Psychiatry Flashcards
1
Q
Management of moderate depression
A
1, Prescribe an SSRI
2. If ineffective for at least 2-4 weeks > check adherence 3. Increase the dose
4. Change to a different SSRI
5. Try alternative class of antidepressant (atypical antidepressants > Mirtazapine)
2
Q
Antidepressants should usually show effect in
A
1-2 week
3
Q
With good response to SSRIs >
A
Continue for at least 6 months after remission as this reduces relapse
4
Q
Patients who had 2 or more depressive episodes in the recent past and who experienced significant functional impairment during episodes
A
Continue for 2 years
5
Q
When stopping SSRIs, the dose should be
A
reduced overa 4-week period
6
Q
If the patient stopped medications abruptly and experiencing delusions
A
Neuropsychiatric analysis
7
Q
Hospital management for depression
A
- Admission to the psychiatric ward
- investigations
- Treatment with SSRIs or SNRIs
4, Augmentation with lithium with CBT - If nothing works > ECT
8
Q
Reasons for hospital admission
A
Serious risk suicide
© Serious risk of harming others
© Significant self-neglect
* Severe depressive or psychotic symptoms
© Lack or breakdown of social support
© Initiation of Electroconvulsive therapy (ECT)
© Treatment-resistant depression (where inpatient monitoring may be helpful)
9
Q
High mood alone in the question (no mention of low mode at all)
A
> Hypomania
10
Q
Low mode alone in the question (no mention of high mode at all)
A
Depression
11
Q
High mode and low mode (depression) (no matter time in between
A
Bipolar
12
Q
High mode with hallucinations and delusions >
A
Mania
13
Q
Risk factors for suicide
A
- Previous suicide attempts © Previous self-harm
- Depression and other mental health problems
- Alcohol and drug abuse
- Low socio-economic status
14
Q
Classically, periods of prolonged and profound depression alternate with periods of excessively elevated and irritable mood, known as mania
A
Bipolar affective disorder (Manic depression)
15
Q
Features of Bipolar affective disorder
(Manic depression)
A
Decreased need for sleep
Pressured speech
Increased libido
Reckless behavior without regard for consequences © Grandiosity
More talkative than usual
16
Q
Treatment for Bipolar affective disorder (Manic depression)
A
Mood stabilizers
Antipsychotics
17
Q
It is a mood stabilizer that despite problems with tolerability, it still remains the gold standard in the treatment for preventing recurrences in bipolar disorder.
A
Lithium
18
Q
Primary agents of choice for the acute treatment of bipolar disorder (mania) after taking into account both efficacy and tolerability
A
Antipsychotics
19
Q
What are the kinds of Mood stabilizers ?
A
Lithium,
Valproic acid,
Carbamazepine,
Lamotrigine
20
Q
Points about lithium
A
Do NOT offer lithium to women who are planning a pregnancy or are currently pregnant, unless antipsychotic medication has not been effective
+ [fa woman taking lithium becomes pregnant consider stopping the drug gradually over4 weeks
- [fa woman continues taking lithium during pregnancy, check plasma lithium levels everyw4eeks, then weekly from the 36% week and adjust the lithium dose to maintain plasma lithium levels at a therapeutic
dose
21
Q
Tetralogy of lithium
A
Ebstein anomaly of the heart
Floppy baby
Thyroid abnormalities
22
Q
A lesser degree of mania with persistent mild elevation of mood and increased activity and energy
A
Hypomania
23
Q
Abnormally elevated mood
A
Mania
24
Q
Hallucinations or delusions
A
Mania
25
No hallucinations or delusions
Hypomania
26
No hallucinations or delusions
27
Significant impairment of the impairment of the patient's day -to-day functioning
Mania
28
Significant impairment of the| No significant impairmentof the patient's day
29
No significant impairment in the patient's day
patient's day-to-day functioning
Hypomania
30
What are the 4 elements of Schizophrenia?
