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Med School Finals > Psychiatry > Flashcards

Psychiatry Flashcards

1
Q

Mental state exam acronym?

A

ASEPTIC:
Appearance and behaviour
Speech
Emotion (mood and affect)
Perception
Thought (form and content)
Insight
Cognition

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2
Q

Screening tools for depression?

A

HAD scale
PHQ-9

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3
Q

Criteria for major (severe) depressive disorder?

A

≥ 5 depressive symptoms for ≥ 2 weeks

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4
Q

List core and additional features of depression?

A

Core = low mood, anhedonia, anergia
Insomnia
Weight change
Suicidal ideation
Psychosis

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5
Q

Conservative management options for depression?

A

Guided self-help
Mindfulness
Cognitive behavioural therapy (CBT)

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6
Q

Drug options for depression?

A

1st line = SSRI (fluoxetine preferred)
2nd line = different SSRI
3rd line = SNRI, mirtazapine, MAOI, TCA

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7
Q

How long should antidepressants be continued after symptoms improve for first episode vs recurrent?

A

First = 6 months (minimum)
Recurrent = 2 years (minimum)

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8
Q

When should patients < 25 be reviewed after starting an antidepressant?

A

1 week

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9
Q

Poor prognostic factors in suicide risk assessment?

A

PMH self-harm/previous attempts
Other mental health disorders
Alcohol or illicit drug abuse
Planned attempt e.g. left a note
Lack of social support network

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10
Q

SSRI examples and mechanism of action?

A

Examples = fluoxetine, sertraline, citalopram, escitalopram, paroxetine
Mechanism of action = inhibits 5-HT re-uptake in the pre-synaptic terminal

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11
Q

List some SSRI side effects?

A

GI upset
Dizziness
Loss of libido
Dry mouth/blurry vision
SIADH → hyponatraemia

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12
Q

Medications SSRIs should not be taken with and why?

A

NSAIDs, anticoagulants, antiplatelets = bleeding risk
Serotonergic agents e.g. triptans = serotonin syndrome

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13
Q

Withdrawal regime for SSRIs?

A

Gradually reduce dose over 4 weeks

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14
Q

SSRI with longest half-life?

A

Fluoxetine

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15
Q

Only SSRI licensed for children?

A

Fluoxetine

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16
Q

SSRI used in patients with CVD?

A

Sertraline

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17
Q

SSRIs with low plasma:milk ratio?

A

Paroxetine
Sertraline

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18
Q

SSRIs most strongly linked to QT prolongation?

A

Citalopram
Escitalopram

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19
Q

Are SSRIs safe in pregnancy?

A

Generally, yes
→ risk of heart defects (1st trimester) and PPHN (3rd trimester)
→ paroxetine linked to congenital malformations (1st trimester)

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20
Q

List features of serotonin syndrome.

A

Tachycardia/tachypnea
Hyperhydrosis
Mydriasis
Tremor
Hyperreflexia
Myoclonus/clonus

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21
Q

SNRI examples and mechanism of action?

A

Examples = venlafaxine, duloxetine
Mechanism of action = inhibits 5-HT and NA re-uptake in the pre-synaptic terminal

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22
Q

TCA examples and mechanism of action?

A

Examples = amitriptyline, clomipramine, imipramine
Mechanism of action = inhibits 5-HT and NA re-uptake in the pre-synaptic terminal

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23
Q

Tetracyclic antidepressant example and mechanism of action?

A

Example = mirtazapine
Mechanism of action = blocks post-synaptic 5-HT and NA receptors

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24
Q

MAOIs examples and mechanism of action?

A

Examples = selegiline, phenelzine, isocarboxazid
Mechanism of action = prevents monoamine breakdown by monoamine oxidases

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25
Q

Antidepressant used if sedation or weight gain is desired?

A

Mirtazapine

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26
Q

Antidepressant linked to hypertensive crisis with tyramine-containing food e.g. cheese?

A

MAOIs (e.g. phenelzine)

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27
Q

Antidepressant linked to hypertension?

A

SNRIs (e.g. venlafaxine)

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28
Q

Indications for ECT and only contraindication?

A

Severe depression (e.g. catatonia), severe mania and severe psychosis
Raised ICP

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29
Q

What is bipolar I and bipolar II?

A

I = mania + depression
II = hypomania + depression

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30
Q

Criteria for bipolar disorder?

