Brainscape's Knowledge GenomeTM

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


See full index

Belle: Phase 3a > Psychiatry > Flashcards

Psychiatry Flashcards

1
Q

Mechanism of action: Z drugs e.g. Zopiclone

A

non-benzodiazepine acting on the α2-subunit of the GABA receptor

different distinct site than benzodiazepines but similar effects (used for insomnia and anxiety)

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

Why should prolonged use of Zopiclone be avoided?

A

Addiction and tolerance

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

Mechanism of action: Benzodiazepines (Diazepam, Clonazepam, Lorazepam)

A

Direct stimulation of GABA receptors by increasing the frequency of chloride channels

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

Mechanism of action: Promethazine and Cyclizine

A

H1 receptor antagonists

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

Side effect of promethazine (H1 receptor antagonist)

A

Sedation

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

Ego defence mechanism: displacement

A

Redirection of emotion to a neutral person
E.g. a person who is angry at their boss goes home and gets angry at their family instead

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

Ego defence mechanism: reaction formation

A

Replacing a warded-off idea or feeling by an unconsciously derived emphasis on its opposite
E.g. a gay person being homophobic

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

Ego defence mechanism: sublimation

A

Replacing an unacceptable wish with a course of action that is similar to the wish but does not conflict with one’s value system e.g. teenager’s aggression is redirected to perform well in sports

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

Example of a psychotic defence mechanism

A

Denial
Distortion
Splitting

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

Example of an immature defence mechanism

A

Projection

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

Example of a neurotic defence mechanism

A

Displacement
Reaction formation
Repression
Dissociation

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

Example of a mature defence mechanism

A

Sublimation
Altruism
Suppression
Humour

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

Mechanism of action: alcohol withdrawal

A

chronic alcohol consumption: GABA mediated inhibition (similar to benzodiazepines) and inhibition of NMDA-type glutamate receptors

alcohol withdrawal: decreased inhibitory GABA and increased NMDA glutamate transmission

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

Features of alcohol withdrawal

A

symptoms start at 6-12 hours: tremor, sweating, tachycardia, anxiety

peak incidence of seizures at 36 hours

peak incidence of delirium tremens is at 48-72 hours: coarse tremor, confusion, delusions, auditory and visual hallucinations, fever, tachycardia

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

Management of alcohol withdrawal

A

1st line: reduced dose protocol of long acting benzodiazepines e.g. chlordiazepoxide or diazepam

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

Schneider’s first rank symptoms of Schizophrenia

A

auditory hallucinations

thought disorders

passivity phenomena

delusional perceptions

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

Types of thought disorders in schizophrenia

A

Thought insertion

Thought withdrawal (often accompanies thought blocking)

Thought broadcasting (others can hear your thoughts)

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

Passivity phenomena in schizophrenia

A

Bodily sensations being controlled by external influence

Actions/impulses/feelings imposed on the individual or influenced by others

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

Delusional perceptions in schizophrenia

A

Two stage process: normal object perceived > sudden intense delusional insight into the objects meaning for the patient

e.g. ‘The traffic light is green therefore I am the King’

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

Negative symptoms of schizophrenia

A

decreased speech
incongruity/blunting of affect (inappropriate emotion for circumstances)
anhedonia (inability to derive pleasure)
alogia (poverty of speech)
avolition (poor motivation)
catatonia

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

Definition of dissociation

A

temporary, drastic change in personality, memory, consciousness or motor behaviour to avoid emotional stress

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

Mechanism of action: antipsychotics

A

Block dopamine receptor pathways

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

Mechanism of action: typical antipsychotics

A

Non-selective: block a wide variety of D2 receptors in the brain including the mesolimbic pathways

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

Mechanism of action: atypical antipsychotics

A

Act on a variety of receptors (D2, D3, D4, 5-HT)

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

Adverse effects of typical antipsychotics

A

Extrapyramidal side-effects

Antimuscarinic

Hyperprolactinaemia

Impaired glucose tolerance

Prolonged QT interval

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

Adverse effects of atypical antipsychotics

A

Metabolic e.g. weight gain
Olanzapine has higher risk of dyslipidemia and obesity
Hyperprolactinaemia (resperidone)

[Atypical antipsychotics should be used first line in schizophrenia due to reduction in EPSEs]