1. Auditory hallucinations
2. Thought disorder
3. Passivity phenomena
4. Delusional perceptions
31
Third-person auditory hallucinations > voices are heard referring to the patient as ‘he’ or ‘she’, rather than ‘you’
Thought echo > an auditory hallucination in which the content is the individual’s current thoughts
- Hearing thoughts after being produced > Echo de la pensée
- Hearing thoughts at the same time or before so thoughts being produced > Gedankenlautwerden
Voices commenting on the patient's behavior
Auditory hallucinations
32
The delusional belief that thoughts are being placed in the patient’s head from outside
Thought insertion
33
The delusional belief that thoughts have been 'taken out' of his/her mind
Thought withdrawal
34
The delusional belief that one’s thoughts are accessible directly to others
Thought broadcasting
35
Thought blocking
a sudden break in the chain of thought
36
Bodily sensations being controlled by external influence
Passivity phenomena
37
A two-stage process where first a normal object is perceived then secondly there is a sudden intense delusional insight into the object's meaning for the patient e.g. 'The traffic light is green therefore | am the King’
Delusional perceptions
38
1st line of management of antipsychotics
Olanzapine or Risperidone
39
A type of antipsychotic If rapid tranquillization is needed
Diazepam
40
- Continuous involuntary movements of the tongue and lower face
- Caused by long-term use of antipsychotic drugs
- Often reported by family members as patients are often unaware of these movements
Tardive dyskinesia
41
Atypical antipsychotics have lower risk of TD
1. Risperidone (tabs, injections)
2. Olanzapine (tabs)
42
> better for incompliant patient (Depot, long-acting injections)
Risperidone
43
Tardive dyskinesia can be treated by
Tetrabenazine
44
1 week after starting anti-psychotic
Drug-induced parkinsonism
45
1 month after starting antipsychotics
Akathisia
46
months-years after starting antipsychotics
Tardive dyskinesia
47
© Hypersensitivity and an unforgiving attitude when insulted
© Unwarranted tendency to question the loyalty of friends
@Reluctance to confide in others
© Preoccupation with constitutional beliefs and hidden meaning
© Unwarranted tendency to perceive attacks on their character
Paranoid personality disorder
48
Onset Starts at two three days after birth and lasts 1-2 days
Postpartum blues
49
Peaks at 3 to 4 weeks postpartum
Postnatal depression
50
Peaks at 2 weeks postpartum
Postpartum psychosis
51
Yes Occasional thoughts of
baby harming baby
Postnatal depression
52
Thoughts of harming baby
Postpartum psychosis
53
Mother cares for baby - Yes
Postpartum blues
54
Mostly crying
Postpartum blues
55
Symptoms of depression:
Feels that she is not
capable of looking after
her child
Feels as if she will not be
a good mother
Tearful, Anxiety
Worries about baby's
health
Postnatal depression
56
Psychotic symptoms
E.g. hears voices saying
baby is evil
Insomnia
Disorientation
Thoughts of suicide
Postpartum Psychosis
57
Management of Postpartum Blues
Reassurance and explanation
58
Management of Postnatal depression
Antidepressant or cognitive behavioural therapy (CBT)
59
Management of Postpartum Psychosis
Admit to specialist mother and baby unit if available
Antidepressant, mood stabilizers (i.e. carbamazepine), and electroconvulsive therapy (ECT)
60
In postpartum depression, 1° line SSRI
Sertraline
61
Postpartum psychosis usually starts with
postpartum depression
62
Postpartum psychosis
= Puerperal psychosis
63
Excessive worry and feelings of apprehension about everyday events, with symptoms of muscle and psychic tension, causing significant distress and functional impairment
Generalized anxiety disorder (GAD)
64
Symptoms of GAD
Restlessness
Concentration difficulties or ‘mind going blank
Irritability
Muscle tension
Sleep disturbance
Palpitations/tachycardia
Sweating
Trembling or shaking
Breathing difficulties as choking sensation
Chest pain or discomfort
Fear of losing control,
65
GAD present most days for at least
6 months + 3 or more somatic symptoms
66
Management of GAD
CBT or applied relaxation or drug treatment
Sertraline (SSRI)
Alternative SSRIs = escitalopram or paroxetine
67
1:t line =>Management of GAD
Sertraline (SSRI)
68
Several sudden onset episodes (>2 panic attacks)