A

≥ 2 episodes of depression or mania/hypomania lasting ≥ 2 weeks
→ 1 episode MUST be mania/hypomania

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31
Q

What is mania vs hypomania? Give features that distinguish them?

A

Mania = elevated mood/behaviour for ≥ 7 days
→ distinguished by psychotic symptoms and severe functional impairment
Hypomania = elevated mood/behaviour for ≥ 4 days

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32
Q

Acute management of mania vs bipolar depression?

A

Mania = oral or IM antipsychotic, IM BZD
Depression = fluoxetine + olanzapine or other antipsychotic monotherapy

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33
Q

Long-term drug options for bipolar disorder?

A

1st line = lithium
2nd line = sodium valproate

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34
Q

Lithium starting regime?

A

Bloods 12 hours post-dose
Aim for 0.4-1.0 mmol/L
Bloods every week until stable
→ every 3 months
→ every 6 months (after 1 year)

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35
Q

Side effects of lithium at therapeutic vs toxic dose?

A

Therapeutic = fine tremor, GI upset, polyuria/polydipsia, thyroid dysfunction
Toxic = coarse tremor, seizures, arrhythmias

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36
Q

Congenital cardiac abnormality associated with maternal lithium use?

A

Ebstein’s anomaly (tricuspid valve defect)

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37
Q

Extra screening requirements for lithium and why?

A

Weight = weight gain
U&Es = nephrotoxic
TFTs = hypothyroid
Ca2+ = hyperparathyroid
ECG = QT prolongation

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38
Q

Typical (1st gen) antipsychotic examples and mechanism of action?

A

Examples = haloperidol, chlorpromazine, prochloperazine
Mechanism of action = D2-receptor antagonists

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39
Q

Atypical (2nd gen) antipsychotic examples and mechanism of action?

A

Examples = olanzapine, clozapine, quetiapine, risperidone, aripiprazole
Mechanism of action = D2 and 5HT-receptor antagonists

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40
Q

What do typical antipsychotics have a higher risk of? Give some examples?

A

Extra-pyramidal side effects:
→ acute dystonia
→ parkinsonism
→ tardive dyskinesia
→ akathisia

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41
Q

Management of acute dystonia vs tardive dyskinesia?

A

Acute dystonia = procyclidine
Tardive dyskinesia = tetrabenazine

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42
Q

Major dopamine pathways and features of inhibition?

A

Mesolimbic = less hallucinations and delusions (desired therapeutic effect)
Mesocortical = low mood
Tuberoinfundibular = hyperprolactinaemia
Nigrostriatal = extra-pyramidal side effects

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43
Q

Antipsychotic side effects (other than extra-pyramidal)?

A

Weight gain
Sedation
QT prolongation
Anticholinergic e.g. dry eyes
Lower seizure threshold
Impaired glucose tolerance
Hyperprolactinaemia

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44
Q

Life-threatening complications of clozapine?

A

Neutropenia
Agranulocytosis
Reduced seizure threshold

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45
Q

Antipsychotics with highest risk of dyslipidaemia and obesity?

A

Olanzapine
Clozapine

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46
Q

Antipsychotic most requiring ECG monitoring for QT prolongation?

A

Haloperidol

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47
Q

Antipsychotic with highest and lowest risk of hyperprolactinaemia?

A

Highest = risperidone
Lowest = aripiprazole

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48
Q

Option for patients with poor antipsychotic compliance?

A

Depot injections

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49
Q

Risk of using antipsychotics in the elderly?

A

VTE and stroke

50
Q

List core and additional features and management of schizophrenia?

A

Core = hallucinations (mainly 3rd person auditory), thought disorder, delusions, passivity phenomena
Blunted affect
Anhedonia
Social withdrawal
Management = CBT + antipsychotic

51
Q

Poor prognostic factors for schizophrenia?

A

Family history
Low IQ
Gradual onset
Prodromal social withdrawal

52
Q

Features and manegement of psychosis?

A

Hallucinations
Delusions
Thought disorders
Lack of insight
Management = CBT + antipsychotic

53
Q

Delusion that own self or body part is dead, dying or non-existent?

A

Cotard’s syndrome

54
Q

De Clerambault’s and Othello’s syndromes?

A

De Clerambault’s = delusion that famous person is in love with you
Othello’s = delusion partner is cheating on you without any evidence

55
Q

Charles-Bonnet syndrome and major cause?

A

Complex hallucinations in a patient with no psychiatric distrubance/preserved insight
Visual impairment e.g. cataracts

56
Q

Typical onset of puerperal psychosis and management?