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

Examples of typical antipsychotics

A

Haloperidol
Chlorpromazine

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

Examples of atypical antipsychotics

A

Clozapine (used only for treatment resistance after sequential use of two other antipsychotics)
Risperidone
Olanzapine
Aripiprazole (partial agonist - good side effect profile)

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

Dangerous side effects of Clozapine that need to be monitored

A

Agranulocytosis
Constipation
Myocarditis
Reduced seizure threshold

30
Q

Features of EPSEs

A

Parkinsonism

acute dystonia: sustained muscle contraction - managed with procyclidine

akathisia (severe restlessness)

tardive dyskinesia (most common is chewing and pouting of jaw)

31
Q

Features of psychosis

A

hallucinations (e.g. auditory)

delusions

thought disorganisation
- alogia: little information conveyed by speech
- tangentiality: answers diverge from topic
- clanging
- word salad: linking real words incoherently → nonsensical content

32
Q

Conditions which can include symptoms of psychosis

A

Schizophrenia (most common psychotic disorder)
Depression (psychotic depression commonly seen in elderly patients)
Bipolar disorder
Brief psychotic disorder (less than one month)
Neurological conditions e.g. PD, HT

33
Q

Two most likely antipsychotics causing hyperprolactinaemia

A

Haloperidol (typical)
Resperidone (atypical)

34
Q

First line pharmacological treatment for children with ADHD

A

Methylphenidate (ritalin)

35
Q

Methylphenidate mechanism of action

A

CNS stimulant
- Dopamine/norepinephrine reuptake inhibitor

36
Q

Side effects of methylphenidate

A

Abdominal pain
Nausea
Dyspepsia

Cardio toxicity - baseline ECG needed

37
Q

Difference between mania (type 1) and hypomania (type 2)

A

Mania: severe functional impairment or psychotic symptoms for 7 days or more

Hypomania: decreased or increased function for 4 days or more

38
Q

What medication should be considered stopping in the management of mania?

A

Antidepressants - increase mania

39
Q

Management of less severe depression NICE guidelines in order of preference

A

guided self-help
cognitive behavioural therapy (CBT) (group then individual)
group exercise/mindfulness/ meditation
interpersonal psychotherapy (IPT)
selective serotonin reuptake inhibitors (SSRIs)

40
Q

Management of more severe depression NICE guidelines order of preference

A

CBT + antidepressant
Individual CBT
SSRI
SNRI
Psychotherapy
Guided self help
Group exercise

41
Q

Two screening questions for depression

A

‘During the last month, have you often been bothered by feeling down, depressed or hopeless?’

‘During the last month, have you often been bothered by having little interest or pleasure in doing things?’

42
Q

Two questionnaires used to screen for depression

A

Hospital Anxiety and Depression scale
X
Patient Health Questionnaire

43
Q

Grading of depression

A
44
Q

Alternative physical causes of anxiety

A

Hyperthyroidism
Cardiac disease
Medication-induced anxiety

45
Q

Medications that can trigger anxiety symptoms

A

salbutamol
corticosteroids
antidepressants
caffeine

46
Q

First line SSRI for generalised anxiety disorder

A

Sertraline

2nd line: alternative SSRI or SNRI (eg venlafaxine)
3rd line: pregabalin

47
Q

Management of GAD NICE guidelines stepwise approach

A
  1. Education + active monitoring
  2. Low intensity psychological interventions (guided self help)
  3. High intensity psychological interventions (CBT or drug treatment)
48
Q

Features of Korsakoff’s syndrome

A

Marked memory disorder seen in alcoholics

  • anterograde amnesia: inability to acquire new memories
  • retrograde amnesia
  • confabulation
49
Q

Underlying cause of Korsakoff’s syndrome

A

Often follows on from untreated Wernicke’s encephalopathy

Thiamine deficiency
- damage and haemorrhage to the mammillary bodies of the hypothalamus and the medial thalamus

50
Q

Features of Wernicke’s encephalopathy

A

Nystagmus
Opthalmoplegia
Ataxia

51
Q

Risk factors for OCD

A

family history
age: peak onset is between 10-20 years
pregnancy/postnatal period
history of abuse, bullying, neglect

52
Q

Personality disorders: cluster A

A

‘Odd or Eccentric’