A panic attack peaks around 10 min then gradually resolves over the next 20min
Panic disorders
69
Features of panic attacks
Palpitations, tremors, sweating, shaking, tachycardia, and shortness of breath that develop rapidly
The patient might feel he's going to die from cardiac or respiratory problems
Dizziness, circumoral paresthesia, carpopedal spasm
Can occur with no obvious trigger and awaken the patient from sleep (nocturnal panic attacks)
70
In a panic ATTACK, simple breathing exercises and reassurance is all what's needed
TRUE
71
Numbness and circumoral paresthesia occur due to hyperventilation and wash of CO2 = respiratory alkalosis
high pH enhances binding between Ca and protein = decreased ionized Ca
72
Management of panic disorder
CBT or applied relaxation or drug treatment
SSRIs (do NOT use fluoxetine)
if SSRIs contraindicated or no response after 12 weeks = imipramine or clomipramine
In an acute setting = Beta-blockers and Rebreathing into paper bags
DO NOT use benzodiazepine for panic attacks
73
1° line Management of panic disorder
SSRIs (do NOT use fluoxetine)
74
Lasts hours-days
Acute stress disorder
75
Persistent fear and anxiety around people or in certain situations, sufferers fear being criticized. They tend to worry excessively before, during, and after the encounter
Social anxiety disorder (Social phobia)
76
Anxiety-provoking situations
Meeting people (especially strangers)
Talking in meetings
Talking to authority figures
Eating or drinking while being observed
Going to school
Going shopping
Being seen in public
77
There are two forms of the condition:
Social anxiety disorder (Social phobia)
1. Generalized social anxiety which affects most, if not all areas of life. this is the more common type (70%)
2. Performance social anxiety which can be seen in certain situations such as public speaking
78
Fear of open places or being in situations escape might be difficult or help wouldn't be available if things go wrong
Agoraphobia
79
Examples of
- Public transport
- Shopping centers
- Leaving home
80
Can be recognized at any age
Autism spectrum disorders
81
Autism spectrum disorders
1. Severe difficulties communicating and forming relationships
2. Difficulties in language
3. Repetitive and obsessive behavior
82
Asperger
- Autism spectrum disorder except language is normal + normal or high IQ
83
Develops following a traumatic event, usually after 6 months since the event
Post-traumatic stress disorder (PTSD)
84
Features of Post-traumatic stress disorder (PTSD)
* Re-experiencing: Flashbacks, nightmares
* Avoidance: Avoiding people, situations or circumstances resembling or associated with the event
* Hyperarousal: Hypervigilance for threat, exaggerated startle response, sleep problems, irritability and
difficulty concentrating
* Emotional numbing: Lack of ability to experience feelings
* Depersonalization can be one of the symptoms
85
Features
* Re-experiencing: Flashbacks, nightmares
* Avoidance: Avoiding people, situations or circumstances resembling or associated with the event
* Hyperarousal: Hypervigilance for threat, exaggerated startle response, sleep problems, irritability and
difficulty concentrating
* Emotional numbing: Lack of ability to experience feelings
* Depersonalization can be one of the symptoms
86
Management of Post-traumatic stress disorder (PTSD)
* Trauma-focused cognitive behavioral therapy (TF-CBT) and eye movement desensitization and
reprocessing (EMDR) = first-line
e SSRI's => second line. e.g. Paroxetine or Sertraline are licensed for PTSD
e Other unlicensed possibilities include: fluoxetine, citalopram, escitalopram, and fluvoxamine
87
If you find all these names of SSRIs difficult to remember. Just remember these 3
Paroxetine, sertraline, and
fluoxetine
88
» Chronic condition, often associated with marked anxiety and depression, characterized by “obsession”
» Characterized by recurrent unreasonable obsessions concerning contamination, guilt, aggression and sex
» Compulsions are peculiar behaviors that reduces anxiety, commonly hand-washing, organizing, checking,
counting and praying
Obsessive-compulsive disorder (OCD)
89
Management of Obsessive-compulsive disorder (OCD)
* Low intensity CBT, including exposure and response prevention (ERP)
* If low intensity CBT is inadequate = more intensive CBT + SSRIs
