Psychiatry Flashcards
Define grandeur/grandiose delusions
Delusions with a strong positive affect where patients believe they have highly positive traits e.g “I’m rich” “I’m the Prime Minister”
Grandiose delusion is associated with which condition?
Mania
Define Persecutory delusion
Persecutory delusions are a set of delusional conditions in which the patient believes they are being persecuted
Define Cotard delusion
Refers to the belief that a patient is dead, non-existent or ‘rotting’
Which personality disorder is characterised by a lack of interest in others, apathy and a lack emotional breadth. Patient’s tend to have few friends and do not form relationships, preferring solitary activities.
Schizoid personality disorder
schzOID = avOID, schizoTYPAL = ATYPICAL
How would you describe this thought disorder:
Patient may stop speaking all of a sudden, and this can last for a few minutes. When the patient starts speaking again, they will talk about an entirely different topic.
Thought blocking
(Similar to thought withdrawal, but the key to the diagnosis is the change of conversation topic)
What is the first line treatment for delirium tremens?
Oral lorazepam
Define Delirium tremens
Rapid onset of confusion precipitated by alcohol withdrawal
Usually develops at around 72 hours after ceasing alcohol intake
Can last for several days.
What is a very significant complication of clozapine
Agranulocytosis particularly within the first few months of treatment
What type of delusion would this be classed as:
Person has a heightened sense of self-worth/power/knowledge or believes they have powers no one else has
Grandiose
What type of delusion would this be classed as:
Person believes they are being conspired against, attacked, harassed or obstructed in the pursuit of a long-term goal.
Persecutory
What type of delusion would this be classed as:
Person is convinced something is wrong with them and will focus on symptoms to a level that results in extreme distress and disrupts day-to-day living. Typically relating to a body function or bodily sensations
Somatic
What type of delusion would this be classed as:
Person believes that someone of a higher status than them (such as a singer, politician or actor) is in love with them
Erotomanic
“EROtic - EROtomanic”
What type of delusion would this be classed as:
Person is adamant about a belief that is impossible, not understandable, and unrelated to normal life
Bizarre
Short term side effects of ECT
Headache
Muscle aches or pains
Nausea
Temporary memory loss
Confusion
Name a long term side effect of ECT
Persistent memory loss (v rare)
Name the four first rank features of schizophrenia
1) Auditory hallucination (third person running commentary)
2) Delusion of thought possession (thought insertion, withdrawal, thought broadcast)
3) Delusional perceptions
2 stage process where a normal object is perceived and secondly there is a delusional insight into its meaning e.g. “I saw the Queen on the television and I knew that the mafia would be set to murder me”.
4) Passivity phenomena (sensation of an external influence controlling the thoughts or actions of the sufferer)
Name the 4 negative symptoms of schizophrenia
1) Alogia (poverty of speech)
2) Anhedonia (inability to derive pleasure)
3) Incongruity/blunting of affect
4) Avolition (poor motivation)
ICD-11 diagnosis of paranoid schizophrenia requires symptoms to be present for at least how long for a diagnosis
Symptoms should have been present for most of the time during a period of at least one month
Name the prognostic indicators in schizophrenia i.e. factors associated with a better prognosis
High IQ/education level
Sudden onset
Obvious precipitating factor such as a traumatic life event
A strong support network
Positive symptoms predominant
First-line treatment for paranoid schizophrenia
Atypical antipsychotics e.g. Risperidone
(Atypical antipsychotics are the first line for all psychotic disorders)
Atypical antipsychotics e.g. Risperidone are the preferred first line treatment for psychotic disorders over typical antipsychotics e.g. Haloperidol
Why is that
Typical antipsychotics e.g. Haloperidol. have a risk of extra-pyramidal symptoms
Name the extra-pyramidal symptoms that can be a side effect of typical antipsychotic medication e.g. Haloperidol
Akathisia
Dystonia
Parkinsonism
Dyskinesia
NICE recommends what medication for children and young people whose schizophrenia has not responded to adequate doses of at least two different antipsychotics used sequentially for 6-8 weeks
Clozapine
What is the first line drug treatment in Generalised Anxiety Disorders
SSRI e.g. Sertraline
NICE guidelines suggest that treatment follows a stepped care approach, initially with active monitoring and psychoeducation, then with individual self-help (e.g. online workbooks). If these do not work, a high-intensity psychological therapy such as Cognitive Behavioural Therapy should be offered, or pharmacological therapies
What is the first line management option for panic disorders
CBT (cognitive behavioural therapy)
What is the first line drug treatment option for panic disorders
SSRIs e.g. Sertraline
(drug treatment is still second line as CBT should be tried first as 50-60% remit with medication; 80-100% with CBT)
What vitamin must be replaced to prevent the development of Korsakoff’s syndrome?
