Brainscape's Knowledge GenomeTM

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


See full index

Phase 3a > Psychiatry > Flashcards

Psychiatry Flashcards

1
Q

Define Bipolar disorder

A

A mood disorder characterised by episodes of depression and mania or hypomania

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

Aetiology of bipolar disorder?

A

Genetic factors: having a first degree relative affected with bipolar disorder increases an individual’s risk of developing bipolar and unipolar mood disorders, as well as schizoaffective disorder. It is a type of polygenic inheritance.

Environmental factors: environmental factors are not specific to this condition. Negative life events can trigger a manic or depressive episode

Neurobiological factors: increased dopamine activity may be important in the aetiology of mania.

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

Risk factors for bipolar disorder?

A

Genetic factors
Prenatal exposure to toxoplasma gondii
Premature birth <32 weeks gestation
Childhood maltreatment
Postpartum period
Cannabis use

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

What are the 2 main forms of bipolar disorder?

A

Bipolar I
Bipolar II

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

What is the difference between bipolar I and bipolar II?

A

Bipolar I: the person has experienced at least one episode of mania
Bipolar II: the person has experienced at least one episode of hypomania but not an episode of mania. They must also have experienced at least one episode

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

Describe the features of mania

A

ICD 10:
Elevated mood out of keeping with the patient’s circumstances
Elation accompanied by increasing energy resulting in overactivity, pressure of speech and a decreased need for sleep
Inability to maintain attention, often marked with distractibility
Self esteem which is often inflated with grandiosity and increased confidence
Loss of normal social inhibitions

The manic episode should last for at least 7 days and have a significant negative functional effect on work and social activities.

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

Describe the features of hypomania

A

Less severe than mania and is characterised by an elevation

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

Management of bipolar disorder?

A

Acute manic episode: atypical antipsychotic eg olanzapine or risperidone OR 2nd line try sodium valproate

Depressive episodes: avoid antidepressant as could cause rapidly cycling moods → try atypical antipsychotic eg olanzapine or quetiapine

General Maintenance:
1st line= lithium

Patients must not drive during an acute episode & must inform DVLA of diagnosis

CBT can be used as a psychological therapy

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

Define depression

A

Low mood lasting >2 weeks

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

Signs and symptoms of depression?

A

Core triad: low mood, anhedonia, anergia

Slow speech, withdrawn, sleep problems, change in appetite/libido, diurnal mood variation, agitation, guilt, hopelessness

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

Investigations for depression?

A

PHQ-9 Questionnaire
<4= none
5-9= mild
10-14= moderate
15-19= severe
>20= severe

Risk assessment: self harm and suicide
Bloods: rule out other causes of tiredness eg anaemia or hypothyroidism

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

Management of depression?

A

Mild: watch & weight w/ group CBT, individual self help etc
Moderate/Severe: SSRIs eg sertraline or citalopram if these are unsuccessful try SNRIs eg venlafaxine

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

Define GAD?

A

Excessive anxiety about a number of situations associated w/ heightened tension for >6 months

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

Define agoraphobia?

A

Fear of public spaces or fear of entering public spaces which immediate escape would not be possible. Marked avoidance of at least 2 of: crowds, public spaces, travelling alone, travelling away from home

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

Define social phobia?

A

Fear of social situations which may lead to embarrassment or humiliation or scrutiny or criticism from other people

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

Define panic disorder?

A

Acute attacks which are unpredictable in nature and not restricted to any particular circumstance or situation. Often first present to A&E

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

Symptoms of GAD?

A

Mental: restlessness, poor concentration, fatigue, irritability, nervousness, fear of losing control

Physical: increased muscle tension, light headedness, palpitations, tachycardia, GI disturbance, breathing difficulties, chest pain, sweating

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

Investigations for GAD?

A

GAD-7:
<4= normal
5-9= mild
10-14= moderate
15+= severe

Bloods/ECG= to rule out other causes

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

Management of GAD?

A

Psychoeducation and explaining GAD to the patient
Self help or psychoeducational groups
CBT

Medication:
SSRIs (sertraline or citalopram) or SNRIs (duloxetine)

Specialist input if cannot tolerate medication or medication/CBT not working

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Define OCD?

A

Characterised by obsessive thoughts and compulsive acts that cause functional impairment and/or distress

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

What other conditions are associated with OCD?

A

Depression, schizophrenia, anorexia, tourette’s

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Signs and symptoms of OCD?