® SSRIs = escitalopram, fluoxetine, sertraline or paroxetine
* If patient is suicidal or severely incapacitated = ECT
90
Most common cause of admissions to child and adolescent psychiatric wards. It is most commonly seen in young women (13-17 years) in which there is marked distortion of body image, pathological desire for thinness, and self-induced weight loss by a variety of methods
Anorexia nervosa
91
Anorexia nervosa Features
* BMI <17.5kg/m? or < 85% of that expected
* Rapid weight loss
¢ Self-induced weight loss = reduce food intake, vomiting, purging, excessive exercise
* Intense fear of being obese
* Disturbance of weight perception
* Endocrine disorders that cause amenorrhea, reduced sexual interest/impotence, raised GH levels, raised
cortisol, altered TFTs, abnormal insulin secretion
* Bradycardia
* Hypotension
+ Fatigue
* Muscle weakness
* Intolerance to cold
92
Management of Anorexia Nervosa if the
* BMI <15 OR rapid weight loss OR evidence of systemic failure (electrolyte disturbance as hypoglycemia or
bradycardia)
- Refer to eating disorder unit (EDU), medical unit (MU)
93
Management of Anorexia Nervosa if the:
* Moderate (BMI 15-17.5) + NO evidence of systemic failure
Refer to the local community mental health team or EDU if available
94
Management of Anorexia Nervosa if the:
* Mild anorexia (BMI >17)
- Building a trusting relationship + self-help books and a food diary
95
Management of Anorexia Nervosa if the:
If BP< 90/60 =
Medical unit
96
Reasons for admission in a psychiatric illness
1. Lack of insight
2. Danger to self
3. Refusal of voluntary admission = mandatory admission under the mental health act
97
» Binge eating followed by compensatory weight loss behaviors (self-induced vomiting, fasting, intensive exercise, abuse of medications such as laxatives, diuretics, thyroxine or amphetamines)
» They don’t usually have to be thin; some have BMI above 17.5 kg/m2
Bulimia nervosa
98
Bulimia nervosa Examination
* Salivary glands (especially the parotid) may be swollen
* Russell's sign may be present (calluses form on the back of the hand, caused by repeated abrasion against
teeth during inducement of vomiting)
* There may be erosion of dental enamel due to repeated vomiting
99
Alcohol drinking questionnaires
AUDIT
CAGE
A-Amnesia
U-Units
D-Doing less work
I-Injured yourself or others
T-Termination
C-Cut down thoughts
A-Annoyed by friends or family asking you to cut down
G-Guilt or remorse after drinking
E-Eye opener drinker
100
» Rare but life-threatening reaction to anti-dopaminergic medications (e.g. clozapine, metoclopramide,haloperidol)
> Onset is usually within a few weeks of starting the anti-dopaminergic medication but can occur at any time
Neuroleptic malignant
101
Features of Neuroleptic Malignant
* High fever
* Confusion or alerted consciousness
* Variable blood pressure
* Extrapyramidal symptoms (e.g. Rigidity, tremors)
* Tachycardia
102
Management of Neuroleptic Malignant
* Stop offending medication
* Rapid cooling
* Dopaminergic agents =» Bromocriptine
103
» Life threatening iatrogenic disorder that’s characterized by triad of autonomic, cognitive and somatic effects
» Precipitated shortly after use of SSRls
Serotonin syndrome
104
Autonomic effects
* Pyrexia
¢ Tachycardia
* Nausea
* Diarrhea
105
Cognitive effects
+ Confusion
* Agitation
* Hallucinations
106
Somatic effects
* Tremors
* Muscle spasms
107
Cocaine overdose
Arrhythmias
Both tachycardia and bradycardia may occur
Hypertension
Seizures
Mydriasis
Hypertonia
Hyperreflexia
Agitation
Psychosis
Effects include necrosis of nasal septum
108
Cocaine withdrawal =
depression
109
Heroin withdrawal =
increasing body secretions (sweating,
runny nose), muscle aches, agitation, and sleep disturbance
110
Benzo withdrawal =
features of a panic attack
111
Heroin
Intense pleasure and pain relief
Relaxation, drowsiness, and clumsiness
Miosis
Confusion
Slurred and slow speech
Slow breathing and heartbeat
Dry mouth
Reduced appetite and vomiting
Decreased sex drive
112
Acute management of opiates (heroin) overdose =
Naloxone IV
113
Chronic management/detoxification/addiction/
withdrawal symptoms =
Methadone
114
It has a short half-life so coma and respiratory
depression often recurs when this wears off, observation is essential and repeated doses might be needed.
