving counselling short-term psychodynamic psychotherapy (STPP) interpersonal psychotherapy (IPT) guided self-help group exercise

Answer 62

Venlafaxine/ SSRI

Answer 63

NSAIDs- need PPI warfarin / heparin- consider mirtazapine instead Aspirin Triptans - increased risk of serotonin syndrome Monoamine oxidase inhibitors (MAOIs) - increased risk of serotonin syndrome

Answer 64

2 weeks 1 week if under 25 or increased suicide risk

Answer 65

Paroxetine

Answer 66

Cluster A: odd or eccentric Cluster B: dramatic, emotional or erratic Cluster C: Anxious and fearful

Answer 67

Paranoid Schizoid Schizotypal

Answer 68

Antisocial Borderline (Emotionally Unstable) Histrionic Narcissistic

Answer 69

Obsessive-Compulsive Avoidant Dependant

Answer 70

Hypersensitivity and an unforgiving attitude when insulted Unwarranted tendency to questions the loyalty of friends Reluctance to confide in others Preoccupation with conspirational beliefs and hidden meaning Unwarranted tendency to perceive attacks on their character

Answer 71

Indifference to praise and criticism Preference for solitary activities Lack of interest in sexual interactions Lack of desire for companionship Emotional coldness Few interests Few friends or confidants other than family

Answer 72

Ideas of reference (differ from delusions in that some insight is retained) Odd beliefs and magical thinking Unusual perceptual disturbances Paranoid ideation and suspiciousness Odd, eccentric behaviour Lack of close friends other than family members Inappropriate affect Odd speech without being incoherent

Answer 73

Failure to conform to social norms with respect to lawful behaviours as indicated by repeatedly performing acts that are grounds for arrest; More common in men; Deception, as indicated by repeatedly lying, use of aliases, or conning others for personal profit or pleasure; Impulsiveness or failure to plan ahead; Irritability and aggressiveness, as indicated by repeated physical fights or assaults; Reckless disregard for the safety of self or others; Consistent irresponsibility, as indicated by repeated failure to sustain consistent work behaviour or honour financial obligations; Lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another

Answer 74

Efforts to avoid real or imagined abandonment Unstable interpersonal relationships which alternate between idealization and devaluation Unstable self image Impulsivity in potentially self damaging area (e.g. Spending, sex, substance abuse) Recurrent suicidal behaviour Affective instability Chronic feelings of emptiness Difficulty controlling temper Quasi psychotic thoughts

Answer 75

Inappropriate sexual seductiveness Need to be the centre of attention Rapidly shifting and shallow expression of emotions Suggestibility Physical appearance used for attention seeking purposes Impressionistic speech lacking detail Self dramatization Relationships considered to be more intimate than they are

Answer 76

Grandiose sense of self importance Preoccupation with fantasies of unlimited success, power, or beauty Sense of entitlement Taking advantage of others to achieve own needs Lack of empathy Excessive need for admiration Chronic envy Arrogant and haughty attitude

Answer 77

Is occupied with details, rules, lists, order, organization, or agenda to the point that the key part of the activity is gone Demonstrates perfectionism that hampers with completing tasks Is extremely dedicated to work and efficiency to the elimination of spare time activities Is meticulous, scrupulous, and rigid about etiquettes of morality, ethics, or values Is not capable of disposing worn out or insignificant things even when they have no sentimental meaning Is unwilling to pass on tasks or work with others except if they surrender to exactly their way of doing things Takes on a stingy spending style towards self and others; and shows stiffness and stubbornness

Answer 78

Avoidance of occupational activities which involve significant interpersonal contact due to fears of criticism, or rejection. Unwillingness to be involved unless certain of being liked Preoccupied with ideas that they are being criticised or rejected in social situations Restraint in intimate relationships due to the fear of being ridiculed Reluctance to take personal risks due to fears of embarrassment Views self as inept and inferior to others Social isolation accompanied by a craving for social contact