Vitamin B1 (thiamine)
Likely Dx:
Triad of:
Confusion
Ataxia
Ophthalmoplegia/nystagmus
Background of chronic alcohol use
Wernicke’s syndrome, which untreated can lead to irreversible memory damage as in Korsakoff’s syndrome
What is the first line management option of Wernicke’s encephalopathy
Vitamin B1 (thiamine) replacement
Wernicke’s encephalopathy is the triad of 3 features
“CAN”:
Confusion
Ataxia (abnormal coordination)
Ophthalmoplegia/nystagmus.
If untreated, Wernicke’s encephalopathy can progress to what condition
Korsakoff’s syndrome
How does Korsakoff’s syndrome present
Profound anterograde amnesia with limited retrograde amnesia
Confabulation can occur where memory gaps are unconsciously filled with false, fabricated memories
Define anterograde amnesia
Refers to an impaired capacity for new learning
Define retrograde amnesia
Refers to the loss of information that was acquired before the onset of amnesia
What type of personality disorder this be classed as:
Irrational suspicion and mistrust of others
Paranoid
What type of personality disorder this be classed as:
Attention seeking behaviours and excessive displays of emotions
Histrionic
What type of personality disorder this be classed as:
Strong feelings of inadequacy and fear of social situations. These patients are extremely sensitive to criticism
Avoidant
What type of personality disorder this be classed as:
Intense psychological need to be cared for by others
Dependent
What type of personality disorder this be classed as:
Pattern of abrupt mood swings, unstable relationships and instability in self-image
Borderline personality disorder
Lewy-body dementia is characterised by three core features
1) Fluctuating cognition
2) Parkinsonism (develop 1-2 years after the symptoms of Lewy-Body dementia)
3) Visual hallucinations
Confusion, ataxia and bone marrow suppression are all side effects of what psychiatric medication
Carbamazepine
Side effects of carbamazepine can be remembered with the mnemonic “CARBA MEAN”
Confusion
Ataxia
Rashes
Blurred vision
Aplastic anaemia
Marrow (bone marrow) suppression
Eosinophilia
ADH release
Neutropenia
Tremor, hypothyroidism, nephrogenic diabetes insipidus are side effects of what psychiatric medication
Lithium
Other side effects of lithium include weight gain, diarrhoea, leukocytosis, poor concentration and drowsiness
Hair loss, weight gain and tremor are side effects of what psychiatric medication
Sodium valproate
Side effects mnemonic “VALPROATE”.
Vomiting
Alopecia
Liver toxicity
Pancreatitis/Pancytopenia
Retention of fats (ie. weight gain)
Oedema
Anorexia
Tremor
Enzyme inhibition
Hirsutism, gingival hyperplasia and lymphadenopathy are side effects of what psychiatric medication
Phenytoin
Other side effects include neuropathies, folate deficiency and drug induced systemic lupus erythematosus (SLE)
DSM criteria for the diagnosis of bipolar disorder
Bipolar disorder is diagnosed when a person has at least one episode of a manic or a hypomanic state, and one major depressive episode
What is the gold standard medication for bipolar disorder
Lithium - acts as a mood stabiliser
What is a suitable second line alternative to lithium to manage bipolar disorder
Sodium valproate
What type of dementia is strongly associated with Downs Syndrome
Alzheimer’s disease
Alzheimer’s disease is caused by an accumulation of amyoid plaques, and the tau protein is also implicated. Down Syndrome is caused by Trisomy 21, and the amyloid precursor protein is found on chromosome 21. The extra copy of APP leads to early onset beta-amyloid plaques
What type of delusion is this:
Delusion that either oneself or another person has been replaced by an exact clone.