A

Obsessive thoughts: patient’s own thoughts. Unpleasant, repetitive, intrusive and irrational thoughts that are regarding sexual or blasphemous subjects or surrounding death.

Compulsions: Repetitive behaviours or mental acts that the patient cannot resist performing and may be overt or covert → washing, checking, contamination, fears, doubts, symmetrical insistence, aggressive thoughts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Diagnostic criteria for OCD?

A
  1. obsession and/or compulsion
  2. time consuming
  3. causes distress or the patient knows it is unreasonable
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Management of OCD?

A

Mild: low intensity psychological intervention eg CBT or ERP, may consider SSRI

Moderate: SSRI & high intensity psychological intervention.

Severe: refer to specialist and combine SSRI with ERP & CBT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Define PTSD?

A

Heightened state of stress occurring after a traumatic event or lots of little traumatic events and must occur over >4 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Signs and symptoms of PTSD?

A

HEAR:
Hyperarousal, emotional numbing, avoidance, intrusive recollections

others may notice depression, drug/alcohol misuse, anger issues

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Management of PTSD?

A

<4 weeks: acute stress reaction- watch & wait

1st line: (1 month after trauma) trauma focused CBT

1st line (3 months after trauma or 2nd line): EMDR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Define schizophrenia?

A

Splitting of thoughts or loss of contact with reality, affecting thoughts, perceptions (sight, smell, taste, touch, sounds), mood, personality, speech etc

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Epidemiology of schizophrenia?

A

onset typically 2nd-3rd decade and second peak in middle age

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Risk factors for schizophrenia?

A

family hx, black Caribbean ethnicity, migrated, live in urban environment, cannabis use

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

1st rank schizophrenia symptoms?

A

Auditory hallucinations: talking about the patient, thought echo or commenting on the patient’s behaviour

Thought disorders: thought insertion, thought withdrawal, thought broadcasting

Passivity phenomena: bodily sensations controlled by something else, actions, impulses or feelings controlled by others

Delusional perception: normal object perceived and then intense delusional insight into the object’s meaning

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

2nd rank schizophrenia symptoms?

A

Auditory hallucinations: 2nd person hallucinations, hallucinations in any other modality

Negative symptoms: incongruity, blunting of affect, amotivation, poverty of speech, poverty of thought, self neglect, lack of insight, anhedonia

Delusions: delusions of reference, paranoid or accusatory delusions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Investigations and diagnosis of schizophrenia?

A

Bloods- rule out other causes & ECG

Diagnosis: 1x first rank symptoms and 2x 2nd rank symptoms for >1 month

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Management of schizophrenia?

A

1st line: atypical antipsychotics eg olanzapine, quetiapine

CBT: to modify CVD risk factors due to behaviours like smoking and links with antipsychotic medication

DVLA: must inform DVLA and must not drive until symptoms have been resolved for 3 months + letter from psychiatrist

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Definition of personality disorders?

A

Life long, ingrained, maladaptive behaviours that characterises an individual and deviates markedly from cultural or accepted norm with onset in early childhood or late adolescence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What are the type A personality disorders?

A

(Mad)

Paranoid
Schizoid
Schizo-typal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What are the type B personality disorders?

A

(Bad)

Antisocial personality disorder
Borderline/EUPD
Histrionic
Narcissistic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What are the type C personality disorders?

A

(Sad/Anxious)

Avoidant
Dependant
OCPD (anankastic)

39
Q

Describe EUPD/Borderline personality disorder?

A

Instability in relationships
Instability in self image
Impulsivity- sex, money, eating
Repetitive suicide/self harm
Frantic efforts to avoid abandonment

40
Q

Describe typical/1st gen antipsychotics?

A

Principally antagonise dopamine D2 receptors, having an immediate quietening effect and have a good effect on positive symptoms

Haloperidol, Chlorpromazine

41
Q

Describe atypical/2nd gen antipsychotics?

A

Have lower D2 receptor affinity but also cause an additional block of 5-HT receptors so better at controlling positive and negative symptoms

42
Q

Side effects more typical of 1st gen/typical antipsychotics?

A

Acute dystonia- sustained muscle contraction

Akathisia- severe restlessness

Tardive dyskinesia- abnormal & involuntary. Has late onset and involves chewing/pouting jaw

Parkinsonism- tremor & bradykinesia

Mx of s/e: Valbenazine/Tetrabenazine

General treatment: procyclidine (anticholinergic)

43
Q

Side effects more typical of 2nd gen/atypical antipsychotics?