Naloxone
115
2"line in detoxification =
Buprenorphine
116
3 line or for shorter detoxification period =
Lofexidine
117
- Used as an adjuvant to prevent relapses =
Naltrexone
118
- Naloxone has a short half-life this often recur after its effect wears off
= coma and respiratory depression
119
Ecstasy (MDMA)
* Uncontrolled body movements
* Dehydration or extreme thirst
* Hyperthermia
* HTN
* [nsomnia
* Tachycardia
* Spots of color/floating colors/flashing colors when their eyes are open
* [Increased RR
* Uncontrolled body movements
* Dehydration or extreme thirst
* Hyperthermia
* HTN
* [nsomnia
* Tachycardia
* Spots of color/floating colors/flashing colors when their eyes are open
* [Increased RR
120
® Visual hallucinations when eyes open =»
Ecstasy
121
Visual hallucinations when eyes closed =
LSD
122
LSD (Lysergic acid diethylamide)
* Mydriasis
* Flushing and sweating
* Diarrhea
* Paresthesia
* Hyperactive reflexes
* Delusions and hallucinations
¢ Intensified senses
* Smelling colors and seeing sound
¢ Testing things that aren't there
123
LSD (Lysergic acid diethylamide) can be treated with
benzodiazepines
124
Lithium poisoning
Causes
* Therapeutic overdosage = common
* Drug interactions with either a diuretic or NSAIDs - common
* Deliberate self-harm (less common)
125
Mild Lithium poisoning
- Nausea
- Altered taste
- Diarrhea
- Blurred vision
- Polyuria
- Fine resting tremors
126
Moderate Lithium Poisoning
- Increasing confusion
- Increased deep tendon reflexes
- Myoclonic twitches and jerks
- Increasing restlessness followed by stupor
127
Severe Lithium Poisoning
- Coma
- Convulsions
- Cardiac arrythmias
- Cerebellar signs
128
With lithium
- Therapeutic dose =>
fine tremors
129
With lithium
- 0D —=>
N, drowsiness & coarse tremors
130
Before commencing on lithium
* Kidney function tests
* TFTs, thyroid disturbance can mimic mania or depression
* ECG, BP, pulse, FBC, U&E and PT if sexually active
131
After commencing on lithium
Serum lithium every 3 months
TFTs and renal function tests every 6 months
132
Lithium duration of monitoring
- Lithium should be checked a week after starting. Following that, lithium levels are checked every 3 months
- Lithium levels should also be checked 12h after taking the last lithium dose
133
* Low mood, anhedonia, guilt, can’t concentrate (for at least 2 weeks) =
Mild depression
134
Mild depression + poor sleep + poor libido + easy fatigue =
Moderate depression
135
Moderate depression + suicidal thoughts =
Severe depression
136
Severe depression + hallucinations + delusions =
Psychotic depression
137
Increase in fatigue, appetite, weight and sleep with low mood but remains reactive, leaden paralysis (feeling of heaviness in the limbs) may occur =
Atypical depression
138
Persistent depressive state, milder than MDD and persists more than 2 years =
Dysthymia
139
Milder form of bipolar lasting 2 years, fluctuating from mild depressive and hypomanic symptoms =
Cyclothymic disorder
140
The individual is unable to cope with a particular stress or major life event, they must occur within 1-3 months
of a particular psychosocial stressor, and shouldn't persist longer than 6 months after the stressor is removed
=
Adjustment disorder
141
Lack of interest in social relationships + tendency towards a solitary lifestyle =
Schizoid personality disorder
142
Mood swings, marked impulsivity, unstable relationships, fear of abandonment and inappropriate anger,
usually attention seekers and may have multiple self-inflicted scars =
Borderline personality disorder
(Emotionally unstable personality disorder) (EUPD)
143
Mild degree of mania where there's elevated mood but no significant impairment of daily activities =
Hypomania
144
Antihypertensive drugs when administered with lithium can cause psoriasis =
ACEls
145
