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Finals > Psychiatry > Flashcards

Psychiatry Flashcards

1
Q

Paracetamol overdose <1 hour + dose <150mg/kg - managament?

A

activated charcoal

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2
Q

Paracetamol staggered overdose or ingestion >15 hours ago - management?

A

Start N-acetylcysteine immediately

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3
Q

When do you consider a liver transplant for paracetamol overdose?

A

Arterial pH < 7.3, 24 hours after ingestion
OR
All of the following:
prothrombin time > 100 seconds
creatinine > 300 µmol/l
grade III or IV encephalopathy

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4
Q

Patients who present 8-24 hours after ingestion of an acute overdose of more than 150 mg/kg of paracetamol - management?

A

N-acetylcysteine

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5
Q

patients who present > 24 hours with paracetamol overdose if they are clearly jaundiced or have hepatic tenderness + high ALT - management?

A

N-acetylcysteine

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6
Q

Difference between type I and type II bipolar disorder?

A

Type I - mania and depression
Type II - hypomania and depression

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7
Q

Severe lithium toxicity management?

A

Haemodialysis

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8
Q

Criteria for anorexia nervosa?

A

DSM 5

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9
Q

Management of anorexia nervosa in young people?

A

‘anorexia focused family therapy - 1st line
CBT - 2nd line

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10
Q

Management of anorexia nervosa in adults?

A

one of:
- individual eating-disorder-focused cognitive behavioural therapy (CBT-ED)
- Maudsley Anorexia Nervosa Treatment for Adults (MANTRA)
- specialist supportive clinical management (SSCM).

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11
Q

Clinical features of anorexia nervosa?

A
  • reduced body mass index
  • bradycardia
  • hypotension
  • enlarged salivary glands
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12
Q

Physiological signs of anorexia nervosa?

A
  • hypokalaemia
  • low FSH, LH, oestrogens and testosterone
  • raised cortisol and growth hormone
  • impaired glucose tolerance
  • hypercholesterolaemia
  • hypercarotinaemia
  • low T3
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13
Q

Criteria for bulimia nervosa?

A

DSM 5

  • recurrent binge eating
  • lack of control when eating
  • compensatory behaviour - laxatives, vomiting
  • at least once a week for 3 months.
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14
Q

Management of bulimia nervosa in adults?

A

bulimia-nervosa-focused guided self-help - 1st line
Individual eating-disorder-focused cognitive behavioural therapy (CBT-ED) - 2nd line

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15
Q

Management of bulimia nervosa in children?

A

bulimia-nervosa-focused family therapy

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16
Q

Pharmacological option for bulimia nervosa?

A

Fluoxetine

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17
Q

Difference between bipolar type 1 and type 2?

A

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

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18
Q

How do you differentiate mania from hypomania?

A

psychotic symptoms (e.g.delusions of grandeur or auditory hallucinations)

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19
Q

Management of bipolar disorder?

A

Lithium - mood stabiliser (valproate is an alternative)

mania - antipsychotics e.g. olanzapine or haloperidol
depression - talking therapies, fluoxetine

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20
Q

Acute stress disorder vs PTSD time frame?

A

first 4 weeks = acute stress
>4 weeks = PTSD

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21
Q

Management of acute stress disorder?

A

trauma-focused cognitive-behavioural therapy (CBT) - 1st line

Benzodiazepines - acute symptoms

22
Q

Delirium tremens - how many hours after withdrawal?

A

48-72hours

23
Q

Symptoms of delirium tremens?

A

coarse tremor
confusion
delusions
auditory and visual hallucinations
fever
tachycardia

24
Q

Management of alcohol withdrawal?

A
  • long-acting benzodiazepines e.g. chlordiazepoxide or diazepam (lorazepam in hepatic failure)
  • carbamazepine
25
Q

Classification of severity used for depression?

A

PHQ-9

score of <16 = mild depression
score of >/=16 = moderate/severe depression

26
Q

Management of less severe depression?

A

guided self-help - 1st line
SSRI - only if patient preference
CBT

27
Q

Management of moderate/severe depression?

A

a combination of individual cognitive behavioural therapy (CBT) and an antidepressant - first line

28
Q

Investigation findings in neuroleptic malignant syndrome?

A
  • raised CK - due to muscle rigidity
  • raised WCC
  • Deranged LFT
  • acute renal failure
  • metabolic acidosis
29
Q

What is somatisation disorder?

A

Excessive worry about physical symptoms (for at least 2 years) which can’t be explained by any disease e.g. abdominal pain

(somatisation - symptoms)

30
Q

what is conversion disorder?

A

Nervous system symptoms such as blindness which occur as a result of anxiety or stressful events and have no specific physical cause. (loss of motor or sensory function)

(Conversion - conduction)

31
Q

What is delusions of passivity?

A

Delusions of being controlled (feelings, impulses, thoughts or actions) by an external force.

32
Q

What is delusional perception?

A

When someone sees something in reality and attributes a false meaning to this (e.g. sees a stranger cough and thinks this means they are a spy.)

33
Q

What is ‘running commentary’ in psych?

A

Auditory hallucination where the voices are commenting on the persons actions

34
Q

What is somatic hallucination?

A

Tactile hallucinations e.g. bugs under the skin

35
Q

What is thought broadcasting?

A

Thinking that people can read your thoughts

36
Q

Management of ADHD?

A

1st line - methylphenidate (always 1st line in children)
2nd line - Dexamfetamine (also 1st line in adults)

37
Q

Management of bipolar?

A

mood stabiliser - lithium (1st line) or sodium valproate (2nd line)

management of mania/hypomania - stop antidepressant + antipsychotic (e.g. olanzapine or haloperidol)

management of depression - talking therapy +/- fluoxetine

38
Q

Personality disorder management?

A

dialectal behaviour therapy

39
Q

which criteria is used for alcohol withdrawal?

A

AUDIT

40
Q

What is catatonia?

A

Stopping of voluntary movement or staying still in an unusual position

41
Q

What is Circumstantiality?

A

the inability to answer a question without giving excessive, unnecessary detail

42
Q

What is Tangentiality?

A

wandering from a topic without returning to it.

43
Q

What are Neologisms?

A

new word formations, which might include the combining of two words.

44
Q

What are clang associations?

A

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

45
Q

What is word salad?

A

describes completely incoherent speech where real words are strung together into nonsense sentences.

46
Q

knights move of thinking - what is it?

A

a severe type of loosening of associations, where there are unexpected and illogical leaps from one idea to another

47
Q

What is ‘flight of ideas’?

A

a thought disorder where there are leaps from one topic to another but with discernible links between them.

48
Q

What is Perseveration?

A

the repetition of ideas or words despite an attempt to change the topic.

49
Q

What is Echolalia?

A

the repetition of someone else’s speech, including the question that was asked.

50
Q

Management of bipolar presenting with mania/hypomania in community?

A
  • mania or severe depression = urgent referral to CMHT
  • hypomania or non-severe depression - routine referral to CMHT

Finals (18 decks)

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