A

Reduced seizure threshold

Metabolic syndrome- weight gain and poor glucose control/diabetes

Olanzapine gives most weight gain

Risperidone gives most hyper-prolactinaemia

44
Q

Side effects of both types of antipsychotics?

A

ACh block- dry mouth, diplopia, blurred vision

Sedation

Prolongation of QT interval

Increased prolactin due to D2 block → gives galactorrhoea and amenorrhoea

SIADH

Postural hypotension

45
Q

Describe paranoid personality disorder

A

Excessive sensitivity to insults, unforgiving of insults, perceiving neutral or friendly actions as hostile, recurrent suspicions without justification, often regarding sexuality of spouse or infidelity, often obsessive self reference and self obsession

46
Q

Describe schizoid personality disorder

A

Characterised by withdrawal from social and affectionate company, preferring own company, fantasies and solitary introspection. Limited capacity to express feelings or experience pleasure.

47
Q

Describe dissocial personality disorder

A

Characterised by disregard for social norms, social obligations and others’ feelings. Disparity between behaviour and social norms. Behaviour is not easy to change, even by punishment. Low tolerance for frustration & quick to anger, especially to violence. Tendency to blame others

48
Q

Describe emotionally unstable personality disorder

A

Characterised by tendency to act impulsively and without thought of consequences. Incapacity to control emotions or behavioural outbursts.

Impulsive type- emotional instability & impulsivity.
Borderline type- disturbances in self image, aims and and internal preferences. Intense and unstable relationships. Frequent suicide attempts & gestures.

49
Q

Describe histrionic personality disorder

A

Characterised by shallow and labile affectivity, self-dramatization, theatricality, exaggerated expressions of emotions, suggestibility, self indulgence, need to be centre of attention, constant searching for excitement and attention

50
Q

Describe anankastic personality disorder

A

(OCPD)

Characterised by perfectionism, feelings of doubt, excessive conscientiousness, checking and preoccupation with details, stubbornness, rigidity, & caution.

51
Q

Describe anxious/avoidant personality disorder

A

Characterised by feelings of tension, apprehension, insecurity and inferiority. Continuous yearning to be liked and accepted, a hypersensitivity to rejection or criticism. A tendency to avoid certain activities by habitual exaggeration of the dangers

52
Q

Describe dependent personality disorder

A

Characterised by passive reliance on other people to make their minor and major life decisions. Great fear of abandonment, feelings of helplessness and incompetence, passive compliance with the wishes of elders and others and a weak response to daily life and demands.

53
Q

Signs and symptoms of opioid overdose/misuse?

A

Rhinorrhoea, needle track marks, pinpoint pupils, respiratory depression, drowsiness, watering eyes, yawning

54
Q

Management of opioid misuse/overdose?

A

Acute overdose: IV/IM naloxone
Opioid withdrawal: methadone, buprenorphine
Relieve withdrawals: iofexidine
Prevent relapse: naltrexone

55
Q

Define delirium tremens?

A

Up-regulation of NMDA receptors and down regulation of GABA receptors → leading to CNS hyperexcitability

56
Q

Signs and symptoms of delirium tremens?

A

Cognitive impairment, Lilliputian hallucinations (little people), paranoid delusion, tremor, fever, tachycardia, sweating, dehydration

57
Q

Management of delirium tremens?

A

Acute:
1st line= IV Pabrinex, long acting BZDs eg chlordiazepoxide, lorazepam in hepatic failure & IM haloperidol if psychotic features

Nil acute:
Disulfiram- gives bad sx when drinking
acamprosate- reduces cravings
naltrexone- reduces pleasure

CBT, motivational meetings, AA, family support

58
Q

Therapeutic/ toxic range of lithium?

A

Normal therapeutic range: 0.4-1.0mmol/L and is excreted renally

Toxicity is >1.5mmol/L

59
Q

Risk factors for lithium toxicity?

A

Dehydration, renal failure, drugs - ACEi, ARBs, metronidazole, especially thiazides.

60
Q

Signs and symptoms of lithium toxicity?

A

TOXICC
Tremor
Oliguric renal failure
Ataxia
Increased reflexes
Convulsions
Coma
Consciousness reduced

61
Q

Management of lithium toxicity?

A

Stop lithium immediately
High fluid & IV NaCl
Can use sodium bicarb

If severe- dialysis

62
Q

When should lithium levels be measured?