A

Within 2 weeks of birth
Management = inpatient admission + antipsychotic/lithium/ECT

57
Q

Typical onset of postpartum depression and management?

A

Up to 1 year after birth
Management = paroxetine or sertraline

58
Q

Typical onset of baby blues and management?

A

3-7 days after birth
Management = support and reassurance

59
Q

Criteria for GAD?

A

≥ 6 months of non-situational anxiety

60
Q

Conservative management options for GAD and panic disorders?

A

Psychoeducation
CBT

61
Q

Drug options for GAD?

A

1st line = SSRI (sertraline preferred)
2nd line = different SSRI or SNRI
3rd line = pregabalin
Beta blockers are also useful for somatic symptoms e.g. tremor, hyperhidrosis

62
Q

Drug choices for panic disorders?

A

1st line = SSRI
2nd line = imipramine or clomipramine

63
Q

Conservative management option for OCD?

A

CBT with exposure response therapy (ERT)

64
Q

Drug options for OCD?

A

1st line = SSRI
2nd line = clomipramine

65
Q

List features of PTSD?

A

HARD:
→ hyperarousal/hypervigilance
→ avoidance
→ re-living
→ dull/detached

66
Q

Conservative management options for PTSD?

A

Trauma-focused CBT
Eye movement desensitisation and reprocessing (EMDR)

67
Q

Drug options for PTSD?

A

1st line = SSRI or venlafaxine
2nd line = risperidone

68
Q

Features and management of acute stress disorder?

A

PTSD-like symptoms presenting within 1 month of incident
1st line = trauma-focused CBT
2nd line = short-term BZD

69
Q

Screening tool for eating disorders?

A

SCOFF

70
Q

BMI criteria for malnourishment?

A

BMI < 18.5

71
Q

Biochemical features of anorexia?

A

Most things low apart from 3 Gs & Cs:
Glucose
Growth hormone
Salivary glands
Cortisol
Cholesterol
Carotene

72
Q

Outline the pathophysiology of re-feeding syndrome?

A
  • Starvation causes insulin decrease and PO4, K and Mg movement out of cells into plasma
  • Re-feeding causes rapid insulin increase and PO4, K and Mg movement back into cells leads to multi-organ complications
73
Q

Typical onset of re-feeding syndrome and first biochemical sign?

A

48-72 hours after re-feeding begins
Hypophosphataemia

74
Q

Re-feeding syndrome guidance?

A

If patient has not eaten for > 5 days, re-feed at no more than 50% of requirements for the first 2 days

75
Q

Complications of vomiting and laxative abuse?

A

Vomiting = metabolic alkalosis from loss of H+ in stomach
Laxative abuse = metabolic acidosis from loss of HCO3 in diarrhoea

76
Q

Initial management of eating disorders in children vs adults?

A

Children = family therapy
Adults = CBT-ED

77
Q

SSRI used for co-morbid depression/OCD in eating disorders and when to avoid?

A

Fluoxetine
Electrolyte imbalance and bradycardia

78
Q

Weekly weight gain goal for anorexia nervosa?

A

0.5kg/week

79
Q

Core features of ADHD?

A

Hyperactivity
Inattention
Impulsivity

80
Q

Drug options for ADHD?

A

Only available for children > 5
→ 1st line = methylphenidate
→ 2nd line = lisdexamfetamine

81
Q

Monitoring of children on ADHD medication?

A

Prior = ECG
6 monthly = height and weight

82
Q

Features of ASD?

A

Impaired communication
Impaired social interaction
Repetitive behaviours
Intense focus on interests

83
Q

Management of ASD?

A

Educational support
Behavioural therapy
Family counselling
Medical therapy

84
Q

Cluster A, B and C personality disorders?

A

A = odd or eccentric
B = dramatic, emotional or erratic
C = anxious and fearful

85
Q

Suspicious of others, hypersensitive, bears grudges?

A

Paranoid PD

86
Q

Apathetic, solitary, few interests?

A

Schizoid PD

87
Q

Odd and eccentric behaviour, lack of friends, suspicious of others?

A

Schizotypal PD

88
Q

Irresponsible, dangerous, shows no remorse?

A

Antisocial PD

89
Q

Unpredictable, unstable relationships, emotional outbursts?

A

Borderline PD

90
Q

Shallow, dramatic, sexually suggestive?

A

Histrionic PD

91
Q

Self-absorbed, arrogant, uses people?