Antihypertensive drug causes hypokalemia + high lithium level =
Thiazide diuretics
146
Other causes of lithium toxicity =
Metronidazole, Dehydration, renal failure
147
Inability to resist impulses to deliberately start fires, in order to relieve tension or for instant gratification =
Pyromania
148
Delusional belief that a famous person is secretly in love with them =
Erotomania (De Clerambaut §)
149
Impulsive urge to pull out one’s hair leading to noticeable hair loss =
Trichotillomania
150
Inability to refrain from stealing =
Kleptomania
151
False belief that significant remarks, events or objects in one’s environment have personal meaning or
significance (e.g. someone constantly gives him messages through the newspaper) =
Delusion of reference
152
Delusional belief that one’s life is being interfered with in a harmful way =
Persecutory delusion
153
Fantastical beliefs that one's famous, wealthy or powerful =
Grandiose delusions
154
False belief that one’s thoughts, feelings, impulses or behavior is being controlled =
Delusion of control
155
Delusional belief that patient died or the world has ended and nothing matter =
Nihilistic delusions
156
Nihilistic delusions + psychotic depression =
Cotard’s
157
Feeling guilty or remorse with no valid reason, one believes they deserve punishment =
Delusions of guilt
158
When the person believes that different people are in fact a single person that changes appearances or in
disguise =
Fregoli delusion (delusion of doubles)
159
Patient believe that a person known to them has been replaced by a double =
Capgras
160
Feigning physical or mental illness, most frequently in prison inmates, they produce “approximate answers” or sometimes wrong however still hold some relevance to them =
Ganser $ [Gangster]
161
Perceptual distortions of the size and shape of objects and altered body images, they might feel their body is
expanding or getting smaller =
Todd’s
162
Delusional jealousy, marked by suspecting a faithful partner of infidelity like cheating, adultery or having an
affair, patient may attempt monitoring his partner =
Othello
163
Delusional parasitosis/infestation where they believe their skin/body is infected with parasites =
Ekbom’s
164
A situation where two people with a close relationship share a delusional belief, this arises as a result of a psychotic illness in one individual, delusion resolves in the second person on separation, the first should be
assessed and treated =
Folie & deux (madness of two)
165
Persistent belief in the presence of an underlying serious disease (e.g. cancer or HIV), patient refuses to
accept reassurance or negative test results =
Hypochondriasis (illness anxiety disorder)
166
Multiple symptoms, multiple investigations, never reassured =
Somatization disorder
167
Feigning symptoms NOT for secondary gain but medical attention =
Munchausen’s $ (factitious disorder)
168
Feigning illness in a child to gain medical attention, a form of child abuse that subjects the child to
unnecessary medical procedures, hospitalization or treatments =
Munchausen’s § by proxy
169
Feigning symptoms for secondary gain (e.g. for compensation, to avoid military service or to obtain an opiate prescription) =
Malingering
170
Motor or sensory dysfunction which initially appears to have a neurological or other physical cause but is
later attributed to a psychological cause, patient doesn’t consciously feign the symptoms or seek material
gain. Memory loss, seizures, loss of speech and paralysis can occur =
Conversion (dissociative) disorders
(functional neurological symptom disorder)
171
Continuous antisocial or criminal acts and inability to conform to social rules, impulsivity, disregard for the
rights of others, aggressiveness, and lack of remorse, they will typically be manipulative, deceitful, and reckless