Answer 79

Difficulty making everyday decisions without excessive reassurance from others Need for others to assume responsibility for major areas of their life Difficulty in expressing disagreement with others due to fears of losing support Lack of initiative Unrealistic fears of being left to care for themselves Urgent search for another relationship as a source of care and support when a close relationship ends Extensive efforts to obtain support from others Unrealistic feelings that they cannot care for themselves

Answer 80

Difficult to treat Psychological therapies- dialectical behaviour therapy Treat coexisting psychiatric conditions

Answer 81

Extrapyramidal side effects and hyperprolacinaemia Examples: Haloperidol Chorpromazine

Answer 82

Metabolic effects Clozapine Risperidone Olanzapine

Answer 83

Parkinsonism Acute dystonia- sustained muscle contraction managed by procyclidine Akathesia- severe restlessness Tardive dyskinesia

Answer 84

Increaed risk of stroke Increased risk VTE

Answer 85

Antimuscarinic: dry mouth, blurred vision, urinary retention, constipation sedation, weight gain Raised prolactin Impaired glucose tolerance Neuroleptic malignant syndrome: pyrexia, muscle stiffness Reduced seizure threshold (greater with atypicals) Prolonged QT interval (particularly haloperidol)

Answer 86

Symptoms start at 6-12 hours- tremor, sweating, tachycardia, anxiety Peak incidence seizures at 36 hours Peak incidence delirium tremens at 48-72 hours- coarse tremor, confusion, delusions, auditory and visual halluciations, fever, tachycardia

Answer 87

History of complex withdrawls- admitted to hosptial Long acting benzos- chordiazepoxide or diazepam. Lorazepam in hepatic failure Carbamazepine effective Phenytoin not

Answer 88

Unwanted intrusive thought, image or urge that repeatedly enters the person's mind

Answer 89

Repetitive behaviours or mental acts that the person feels driven to perform Can be external and observable overt or internal such as repeating a phrase covert

Answer 90

FH Age- peak onset is 10-20 Pregnancy/postnatal period History of abuse, neglect, bullying

Answer 91

Mild functional impairment- CBT and exposure and response prevention (ERP) If this is insufficient course of SSRI or more intensive CBT

Answer 92

Choice of SSRI (any SSRI but fluoxetine for body dysmorphic disorder) or more intensive CBT Consider clomipramine as alternative first line, patient preference or if SSRI contraindicated

Answer 93

OCD taking >3 hours a day Refer to secondary care mental health team for assessment Whilst awaiting assessment offer combined SSRI and CBT or clomipramine as alternative

Answer 94

At least 12 months Compared to depression SSRI usually requires a higher dose and longer treatment duration (at least 12 weeks) for initial response

Answer 95

Atypical antipsychotics- main advantage is the reduction in extrapyramidal side effects

Answer 96

Weight gain Clozapine causes agranulocytosis Hyperprolactinemia Increased risk stroke/VTE in elderley patient

Answer 97

Clozapine Olanzapine- higher risk obesity Risperidone Quetiapine Amisulpride Aripriprazole- good side effect profile, particualrly for prolactin elevation

Answer 98

Bloods for agranulocytosis Only used when resistant to other antipsychotics

Answer 99

Clozapine should be introduced if schizophrenia is not controlled despite the sequential use of two or more antipsychotic drugs (one of which should be a second-generation antipsychotic drug), each for at least 6–8 weeks.