Paranoid e.g. perceive attacks on their character
Schizoid e.g. lack of desire
Schizotypal e.g. unusual perceptual disturbances

53
Q

Personality disorders: cluster B

A

‘Dramatic, Emotional, or Erratic’

Antisocial e.g. consistent irresponsibility, aggressiveness
Borderline (EU) e.g. unstable interpersonal relationships which alternate between idealisation and devaluation, recurrent suicidal behaviour
Histrionic e.g. inappropriate sexual seductiveness
Narcissistic e.g. grandiose sense of self importance

54
Q

Personality disorders: cluster C

A

‘Anxious and Fearful’

Obsessive-compulsive e.g. perfectionism
Avoidant e.g. avoid significant interpersonal contact due to fear of rejection
Dependent e.g. need for excessive reassurance from others

55
Q

Features of PTSD

A

re-experiencing
avoidance
hyperarousal
emotional numbing
depression
drug or alcohol misuse
anger
unexplained physical symptoms

56
Q

Definition of psychosis

A

a person experiencing things differently from those around them

57
Q

Factors associated with poor prognosis in schizophrenia

A

strong family history
gradual onset
low IQ
prodromal phase of social withdrawal
lack of obvious precipitant

58
Q

Factors associated with an increased risk of suicide

A

Male sex (although women more commonly attempt suicide, men are more likely to use lethal methods)
History of deliberate self harm
Alcohol or drug misuse
History of mental illness
History of chronic disease
Advancing age
Unemployment or living alone
Being unmarried

59
Q

Somatostatin disorder definition

A

Multiple physical symptoms present for at least 2 years with no organic cause

Patient refuses to accept reassurance or negative test results

60
Q

Conversion disorder definition

A

Typically involves loss of motor or sensory function

The patient doesn’t consciously feign the symptoms (factitious disorder/Munchausen’s) or seek material gain (malingering)

61
Q

Uses of benzodiazepines

A

sedation
hypnotic
anxiolytic
anticonvulsant
muscle relaxant

[should only be prescribed for a short period of time due to tolerance and dependence]

62
Q

Mechanism of action: barbiturates

A

Enhance GABA by increasing the DURATION of chloride channel opening
- been replaced by benzodiazepines

63
Q

Adverse effects of lithium

A

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

64
Q

Monitoring of patients on lithium therapy

A

~ Hot topic on exams ~

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 be checked every 3 months
Thyroid and renal function should be checked every 6 months

65
Q

First line SSRIs in the treatment of depression

A

Currently preferred:
Citalopram
Fluoxetine

Sertraline post MI

66
Q

Adverse effects of SSRIs

A

gastrointestinal symptoms are the most common side-effect
- increased risk of gastrointestinal bleeding

patients should be counselled to be vigilant for increased anxiety and agitation after starting a SSRI
fluoxetine and paroxetine have a higher propensity for drug interactions

67
Q

SSRI associated with dose-dependent QT interval prolongation

A

Citalopram and escitalopram

68
Q

SSRI drug interactions

A

NSAIDs: NICE guidelines advise ‘do not normally offer SSRIs’, but if given co-prescribe a proton pump inhibitor

warfarin / heparin: NICE guidelines recommend avoiding SSRIs and considering mirtazapine

triptans - increased risk of serotonin syndrome

monoamine oxidase inhibitors (MAOIs) - increased risk of serotonin syndrome

69
Q

Method of stopping an SSRI

A

Dose should be gradually reduced over a 4 week period after review by a doctor

70
Q

Discontinuation symptoms after stopping an SSRI

A

increased mood change
restlessness
difficulty sleeping
unsteadiness
sweating
gastrointestinal symptoms: pain, cramping, diarrhoea, vomiting
paraesthesia

71
Q

Use of SSRIs during pregnancy

A
  • Use during the first trimester gives a small increased risk of congenital heart defects
  • Use during the third trimester can result in persistent pulmonary hypertension of the newborn
  • Paroxetine has an increased risk of congenital malformations, particularly in the first trimester
72
Q

Use of tricyclic antidepressants

A

low-dose amitriptyline is commonly used in the management of neuropathic pain and the prophylaxis of headache (both tension and migraine)

lofepramine has a lower incidence of toxicity in overdose

amitriptyline and dosulepin (dothiepin) are considered the most dangerous in overdose

Belle: Phase 3a (7 decks)

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