Capgras delusion
What type of delusion is this:
Delusional belief where a patient feels that they are infested with parasites. They often complain of feeling “crawling” in the skin
Ekbom’s syndrome
What type of delusion is this:
Delusional belief that they are dead, non-existent or ‘rotting’
Cotard delusion
What type of delusion is this:
Strong delusional belief that their spouse or partner is unfaithful with little or any proof to back up their claim
Othello syndrome
“oh hello cheater”
Likely Dx:
Elderly patient
Visual field defects e.g. blindness
Visual hallucinations
Charles Bonnet syndrome
Organic brain syndrome of the elderly associated with visual field defects. Cortical input from other areas eg. memory association areas closely involved with the occipital lobe is hypothesised to fill in for a visual deficit, producing a hallucinogenic effect
What type of delusion is this:
Patient believes that everyone they meet is the same person but with different disguises
Fregoli delusion
What is the first-line treatment of autoimmune encephalitis
Steroids and IV immunoglobulin
What is the thought disorder:
Patient attributes a false meaning to a true perception. An example of might be a TV presenter wearing a blue tie means that it is dangerous to go outside today.
Delusional perception
Acute stress reaction is a transient disorder that develops in an individual with no other apparent mental disorder in response to exceptional physical and/or mental stress.
Symptoms usually subsides within hours or days. It should last no more than how long?
Should last no more than one month.
What type of delusion is this:
Belief that one deserves to be punished. Usually, the ‘sin’ is an innocent error out of proportion to the guilt felt
Delusion of guilt
Clozapine is associated with a high risk of what which necessitates regular FBC monitoring and close follow up.
Agranulocytosis
Student concerned about her exams, has taking an illicit drug to increase her concentration and focus
Pathognomonic of what substance
Methylphenidate
Stimulant drug usually used in the treatment of Attention Deficit Hyperactivity Disorder (ADHD)
Severely malnourished anorexic patient was admitted to hospital. The consultants have decided that she needs re-feeding via a nasogastric tube. The patient declines treatment.
Can she legally be treated?
This patient can be treated under the Mental Health Act as her physical problem is a result of her mental disorder
Eating disorders are mental disorders. Patients with eating disorders may be putting their lives at risk and may require in-patient treatment. They can be admitted under Section 3 of the Mental Health Act (and equivalent legislation) and treated against their will, although this should rarely be required. It is essential that it is done when necessary, however, and for this a qualified psychiatrist, another mental health worker and another doctor are required. z Under the Mental Health Act feeding is recognised as treatment for anorexia nervosa and can be done against the will of the patient as a life-saving measure
Name this phenomenon
Inability to recognise people, objects or places that were once known to a person
Agnosia
What is agnosia
Phenomenon in which a pt is unability to recognise people, objects or places that were once known to a person
Name this phenomenon
Inability to carry out skilled motor function, despite normal motor function
Apraxia
What is apraxia
Phenomenon in which a patient has the inability to carry out skilled motor function, despite normal motor function
Seen in Alzheimer’s Disease
Name this phenomenon
Inability to derive pleasure
Anhedonia
What is anehdonia
Phenomenon in which a person has the inability to derive pleasure.
Characteristic of mood disorders such as depression, or a negative symptom of schizophrenia
Name this phenomenon
Loss of motivation
Avolition
What is avolition
Phenomenon in which a person has loss of motivation.
Characteristic of mood disorders such as depression, or a negative symptom of schizophrenia
Name this phenomenon
Loss of speech and language function
Aphasia
What is aphasia
Aphasia is a loss of speech and language function.
It can result in word-finding difficulties, or speech that is muddled.
Common feature of Alzheimer’s disease
Infarction in multiple areas of the brain is a pathological finding of what kind of dementia
Vascular dementia
Likely dementia:
Sudden onset cognitive decline and stepwise deterioration in someone with previous cardiovascular illness or events
Vascular dementia
Atrophy of the frontal lobe is a pathological finding of what kind of dementia
Fronto-temporal dementia
Likely dementia:
Cognitive impairment, personality change and disinhibition, in keeping with the frontal area of the brain which is affected
Fronto-temporal dementia
Hypomania vs Mania
In both, you get abnormally elevated or irritable mood, with features such as a reduced need for sleep, psychomotor agitation and pressured speech.