Answer 100

Agranulocytosis, neutropenia Reduced seizure threshold Constipation Myocarditis- baseline ECG before starting Hypersalivation Dose adjustment may be needed if smoking started or stopped during treatment

Answer 101

Clozapine S/E C - constipation Lo - lower seizure threshold Z - zzz sedation A - agranulocytosis P - phat weight gain I - increased salivation N - neutropenia E - ECG changes

Answer 102

Hyperthyroidism, cardiac disease and medication induced anxiety Medications that may induce anxiety- salbutamol, theophylline, corticosteroids, antidepressants and caffeine

Answer 103

1- education and active monitoring 2- Low intensity psychological interventions (individual guided self help) 3- High intensity psychological interventions- CBT or drug interventions 4- Highly specialised input

Answer 104

1st sertraline If sertraline ineffective offer alternative SSRI or SNRI (duloxetine/venlafaxine) If not SSRI/SNRI offer pregabalin Weekly follow up for month in patients unde r30 as increased risk suicide and self harm

Answer 105

step 1: recognition and diagnosis step 2: treatment in primary care - see below step 3: review and consideration of alternative treatments step 4: review and referral to specialist mental health services step 5: care in specialist mental health services Primary care: CBT or drug treatment SSRI first line, if contraindicated or no response after 12 weeks then imipramine or clomipramine

Answer 106

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

Answer 107

When checking levels done 12 hours post dose After starting lithium levels taken weekly and after each dose change until concentrations are stable Once established, blood level checked every 3 months After change in dose levels taken week later and weekly until stable Thyroid and renal function every 6 months Patients provided with information booklet, alert card and record book

Answer 108

Multiple physical SYMPTOMS present for at least 2 years Patient refuses to accept reassurance or negative test results

Answer 109

Persistent belief in the presence of an underlying serious DISEASE, e.g. cancer Patient again refuses to accept reassurance or negative test results

Answer 110

Also known as Munchausen's syndrome The intentional production of physical or psychological symptoms

Answer 111

Dissociation is a process of 'separating off' certain memories from normal consciousness In contrast to conversion disorder involves psychiatric symptoms e.g. Amnesia, fugue, stupor Dissociative identity disorder (DID) is the new term for multiple personality disorder as is the most severe form of dissociative disorder

Answer 112

Type 1- mania and depression Type 2- hypomania and depression

Answer 113

Mania has psychotic symptoms (delusions of grandeur or auditory hallucinations

Answer 114

Psychological interventions for bipolar Lithium. alternative is valproate Management of mania/hypomania- consider stopping antidepressant, antipsychotic therapy- olanzapine or haloperidol Managment of depression- fluoxetine, talking therpaies Address co morbities- increaed risk with DM, CVD and COPD

Answer 115

Enhance the effect of GABA

Answer 116

Withdraw approximately 1/8 of the dose every fortnight If being difficult Switch patients to equivelant dose of diazepam Reduce dose of diazepam every 2-3 weeks in steps of 2 or 2.5 mg Time needed for withdrawal can vary from 4 weeks to a year or more

Answer 117

May occur up to 3 weeks after stopping Insomnia Irritability Anxiety Tremor Loss of appetite Tinnitus Perspiration Perceptual disturbances Seizures

Answer 118

Benzodiazipines increase the frequency of chloride channels Barbiturates increase the duration of chloride channel opening

Answer 119

Short history, rapid onset Biological symptoms- 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

Answer 120

Hypokalaemia

Answer 121

Reduced body mass index Bradycardia Hypotension Enlarged salivary glands (Failure secondary sexual characteristics, cold intolerance, yellow skin)

Answer 122

Hypokalaemia Low FSH, LH, oestrogens and testosterone Raised cortisol and growth hormone Impaired glucose tolerance Hypercholesterolaemia Hypercaritonemia- yellow tinge on skin Low T3

Answer 123

Paralysis- occurs after waking up or before falling asleep Hallucinations- images or speaking that occur during the paralysis

Answer 124

If troublesome clonazepam may be used

Answer 125

HEART: Hyperarousal Emotional numbing Avoidance of triggers Re-experiencing Time

Answer 126

Re-experiencing- flashbacks, nightmares, repetitive and distressing intrusive images Avoidance- avoiding people, situations or circumstances resembling or associated with the event Hyperarousal- hypervigilance for threat, exaggerated startle response, sleep problems, irritability and difficulty concentrating Emotional numbing- lack of ability to experience feelings, feeling detached Depression Drug/alcohol misuse Anger Unexplained physical symptoms

