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MRCP Part 1 > Psychiatry > Flashcards

Psychiatry Flashcards

1
Q

What are the 5 criteria needed for detention?

A

MS THC

Mental health disorder likely

Significantly impaired decision making ability

Treatment is available

Harm to themselves or others

Care on informal/voluntary basis not possible

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2
Q

Compare emergency detention, short-term and compulsory treatment orders based on…

Treatment

Personnel needed

Time limit

Right of appeal

A

EDO // STDO // CTO

No // Yes // Yes

>=FY2 +/- MHO // AMP + MHO // AMP + MHO

72hrs // 28 days // 6 months

No // Yes // Yes

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3
Q

Can you extend/renew detention orders?

A

STDO: EXTEND 3 days before OR 5 days after CTO submission

CTO: RENEW at 6 months then yearly

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4
Q

What treatments are not covered by detention orders?

A

Neurostimulation/surgery

Sex drive blunting

Artificial nutrition

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5
Q

SSRI vs SNRI

Venlafaxine

citalopram

sertraline

duloxetine

fluoxetine

A

SSRI: blocks reuptake of serotonin from synatpic cleft

Citalopram

Fluoxetine

Sertraline

SNRIs: Blocks reuptake of serotonin + noradrenaline

Venlafaxine

Duloxetine

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6
Q

Categorise the following TCAs into more or less sedative…

Clomipramine

Dosulepin

Lofepramine

trazadone

Amitriptyline

Notriptyline

Imipramine

A

NIL DCAT

Less: Nortripyline, imipramine, lofepramine

More: Dosulepin, Clomipramine, Amitriptyline, Trazadone

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7
Q

Hyponatraemia, GI upset and QT prolongation can occur with which group of drugs?

A

SSRIs (-pram prolongs QT)

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8
Q

What psych drug class causes dryness, blurred vision, drowsiness and prolonged QT?

A

TCAs

‘Dryly, drowsily, blurry + QT’

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9
Q

If someone on a warfarin/heparin asks for an SSRI, what can you give?

A

Mirtazepine

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10
Q

What is the problem with SSRIs and…

NSAIDs

MAOI, Triptans

A

NSAIDS: Increased bleeding risk

MAOI, Triptans: serotonin syndrome

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11
Q

What antidepressant drugs should be avoided in the following groups?

IHD

HTN

Enlarged prostate

A

IHD: SNRIs + TCAs

HTN: SNRI

Enlarged prostate: TCAs

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12
Q

What antenatal side effects can occur with SSRIs?

A

1er: congenital heart defects
3er: Persistent pulmonary HTN

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13
Q

Compare serotonin syndrome and neuroleptic malignant syndrome in terms of…

Causative drugs

Clinical features

Timescale

Treatment

A

Serotonin // NMS

Antidepressants, stimulants // antipsychotics

Both: Raised HP, BP, temp, rigidity + sweaty

Hyper-reflexia // hyporeflexia

Hours // days

IV fluids + benzos

Cyproheptadine and chlopromazine // dantrolene

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14
Q

What are the counselling points for SSRIs regarding

Starting

Reducing

A

Starting: Review in 1 week < 30yrs, 2 weeks otherwise

Step down after 6 months stability,

Reduce dose over 4 weeks

GI upset, irritability common side effects

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15
Q

The following drugs are members of which antipsychotic group? list the members of the other group

Haloperidol

Chlorpromazine

A

Typical

Atypicals (ORC cos they look atypical):

Olazapine

Risperidone

Clozapine

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16
Q

How do typical and atypical antipsychotics differ in terms of

Receptors

EPSES, hyperprolactinaemia

A

Typical // Atypical

D2 antagonism // D2-4, 5HT antagonism

More common // Less common

17
Q

What side effects are more associated with atypical antipsychotics?

A

Agranulocytosis

Seizure threshold reduction

18
Q

What is the name of the following extrapyramidal side effects?