In hypomania, the episode is not severe enough to impair social or occupational functioning, and there are no psychotic features.
In mania, the episode is severe there is significant social or occupational impairment, and may be evidence of psychotic features, which this patient does not show
Creutzfeldt–Jakob disease is caused by which infective organism or molecule
Prion
Prions are misfolded proteins that induce other proteins to misfold. This causes neurones to die, leaving holes in the brain tissue. This leads to a sponge-like appearance giving rise to the alternative name of subacute spongiform encephalopathy
Who needs to be present to grant the short term detention
Psychiatrist
Mental health officer
Short term detention certificate is granted.
How long can you be kept in hospital under the certificate
Up to 28 days (however can be extended if needed)
Who can grant an Emergency detention certificate
Certified doctor i.e. FY2 or above
Before granting the certificate, the doctor must consult a mental health officer and get his/her agreement, unless it is not possible for this consultation to take place.
How long can you be kept in hospital under the emergency detention certificate
Up to 72 hours (3 days)
What happens in Echopraxia
In echopraxia, a patient imitates another person’s movements
What happens in Logoclonia
Patient repeats the last syllable of a word or phrase
Logocloniaiaiaiaiaiaiaiaia
NICE recommends that adolescents and young adults should be monitored for what side effect soon after starting antidepressants
Suicidal behaviour or self-harm; particularly at the beginning of treatment or if the dose is changed
Likely eating disorder:
Consuming an excessive amount of food, associated with shame and a perceived loss of control with purges i.e. compensatory behaviours such as vomiting, laxatives or excessive exercise.
Bulimia
What is the first line management option for Bulimia
CBT
Likely eating disorder:
Consumption of excessive amount of food in a relatively short period of time (binges). These are typically associated with shame and a perceived loss of control.
No purge i.e. compensatory behaviours such as vomiting, laxatives or excessive exercise
Binge-eating disorder
For binge eating-disorder to be diagnosed, the binges must occur at least once per week for at least 6 months
What antidepressant medication causes urinary retention
Tricyclic antidepressants e.g. Amitriptyline
Known to cause dry mouth and urinary retention
Name the personality disorder:
Unusual social behaviour, bizarre or magical thinking and distorted perception
Does not hold their unusual beliefs with such unwavering certainty.
Schizotypal personality disorder
Different to schizophrenia, in which a patient will hold their unusual beliefs with such unwavering certainty and not able to maintain a grasp on reality.
schzOID = avOID, schizoTYPAL = ATYPICAL
Likely personality disorder:
Lack of interest in others, apathy and a lack of emotional breadth e.g. no friends
Schizoid personality disorder
What section of the mental health act allows for hospitalisation of up to 28 days to assess the patient. (on-renewable and requires 2 doctors)
MHA section 2
DATED
D- Definition - Section 1 defines the mental health act
A- Assessment - Section 2 allows for hospitalisation of up to 28 days to assess the patient. (on-renewable and requires 2 doctors)
T- Treatment - Section 3 allows for hospitalisation of up to 6 months to treat the patient. it is renewable
E - Emergency - Section 4 allows for detention of a patient in an emergency/urgent situation in which there is only one doctor to asses (if two are present, they can use section 2)
D - Detention - Section 5 applies for detention(retention) of patients already in hospital/place of care. section 5(2) Doctors holding power (5(2) = 72 hours). Section 5(4) Nurse’s holding power, 6 hours (mnemonic: 6,5,4)
What section of the mental health act allows for hospitalisation of up to 6 months to treat the patient
Section 3
DATED
D- Definition - Section 1 defines the mental health act
A- Assessment - Section 2 allows for hospitalisation of up to 28 days to assess the patient. (on-renewable and requires 2 doctors)
T- Treatment - Section 3 allows for hospitalisation of up to 6 months to treat the patient. it is renewable
E - Emergency - Section 4 allows for detention of a patient in an emergency/urgent situation in which there is only one doctor to asses (if two are present, they can use section 2)
D - Detention - Section 5 applies for detention(retention) of patients already in hospital/place of care. section 5(2) Doctors holding power (5(2) = 72 hours). Section 5(4) Nurse’s holding power, 6 hours (mnemonic: 6,5,4)
What section of the mental health act allows for the emergency detention of a patient
Section 4
DATED
D- Definition - Section 1 defines the mental health act
A- Assessment - Section 2 allows for hospitalisation of up to 28 days to assess the patient. (on-renewable and requires 2 doctors)
T- Treatment - Section 3 allows for hospitalisation of up to 6 months to treat the patient. it is renewable
E - Emergency - Section 4 allows for detention of a patient in an emergency/urgent situation in which there is only one doctor to asses (if two are present, they can use section 2)
D - Detention - Section 5 applies for detention(retention) of patients already in hospital/place of care. section 5(2) Doctors holding power (5(2) = 72 hours). Section 5(4) Nurse’s holding power, 6 hours (mnemonic: 6,5,4)
Define Obsessive–compulsive personality disorder
Patients are preoccupied with extreme perfectionism.