Answer 127

Traumatic event single session interventions Watchful waiting for symptoms less than 4 weeks Trauma-focused CBT or eye movement desensitisation and reprocessing (EMDR) in more severe cases Drug treatment not first line but if required- venlafaxine or SSRI such as sertraline. In severe cases risperidone may be used

Answer 128

General muscle freezing Torticollis Oculogyric crisis Managed with procyclidine

Answer 129

Male sex (hazard ratio (HR) approximately 2.0) History of deliberate self-harm (HR 1.7) Alcohol or drug misuse (HR 1.6) History of mental illness depression Schizophrenia: NICE estimates that 10% of people with schizophrenia will complete suicide History of chronic disease Advancing age Unemployment or social isolation/living alone being unmarried, divorced or widowed

Answer 130

Efforts to avoid discovery Planning Leaving a written note Final acts such as sorting out finances Violent method

Answer 131

Family support Having children at home Religious belief

Answer 132

Auditory hallucinations of a specific type: two or more voices Discussing the patient in the third person Thought echo Voices commenting on the patient's behaviour Thought disorders thought insertion thought withdrawal thought broadcasting Passivity phenomena: bodily sensations being controlled by external influence actions/impulses/feelings - experiences which are imposed on the individual or influenced by others Delusional perceptions a two stage process) where first a normal object is perceived then secondly there is a sudden intense delusional insight into the objects meaning for the patient e.g. 'The traffic light is green therefore I am the King'.

Answer 133

Retrograde amnesia

Answer 134

Raised ICP

Answer 135

Headache Nausea Short term memory impairment Memory loss of events prior to ECT Cardiac arrhythmia

Answer 136

Oral atypical antispychotics are first line CBT offered to all patients High risk of CVD in schizophrenia patients so check RFs

Answer 137

Delusional parasitosis

Answer 138

Hypokalaemia

Answer 139

Delution with an amourous quality. Believing a famous actor in love with you

Answer 140

Dysglycaemia, dyslipidemia and DM

Answer 141

Typical antipsychotics Extrapyramidal side effects: Parkinsonism Acute dystonia- managed with procyclidine Akathesia Tardive dyskinesia Haloperidol Chorpromazine

Answer 142

CORQA Clozapine Olanzapine Risperidone Quetiapine Arripriprazole

Answer 143

Haloperidol Cholpromazine

Answer 144

Aged 35-54 Being divorced or separated Living alone Being a lone parent Protective 16-24 Married or cohabiting

Answer 145

Depression around winter

Answer 146

Unilateral more likely to be Parkinson's disease Bilateral more likely to be drug induced Parkinsonism

Answer 147

Treatment resistant schizophrenia- not responded to two different antipsychotics including one atypical Treatment of persistent negative symptoms- efficacy in reducing negative symptoms

Answer 148

Serotonin syndrome Faster onset Reflexes- clonus, dilated pupils Mx- cyprohepatadine, chlorpromazine Neuroleptic malignant syndrome Slower onset Reflexes- lead pipe rigidity Mx- dantrolene

Answer 149

Hyperparathyroidism which causes hypercalcemia

Answer 150

Disulfiram

Answer 151

Acamprosate

Answer 152

Methadone- commonest Buprenorphine- sublingual tablet less sedating than methadone

Answer 153

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

Answer 154

Give IM depot antispychotic injections

Answer 155

Posterior communicating artery aneurysm (pupil dilated) = Think: 3rd nerve palsy = ptosis + dilated pupil Cavernous sinus thrombosis = absent corneal reflex + proptosis