Tremor, bradykinesia, rigidity

Sustained muscle contraction

Severe restlessness

Late jerking, writhing movements

A

Parkinsonism

Acute dystonia (give procyclidine)

Akathisia:(literally ‘can’t sit’)

Tardive dysKINESIA

19
Q

Regarding lithium, what is the…

Therapeutic range

level checking time after titrating

Level checking time routinely

time to check renal and TFTs

A

~6.0-1.00 mmol

7 days, 12 hours post dose

3 months, 12 hours post dose

Every 6 months

20
Q

How do you manage a lithium patient experiencing the following…

Increased tremor, reflexes, urination

+ confusion/seizure/coma

A

Reverse precipitants: Fluids, diuretics, ACE/ARBs, NSAIDs

+ haemodialysis if severe

21
Q

How does lithium affect

Kidneys

Thyroid

White cells

ECG

A

toxicity

hyper or hypothyroidism

raised WCC

T wave flattening/inversion

22
Q

What advice should be given regarding pregnancy and breastfeeding for lithium?

A

Pregnancy adjustments needs psych input

breastfeeding is contraindicated

23
Q

What raises suspicion of a depression diagnosis

What further symptoms do you then ask about?

A

In past month for at least 2 weeks

Feeling down.depressed hopeless AND/OR little pleasure in doing things

+ RISK: want to hurt yourself or others

+ Biological: fatigue, sleep, appetite

+ Psychological: Guilt, worthless

2-4: mild

Functional impairment: Moderate, severe

24
Q

What scoring systems aid depression diagnosis?

A

HAD >11

PHQ-9: 5-9 mild, 10-19 mod, >=20 severe

25
Q

How is depression managed?

A

Initial
Mild: CBT +/- group support

mod/severe: SSRI + regular psychotherapy over 3-4 months

Try another SSRI or new gen before TCAs or MAOIs

ECT if acute-severe or resistant

26
Q

What should you do before administering ECT

A

Reduce antidepressant dose

Rule out potential ICP

27
Q

How do manic (I) and hypomanic (II) bipolar disorder compare in terms of

Duration

Psychosis

Function/risk

A

Mania // Hypomania

>=7 days // < 7 days

Yes // no

Significant impairment and risk // lesser risk or impairment

28
Q

How do you manage bipolar disorder?

A

Lithium for mood stability

Antidepressant for low mood (fluoxetine)

If acute: Stop antidepressant, start antipsychotic

29
Q

How does referral differ between hypomanic and manic bipolar?

A

hypo: routine

Manic: urgent

30
Q

How do GAD panic disorder compare in terms of treatment

A

Both start with therapy and SSRI (sertraline for GAD)

Further

GAD: Another SSRI/SNRI –> pregabalin

PD: imipramine/clomipramine (TCAs) –> specialist

31
Q

What is obsessive compulsive disorder and how is it managed?

A

Obsessions: unwanted, obstrusive thoughts

Compulsions: Repetitive behaviours that are either internal or external

Management

Mild: CBT + exposure based prevention

Mod: SSRI 12 months + intensive CBT

32
Q

How do the following conditions differ in terms of symptom course

Alzheimer’s

Vascular

Lewy body

Frontotemporal

Normal pressure hydrocephalus

A

Alzheimer’s: Short term then executive memory

Vascular: Step wise +/- focal neuro symptoms

Lewy body: fluctuating cognition, visual hallucinations, parkinsonism

Frontotemporal: Disinhibition, memory + perception relatively preserved

Normal pressure hydrocephalus: dementia + parkinsons gait + incontinence

33
Q

Which dementias are treated with AChEis

A

Alzheimer’s: donepezil/galmantine/rivastigmine

Lewy body: donepezil/rivastigmine –> galantamine

34
Q

How do you treat vascular dementia

A

Alter cardiovascular risk factors

35
Q

How do you treat acute stress disorder, how does it compare to PTSD?

A

Trauma focused CBT +/- benzos for acute symptoms

PTSD only 4 weeks after event

36
Q

What are the following unexplained symptom disorders

Presence of multiple SYMPTOMS (patient reported) for last 2 years, refusal to accept reassuring negative test results

Loss of FUNCTION without feigning or malingering, Can sometimes appear indifferent to the loss

Persistent belief of underlying serious DISEASE

Fraudulent simulation or exaggeration of symptoms to attain financial or other gain

Symptoms that have been intentionally produced (eg taking medication induce symptoms of illness)

A

Somatisation (SYMPTOMS)

Conversion

Hypochondriasis/illness anxiety (CANCER)

Malingering

Munchausen’s

MRCP Part 1 (32 decks)

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