As a result, they may prioritise work to the detriment of other aspects of their lives.
However, these activities are perceived as pleasurable rather than distressing.
Grief reaction starts within 3 months of the stressor but does not persist for longer than?
6 months
What medication can be used to treat the somatic symptoms of generalised anxiety disorder?
Non-selective beta blocker e.g. propranolol
Define of treatment resistance schizophrenia
Schizophrenia that does not respond to two consecutive trials of antipsychotics
Schizophrenia that does not respond to two consecutive trials of antipsychotics (treatment resistance) what is the next step in their management
Clozapine
What is the most appropriate first-line pharmacotherapy to deal with the acute episode of mania
Antipsychotics with mood-stabilising properties
Most commonly olanzapine
Splitting is a common phenomena characteristic of emotionally unstable personality disorder.
What does it mean?
Relationships alternate between idealisation and devaluation. As a result, patients may regard others as either wholly good, or wholly bad, often without reasonable grounds to hold such opinions
What antipsychotic medication is contraindicated in patients with Parkinson’s disease
Haloperidol since it is a dopamine blocker
What two pharmacological support is there to help in the detoxification from opiates, and in maintenance therapy in order to prevent further use.
Methadone
OR
Buprenorphine
(Both are opioids)
What happens to the serum cholesterol level in patients with anorexia nervosa?
Raised serum cholesterol
Thought to be due to an increase in LDL-cholesterol, with the loss of body fat leading to changes in thyroid hormones and endogenous cholesterol synthesis
Name a life-threatening complication of taking dopamine antagonist medication. Most cases start within 4-14 days of commencing the medication, but some cases may occur many years after taking the same drug, at the same dose.
Neuroleptic malignant syndrome (NMS)
Neuroleptic malignant syndrome
Life-threatening complication of taking dopamine antagonist medication
Most cases start within 4-14 days of commencing the medication, but some cases may occur many years after taking the same drug, at the same dose.
Clinical signs and symptoms include fever, muscle rigidity, confusion, rhabdomyolysis, metabolic acidosis, autonomic lability, and a raised white cell count.
Takes up to 2 weeks to recover after stopping the medication.
Treatment is with supportive measures (fluids, keeping the patient cool), dopamine agonists such as bromocriptine, or dantrolene
Likely Dx:
Confusion
Hallucinations, particularly visual and tactile hallucinations
Precipitated by acute alcohol withdrawal
Delirium tremen
NICE specifies that symptoms should be present for at how long for a diagnosis of depression to be made
At least 2 weeks
Management option for patients who have missed methadone doses for 3 days consecutively
Reduce methadone dose because they are likely to have lost some tolerance to opioids
Management option for patients who have missed methadone doses for 5 days consecutively
Reassess and determine if methadone needs reindroduced
Determine the suitable dose of methadone to minimise withdrawal symptoms and prevent overdose
First line medication to manage mild to moderate Alzheimer’s disease
Acetylcholinesterase inhibitors such as Donepezil, Galantamine and Rivastigmine are recommended by NICE guidelines as options for managing mild to moderate Alzheimer’s disease.
Donepezil is not a cure for Alzheimer’s disease, but it can slow the progression of its course
What blood tests should be performed when starting lithium?
Thyroid function tests as lithium can interfere with normal thyroid functioning. Untreated hypothyroidism is a contraindication to prescribing lithium.