A

Narcissistic PD

92
Q

Perfectionist, stubborn, inflexible?

A

Obsessive-compulsive PD

93
Q

Fears rejection, low self-worth, socially isolated?

A

Avoidant PD

94
Q

Needy, submissive, lacks initiative?

A

Dependent PD

95
Q

Management of personality disorders?

A

Dialectical behaviour therapy

96
Q

Emergency detention (Section 5(4)) timescale, who is involved and can you provide treatment?

A

Up to 72 hours
FY2 or above +/- MHO
Can’t provide treatment unless emergency (form T4 required)

97
Q

Short-term detention (Section 2) timescale, who is involved and can you provide treatment?

A

Up to 28 days
Psych reg/consultant + MHO
Can provide treatment (care plan not required)

98
Q

CTO (Section 3) timescale, who is involved and can you provide treatment?

A

Up to 6 months
Psych reg/consultant + MHO
Can provide treatment (only medications on care plan)

99
Q

Screening tools for alcohol dependency?

A

AUDIT
FAST

100
Q

Pharmacology of alcohol withdrawal and list features?

A

Decreased GABA (inhibitory) and increased glutamate (excitatory) activity:
Tachycardia/tachypnea
Hyperhydrosis
Mydriasis
Seizures
Psychological disturbance

101
Q

When do symptoms of alcohol withdrawal begin, peak incidence of seizures and delirium tremens?

A

Begin 6-12 hours after last drink
Seizures peak at 12-48 hours
Delirium tremens 48-72 hours

102
Q

Acute drug options for stable vs unstable alcohol withdrawal?

A

Stable = chlordiazepoxide + pabrinex (thiamine)
DT or seizure = short-acting BZD e.g. lorazepam

103
Q

Long-term management of alcohol addiction?

A

1st line = CBT
2nd line = acamprosate, naltrexone, disulfiram

104
Q

Main role of thiamine?

A

Co-enzyme in glucose metabolism

105
Q

How does alcoholism reduce thiamine levels?

A
  • Inhibits conversion to active form (thiamine pyrophosphate)
  • Reduces duodenal absorption
  • Cirrhosis affects storage
106
Q

Wernicke’s encephalopathy and Korsakoff syndrome triads?

A

Wernicke’s = altered mental state, ophthalmoplegia, nystagmus and ataxia
Korsakoff = anterograde amnesia, retrograde amnesia and confabulation

107
Q

BZD examples and mechanism of action?

A

Examples = diazepam, lorazepam, midazolam
Mechanism of action = increases GABA-A receptor affinity for GABA

108
Q

Examples of a short and long-acting BZDs?

A

Short = midazolam, lorazepam
Long = diazepam, chlordiazepoxide

109
Q

BZDs not metabolised by the liver?

A

Out The Liver:
→ oxazepam
→ temazepam
→ lorazepam

110
Q

BZD maximum duration of treatment?

A

2-4 weeks

111
Q

BZD withdrawal regime?

A

Switch to equivalent dose of diazepam
→ reduce by 1/8th of the daily dose every fortnight

112
Q

Opiate vs opioid and give examples?

A

Opiate = natural compound derived from poppies
→ opium, morphine, codeine
Opioid = semi or fully synthetic subset of opiates
→ heroin, methadone, oxycodone

113
Q

Drug options for opioid replacement?

A

1st line = methadone, buprenorphine, suboxone (buprenorphine + naloxone)
2nd line = lofexidine

114
Q

Criteria for insomnia?

A

Trouble falling asleep for ≥ 3 nights/week for > 3 months

115
Q

Advice for drug management of insomnia and options?

A

Only if daytime impairment is severe
Use lowest dose for shortest time
1st line = short-acting BZD or Z-drug

116
Q

Z-drug examples and mechanism of action?

A

Examples = zopiclone, zolpidem and zaleplon
Mechanism of action = increases GABA-A affinity for GABA

117
Q

Multiple physical symptoms present for > 2 years with no organic cause found?

A

Somatisation disorder

118
Q

Persistent belief of having a certain disease e.g. cancer?

A

Hypochondriasis (illness anxiety disorder)

119
Q

Loss of motor or sensory function with no organic cause found?

A

Conversion disorder

120
Q

IQ cut offs for mild, moderate, severe and profound learning disability?

A

Mild = less than 70
Moderate = 35-50
Severe = 20-34
Profound = less than 20

Med School Finals (18 decks)

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