Answer 156

COAT (Wernicke's encephalopathy), RACK (Korsakoff's syndrome) Confusion Ophthalmoplegia (nystagmus) Ataxia Thiamine deficiency Retrograde amnesia Anterograde amnesia Confabulation Korsakoff's syndrome

Answer 157

Yes something like haematoma can give 3rd nerve palsy signs

Answer 158

Semen analysis Serum progesterone 7 days prior to expected next period. For typical cycle this is day 21, but could be different if longer cycle. Follicular phase of menstrual cycle variable, the luteal phase after ovulation is constant at 14 days- (progesterone peaks 7 days after ovulation occurs)

Answer 159

Tardive dyskinesia occurs after long term antipsychotic use Tardive dyskinesia- terabenezine- both begin with T Acute dystonia- procyclidine Propanolol can be used for akathesia

Answer 160

Face or body sudden movements you can't control- chewing or pouting of the jaw

Answer 161

A - Auditory hallucinations --> 2nd and 3rd person B - Broadcasting of thoughts, withdrawal, insertion C - Controlled emotions and actions, passive impulsivity phenomena D - Delusional perceptions

Answer 162

Auditory hallucinations Thought disorders Passivity phenomena Delusional perceptions

Answer 163

Under 6 months (another place says up to 12 months)

Answer 164

Denial: this may include a feeling of numbness and also pseudohallucinations of the deceased, both auditory and visual. Occasionally people may focus on physical objects that remind them of their loved one or even prepare meals for them Anger: this is commonly directed against other family members and medical professionals Bargaining Depression Acceptance

Answer 165

Delayed grief: sometimes said to occur when more than 2 weeks passes before grieving begins Prolonged grief: difficult to define. Normal grief reactions may take up to and beyond 12 months

Answer 166

Strong family history Gradual onset Low IQ Prodromal phase of social withdrawal Lack of obvious precipitant

Answer 167

Diagnosed after 3 months, need to have trouble falling or staying asleep at least 3 nights per week

Answer 168

Female gender Increased age Lower educational attainment Unemployment Economic inactivity Widowed, divorced, or separated status

Answer 169

Alcohol and substance abuse Stimulant usage Medications such as corticosteroids Poor sleep hygiene Chronic pain Chronic illness: patients with illnesses such as diabetes, CAD, hypertension, heart failure, BPH and COPD have a higher prevalence of insomnia than the general population. Psychiatric illness: anxiety and depression are highly correlated with insomnia. People with manic episodes or PTSD will also complain of extended periods of sleeplessness

Answer 170

Mania and depression

Answer 171

Hypomania and depression

Answer 172

(SSRIs) Discontinuation Syndrome (FIRM STOP) Flu like Sx Insomnia Restlessness Mood swings Sweating Tummy problems (pain, cramps, D+V) Off balance Parasthaesia

Answer 173

Charles-Bonnet syndrome (CBS) is characterised by persistent or recurrent complex hallucinations (usually visual or auditory), occurring in clear consciousness Usually associated with visual impairment Insight preserved Must be in the absence of any other significant neuropsychiatric disturbance RFs: Advanced age Peripheral visual impairment Social isolation Sensory deprivation Early cognitive impairment

Answer 174

In children under 2 is normal and will resolve with time- may be bulging when they wee

Answer 175

One week after dose change then weekly until stable Once stable checked every three months

Answer 176

antimuscarinic: dry mouth, blurred vision, urinary retention, constipation sedation, weight gain raised prolactin may result in galactorrhoea due to inhibition of the dopaminergic tuberoinfundibular pathway impaired glucose tolerance neuroleptic malignant syndrome: pyrexia, muscle stiffness reduced seizure threshold (greater with atypicals) prolonged QT interval (particularly haloperidol)

Answer 177

Psychosis lasting less than a month with a subsequent return to baseline

Answer 178

Monitor leucocyte and differential blood counts. Clozapine requires differential white blood cell monitoring weekly for 18 weeks, then fortnightly for up to one year, and then monthly as part of the clozapine patient monitoring service

Answer 179

repeating the same words/answers

Answer 180

disorganised speech, sentences that do not make sense

Answer 181

making up new words

Answer 182

repeating exactly what someone has said

Answer 183

the inability to answer a question without giving excessive, unnecessary detail. However, this differs from tangentiality in that the person does eventually return to the original point.