Urea and electrolytes (including calcium)
Estimated glomerular filtration rate (eGFR)
Full blood count
Name this personality disorder
Excessive displays of emotions and attention seeking behaviours. They can be sexually inappropriate, and may consider relationships more intimate than they really are
Histrionic personality disorder
Slurred speech and coarse tremor are pathognomonic of what kind of toxicity
Lithium toxicity
How is lithium toxicity managed
Urgent referral to hospital
Fluids and general supportive measures.
If toxicity is severe and refractory, this patient may require dialysis
ECG change associated with haloperidol use
Prolongation of the QT interval
Advice about lithium taking during pregnancy
Stop the medication during the first trimester as it is known to increase the risk of developing Ebstein’s abnormality, where the leaflets of the tricuspid valve are displaced, resulting in a large right atrium and a small right ventricle
Early morning waking is pathognomonic of what mental health condition
Depression
What psychiatric medication commonly causes side effect erectile dysfunction
SSRIs e.g. Citalopram
PHQ-9 is a tool used in aiding the diagnosis of what psychiatric condition
Depression
Can be used to measure the severity of depression and monitor treatment response
MMSE can be used to assess what?
Assess cognitive function. It can be used as a screening tool for dementia, however it is not a diagnostic test
AQ-10 use?
Autism spectrum quotient, used to screen adults for autism
CIWA score tool for?
Used to monitor symptoms of alcohol withdrawal
ECG findings is more common in patients with severe Anorexia Nervosa
Prolonged QT interval (>450ms)
What is the NICE recommended first line intervention for patients who present with ‘less severe’ depression
Guided self-help
What is the NICE recommended first line intervention for patients who present with ‘more severe’ depression
Combination of individual cognitive behavioural therapy (CBT) and an antidepressant
What is Clang associations
Phenomenon in which patients have ideas related only by rhyme or being similar sounding (often spoken)
‘How do I feel? Like a wheel that’s rolling away, and I stay and I sway with the breeze’. (think katy perry song about the plastic bag)
Name the 5 atypical antipsychotics
If youre taking atypical antipsychotics youre having a CORQA (corker) of a day:
Clozapine
Olanzapine
Risperidone
Quetiapine
Aripiprazole
What’s the difference between bipolar type I and II
Type 1 - Manic episode +/- Hx of major depressive episode;
Type 2 - Hypomania (not mania) AND Hx of major depressive episode
Antipsychotics is associated with an increased risk of what condition in elderly patients
Venous thromboembolism (VTE)
Name this condition:
Persistent belief in the presence of an underlying serious disease, e.g. cancer despite a lack of evidence
Patients often demand unnecessary tests and investigations
Illness anxiety disorder (hypochondriasis)
hypoChondria = Cancer
Name this disorder:
Presence of physical symptoms that cannot be explained by a medical condition, drug or other mental health disorder
Unconscious process
Somatoform disorder
Somatisation = Symptoms
Name this condition:
Patients intentionally fake signs and symptoms (e.g. adding blood to urine and complaining of pain) in order to gain attention and play “the patient role”.
Muchausen’s syndrome
Name this condition:
Patients intentionally fake or induce illness for secondary gain; e.g. drug seeking, disability benefits, avoiding work or prison time.
Malingering
Name this disorder:
Presentation of neurological symptoms without any underlying neurological cause e.g. paralysis, pseudoseizures, sensory changes
Not an intentional process, and the symptoms are very much “real” to the patient
Conversion disorder
SSRI of choice post myocardial infarction
Sertraline
What ECG changes may occur with Citalopram
QT prolongation and Torsades de pointes
After a change in dose, when would it be most appropriate to re-check the lithium levels?
1 week later and weekly thereafter until the levels are stable
What is the strongest risk factor for psychotic disorders
Family history
What is there an increased risk of in the first trimester with sertraline?
Congenital heart defects
What medication is used to treat moderate/severe tardive dyskinesia
Tetrabenazine
Tetrabenazine = Tardive dyskinesia
Acute dystonia is an extrapyramidal side-effect of typical antipsychotics.
How is acute dystonia managed
Procyclidine
Akathisia (restlessness) is an extrapyramidal side-effect of typical antipsychotics.