—>
Antisocial Personality disorder (Antisocial behavioral disorder)
172
A young patient <18y with similar features as Antisocial Personality disorder =
Conduct disorder => Tx:
juvenile detention
173
Young children with negative, defiant behavior WITHOUT serious violation of social norms, are more common with interaction with adults =
Oppositional defiant disorder = Tx: parenting
174
Inattention + hyperactivity + impulsiveness =
Attention deficit hyperactivity disorder (ADHD)
175
An incompliant patient in need for antipsychotics =
Depot haloperidol
176
An incompliant patient + tardive dyskinesia =
Depot risperidone
177
Pinpoint pupils, confusion, agitation and copious secretions =
Organophosphate poisoning
178
To avoid anxiety before a certain event =
Beta-blocker
179
If the patient is having an attack = Rebreathe into paper bags, if very severe >
Benzodiazepines
180
For long-time management and to prevent further attacks =
CBT or SSRIs
181
SSRs are the first line medical management in =
GAD, OCD, PTSD and Panic disorders
182
Drugs that interact with SSRIs =
NSAIDs, Aspirin, Heparin, Warfarin, Triptan [TWHAN]
183
Preferred SSRIs with MI patients =
Sertraline then, Citalopram
184
Preferred SSRIs with no relevant medical history =
Citalopram then, Fluoxetine
185
Preferred SSRI in young kids =
Fluoxetine
186
For rapid tranquillization in an aggressive NOT-psychotic patient =
oral lorazepam, then IM
187
For rapid tranquillization in a psychotic patient
1st Lorazepam IM, haloperidol IM
188
For rapid tranquilization in a psychotic episode in elderly =
Haloperidol IM
189
1% line for status epilepticus =
IV Lorazepam
190
Binge eating followed by compensatory weight loss behaviors =
Bulimia nervosa
191
Low weight, food restriction, fear of gaining weight and strong desire to be thin =
Anorexia nervosa
192
Ability to recognize one’s own mental illness (OCD, phobias)
Insight
193
A very fast and accelerated speech without a pause, hard to follow, cannot be interrupted, seen in mania =
Pressure of speech
194
Thought and words leap from topic to another with frequent shifts abruptly =
flight of ideas
195
Irrational fear of confined spaces =
Claustrophobia
196
Fear of spiders =
Arachnophobia
197
Fear of heights =
Acrophobia
198
Hallucinations hours after heavy drinking (12-24h) =
Alcohol hallucinosis
199
Hallucinations/tremors/disorientation/diaphoresis in a chronic alcoholic following a day of abstinence =
Delirium termens
200
Transient false perception experienced when the person is on the verge of falling asleep =
Hypnagogic
hallucinations [go to sleep]
201
Transient false perception experienced while waking up =
Hypnopompic hallucinations
202
A psychotic feature of bipolar disorder where a person’s belief or action does not match their mood (e.g.
laughing at a funeral, believing to have superpowers while depressed) =
Mood incongruence
203
A psychotic feature of bipolar where the belief or action is consistent with the mood =
Mood congruence
204
Encourage women with a mental health problem to breastfeed unless they're taking =
Carbamazepine, clozapine or lithium,
205
Everything is decreased + miosis =
Heroin
206
Everything is increased + mydriasis =
Cocaine
207
Colors when eyes open + increased thirst + uncontrolled body movements + hyperthermia, tachycardia,
tachypnea, insomnia =
Ecstasy
208
Colors when eyes closed + heightened senses + flushing, sweating =
LSD
209
Antidote for benzodiazepines (e.g. drowsiness after benzo)
Flumazenil
210
Blood findings that support chronic alcoholism =
High GGT, high MCV
211
The first line in delirium tremens =
Lorazepam, diazepam
212
If de-escalation techniques failed in delirium =
Olanzapine, haloperidol
213
may precipitate mania and should be ceased if patients have manic episodes
Antidepressants