Answer 184

refers to wandering from a topic without returning to it

Answer 185

when ideas are related to each other only by the fact they sound similar or rhyme

Answer 186

a severe type of loosening of associations, where there are unexpected and illogical leaps from one idea to another. It is a feature of schizophrenia

Answer 187

a feature of mania, is a thought disorder where there are leaps from one topic to another but with discernible links between them

Answer 188

ASEPTIC ● Appearance and behaviour ● Speech - rate, tone, volume, quantity, flow ● Emotion (Mood and Affect) ● Perception ● Thoughts - form, content, possession ● Insight ● Cognition (Orientation to time, place, person)

Answer 189

They have a mental disorder that poses significant risk to themselves or others, and treatment in the community is not possible because of this

Answer 190

Holding Powers - to stop patient leaving a ward, no MHA needed * Section 5(4): MH Nurse HP: can stop psychiatric patient leaving a ward up to 6hrs to allow for assessment by a doctor * Section 5(2): Doctor HP: can stop a patient leaving any ward up to 72hrs to allow for MHA to be organised Require MHA Assessment - 1 AHMP + 2 Section 12 Approved doctors * Section 2: 28 days ; for assessment (can treat) * Section 3: 6 months ; for treatment * Patient has right to appeal via tribunal Police Powers * Section 136: to take an individual to a place of safety - from a public place * Section 135: to enter someone’s property and take them to a place of safety, needs magistrate approval

Answer 191

* Section 5(4): MH Nurse HP: can stop psychiatric patient leaving a ward up to 6hrs to allow for assessment by a doctor * Section 5(2): Doctor HP: can stop a patient leaving any ward up to 72hrs to allow for MHA to be organised Section 17a Supervised Community Treatment (Community Treatment Order) can be used to recall a patient to hospital for treatment if they do not comply with conditions of the order in the community, such as complying with medication

Answer 192

Require MHA Assessment - 1 AHMP + 2 Section 12 Approved doctors * Section 2: 28 days ; for assessment (can treat) * Section 3: 6 months ; for treatment * Patient has right to appeal via tribunal Section 4 72 hour assessment order used as an emergency, when a section 2 would involve an unacceptable delay a GP and an AMHP often changed to a section 2 upon arrival at hospital

Answer 193

Police Powers * Section 136: to take an individual to a place of safety - from a public place * Section 135: to enter someone’s property and take them to a place of safety, needs magistrate approval

Answer 194

Negative symptoms suggestive of schizophrenia include: Incongruity/blunting of affect Anhedonia (inability to derive pleasure) Alogia (poverty of speech) Avolition (poor motivation) Social withdrawal

Answer 195

Bromocriptine or Dantrolene

Answer 196

Steven-Johnson syndrome

Answer 197

Hyponatraemia GI upset Anxiety and agitation after starting

Answer 198

Raised ICP

Answer 199

Supportive- IV fluids Benzodiazepines Severe cases managed with- cyproheptadine or chlorpromazine

Answer 200

Causes Monoamine oxidase inhibitors SSRIs St John's Wort Tramadol may also interact with SSRIs Ecstasy Amphetamines

Answer 201

Features Neuromuscular excitation hyperreflexia myoclonus rigidity Autonomic nervous system excitation hyperthermia sweating Altered mental state confusion

Answer 202

3 P’s: Pre-disposing factors Precipitating factors Perpetuating factors Explain briefly what these mean and give examples: Predisposing = family history of a mental disorder Precipitating = traumatic life event Perpetuating = lack of support/stable social situation