How is akathisia (restlessness) managed
Propanolol
The risk of developing schizophrenia if one monozygotic twin is affected is approximately
50%
What is the most appropriate medication choice to prevent further seizures in delirium tremens/alcohol withdrawal
Chlordiazepoxide or diazepam
Is this hypomania or mania:
Elevated mood, pressured speech and flight of ideas but without psychotic symptoms
Hypomania
First-line management for acute stress disorders
Trauma-focused cognitive-behavioural therapy (CBT)
OR
Eye movement desensitisation and reprocessing therapy (EMDR)
What symptom would point towards a diagnosis of mania over a diagnosis of hypomania?
Psychotic symptoms
How are lithium levels checked with maintenance lithium
Blood test 12 hours post dose every 3 months
What kind of thought form is this:
Patients wandering away from a topic without returning to it.
Tangentiality or tangential thinking
What kind of thought form is this:
Patients wandering away from a topic eventually returning to the topic of conversation
Circumstantiality
What kind of thought form is this:
Illogical and unexpected jumps from topic to topic without any discernible links between them, and failure to answer the question
Derailment of thoughts
What feature would point towards flight of ideas instead of tangentiality
In flight of ideas the patients answers the question and then proceed to jump to another related topic
What medication is used to treatment of delirium tremens/alcohol withdrawal
Chlordiazepoxide or diazepam
Pabrinex does have a role but it prevents the development of Wernicke’s encephalopathy rather than the symptoms of delirium tremens and does not reduce the risk of alcohol withdrawal-related seizures.
Which of the psychiatric medications used for depression may help with increasing appetite and low mood
Mirtazapine may be prescribed due to useful side effects (sedation and increased appetite)
Adverse effects of clozapine
Agranulocytosis
Neutropaenia
Reduced seizure threshold
When is the peak incidence of seizures following alcohol withdrawal?
36 hours
When is the peak incidence of delirium tremens following alcohol withdrawal?
72 hours
When is the peak incidence of symptoms presenting following alcohol withdrawal?
6-12 hours
How soon after SSRIs should patients under 25 be reviewed
1 weeks
(over 25 its 2 weeks)
What is the mainstay in managing personality disorders.
Dialectical behaviour therapy (DBT)
Define Schizoaffective disorder
Combination of symptoms of schizophrenia, such as hallucinations or delusions, and mood disorder symptoms, such as depression or mania.
What is the earliest stage after the event that you could confirm a diagnosis of post-traumatic stress disorder (PTSD)
4 weeks
Acute stress disorder is defined as an acute stress reaction that occurs in the 4 weeks after a traumatic event, as opposed to PTSD which is diagnosed after 4 weeks
What clinical test/sign is used differentiate organic from non-organic leg paresis
Hoover’s sign
Dizziness, electric shock sensations and anxiety are symptoms pathognomonic of stopping what medication
SSRI discontinuation syndrome
Occurs when suddenly stopping or reducing SSRIs
What feature would differentiate psychosis from obsessive-compulsive disorder?
Obsessive-compulsive disorder can be differentiated from psychosis by the level of insight into their actions
Obsessive-compulsive disorder they typically have a good level of insight into their condition
Psychosis they lack insight
What are the features of post-traumatic stress disorder
HEART:
Hyperarousal
Emotional numbing
Avoidance of triggers
Re-experiencing
Time
Involuntary pouting of the mouth (side-effect of antipsychotic medication) is what:
A) Acute dystonia
B) Tardive dyskinesia
B) Tardive dyskinesia
What antidepressant increases risk of a GI bleed the most, therefore, warranting a protein pump inhibitor as cover?
SSRI e.g. citalopram
Most common adverse effect of atypical antipsychotics such as olanzapine
Weight gain
O in Olanzapine looks like a belly
What medication is used as a ‘deterrent’ medication to prevent alcohol relapse. If alcohol is consumed, they have ‘violently vomit’.
Disulfiram (also known as Antabuse)
Irreversible inhibitor of acetaldehyde dehydrogenase.
Can be life-threatening it is not recommended for patients with underlying frailty, neurological, cardiac or hepatic conditions.
Take once a day and its effects last seven days
What medication can be given three times a day to help prevent alcohol relapse in combination with psychological support following detoxification in alcohol dependence syndrome.