A

12 hours after the dose

63
Q

Define serotonin syndrome

A

High synaptic concentration of serotonin

64
Q

Causes of serotonin syndrome?

A

Normally when a serotonergic medication is given to a patient and they are already taking one, can rarely occur if patient is switching medications and don’t have a long enough ‘wash out’ period. Or seen in accidental child drug overdosing.

SSRIs
SNRIs
Opioids
MAOi
Lithium
TCAs
St John’s wort
Stimulants eg amphetamines

65
Q

Signs and symptoms of serotonin syndrome?

A

Neuromuscular excitation- hyperreflexia, myoclonus & rigidity.

Autonomic NS excitation- hyperthermia & sweating

Altered mental state- confusion, hallucinations

66
Q

Management of serotonin syndrome?

A

Stop medications responsible

Supportive treatments- IV fluids & BZDs

Severe cases- serotonin antagonist eg chlorpromazine or cyproheptadine

SSRI overdose- activated charcoal

67
Q

Differential diagnosis for serotonin syndrome?

A

Neuroleptic malignant syndrome - WCC will be ↑ in this but normal in serotonin syndrome

68
Q

How long does a section 2 last?

A

28 days

69
Q

What is the purpose of a section 2?

A

to assess and treat a patient (without their consent)

70
Q

Which professionals are involved in a section 2?

A

2x doctor & AMHP

71
Q

What are the requirements for a section 2?

A

Patient must be suffering from a mental disorder that requires them to be detained in hospital for assessment and they must be detained for their own health and safety and/or that of others

72
Q

How long does a section 3 last?

A

6 months (can be renewed)

73
Q

What is the purpose of a section 3

A

For treatment

74
Q

Which professionals are involved in enacting a section 3?

A

2x doctors and an AMHP

75
Q

What is the purpose of a section 3?

A

Patient must be suffering from a disorder that requires them to be in hospital and the treatment is in their best interest for their health and safety and the protection of others AND appropriate treatment must be available

76
Q

How long does a section 4 last?

A

72 hours

77
Q

What is the purpose of a section 4?

A

It is an emergency order where waiting for a second doctor would lead to undesirable delay

78
Q

Which professionals are involved in a section 4?

A

1x dr and 1x AMHP

79
Q

What are the requirements for a section 4?

A

Patient must be suffering from a disorder that requires them to be in hospital for assessment and patient must be detained for their own safety and that of others and there is not enough time for a second doctor to attend

80
Q

How long does a section 5(4) last?

A

6 hours

81
Q

What is a section 5(4)?

A

For a patient already admitted in either a general or psychiatric hospital but wants to leave- allows nurses to keep patient in hospital until doctor can attend BUT cannot be treated coercively under this power.

82
Q

How long does a section 5(2) last?

A

72 hours

83
Q

What is a section 5(2)?

A

Doctors’ holding power. Allows doctors to detain a patient in hospital (must already be admitted) in order to allow enough time for a section 2 or 3 assessment. Cannot be treated coercively under this section.

84
Q

What is a section 136?

A

Police section lasting 24 hours for a person suspected of having a mental disorder in a public place.

85
Q

What is a section 135?

A

A police section lasting 36 hours needing a court order to remove a patient to either a place of safety (police cell/psychiatric unit) or for further assessment (section 2 or 3)

86
Q

Side effects of MAOIs?

A

Cheese- react with tyramine rich foods eg cheese causing a hypotensive tension
Extensive drug interactions

87
Q

Side effects of tricyclic antidepressants?

A

Anticholinergic effects
Overdose can lead to seizures

88
Q

Side effects of SSRIs?

A

GI upset- N&V
Agitation, anxiety, akathisia
Sexual dysfunction
Insomnia
Hyponatraemia

89
Q

Signs and symptoms of neuroleptic malignant syndrome?

A

Tremor, muscle cramps, fever, autonomic instability, delirium

90
Q

Key investigation finding in neuroleptic malignant syndrome?

A

Creatinine kinase will always be raised- if not raised, is not NMS

91
Q

Side effects of clozapine?

A

Agranulocytosis (monitoring needed), hypersalivation and constipation

92
Q

Side effects of atypical antipsychotics?

A

QT prolongation
Weight gain
Reduced seizure threshold 0
Orthostatic hypotension
Sexual dysfunction

93
Q

Difference between atypical and typical psychotics?

A

Both very similar and no difference in efficacy

Typical have a smaller therapeutic window

Atypical have a larger therapeutic window

Phase 3a (8 decks)

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