Safe in combination with alcohol
Acamprosate (or Campral)
Define obsessive compulsive disorder
Obsessions or compulsions, or both, persisting for greater than 2 weeks
Adverse effect of mirtazapine
MirtaZapine
think of Mhmmm while eating i.e. large increase in appetite
ZZZZZ - sleep i.e drowsiness
Adverse effect of mirtazepine
MirtaZapine
think of Mhmmm while eating i.e. large increase in appetite
ZZZZZ - sleep i.e drowziness
Side effects of Tricyclic antidepressants
Dry mouth (anticholinergic) and weight gain (antihistaminic)
If trauma focused cognitive based therapy (CBT) or eye movement desensitisation and reprocessing (EMDR) therapy is ineffective in post traumatic stress disease (PTSD)
What is the first line drug treatments
Selective serotonin reuptake inhibitor (SSRI) e.g. sertraline
OR
Serotonin and noradrenaline reuptake inhibitors (SNRIs) e.g. venlafaxine
Management of mania/hypomania in patients taking antidepressants
stopping the antidepressant and start antipsychotic therapy
second-generation antipsychotic would be first line e.g. olazepine as lithium can take up to 2 weeks to become effective
Catatonia is the stopping of voluntary movement or staying still in an unusual position (Cat like position getting ready to bounce).
How is it managed?
Benzodiazepines
Some centres may use electroconvulsive therapy
When does normal grief reactions turn into abnormal grief reaction?
Abnormal if present 6+ months following the bereavement
SSRIs are associated with what kind of electrolyte imbalance
Hyponatraemia
“SSRI = Sodium Reduced”
What is the diagnostic criteria for chronic insomnia
Trouble falling asleep or staying asleep at least three nights per week for at least 3 months
What are the two somatic symptoms of depression
Early morning waking
Changes in appetite and weight
Management if a patient misses their clozapine doses for more than 2 consecutive days (48 hours)
Re-titrate the clozapine slowly (like when they first started on it)
What electrolyte imbalance can result in long term use of lithium
Hypercalcaemia secondary to hyperparathyroidism
What is a potential risk of SSRI when used in the third trimester of pregnancy?
Persistent pulmonary hypertension of the newborn
What is a potential risk of SSRI when used in the first trimester of pregnancy?
Congenital heart defects
What food should a patient be advised to avoid when starting on monoamine oxidase inhibitor (MAOIs) for depression
Cheese
Consumption of foods high in tyramine (such as cheese) can result in a hypertensive crisis.
What should be monitored at initiation and dose titration of serotonin noradrenaline reuptake inhibitors (SNRIs)
NICE recommend that all patients have their blood pressure monitored at initiation and each dose titration of venlafaxine
Associated with the development of hypertension
What kind of amnesia is a common side effect of ECT
Retrograde amnesia
What medication has the most tolerable side effect profile of the atypical antispsychotics, particularly for prolactin elevation
Aripiprazole
What endocrine disorder might occur as a result of chronic lithium toxicity
Hypothyroidism
Antipsychotics in the elderly increases the risk of what?
Stroke and VTE
One of the side effects of Electroconvulsive therapy (ECT) is memory impairment.
What kind of amnesia does it cause?
Retrograde amnesia (loss of memory for information acquired before the insult i.e. ECT)
Likely Dx:
Episode of psychosis lasting less than a month with a subsequent return to baseline functioning.
Brief psychotic disorder
Personality disorders are often not formally diagnosed before what age?
18
Features of anorexia nervosa
Everything low except the Cs and Gs (which are raised)
Growth hormone (because their body is telling them they need to grow)
Glucose (because cortisol mobilises glucose from its stores)
salivary Glands (because their mouth is gagging for food)
Cortisol
Cholesterol (because cortisol mobilises fats from its stores)
Carotinaemia (they eat more carrots)
What type of urinary incontinence is the most associated with amitriptyline?
Overflow incontinence
Anticholinergic side effects
Can’t see or pee, can’t spit or shit
Blurring of vision
Urinary incontinence
Dry mouth
Constipation
Type I bipolar is associated with:
A) Hypomania
B) Mania
Type I bipolar is associated with mania
Type II bipolar is associated with:
A) Hypomania
B) Mania
Type II bipolar is associated with hypomania
