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PlusM > Psychiatry > Flashcards

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)

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2
Q

Antidepressants should usually show effect in

A

1-2 week

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3
Q

With good response to SSRIs >

A

Continue for at least 6 months after remission as this reduces relapse

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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

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5
Q

When stopping SSRIs, the dose should be

A

reduced overa 4-week period

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6
Q

If the patient stopped medications abruptly and experiencing delusions

A

Neuropsychiatric analysis

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7
Q

Hospital management for depression

A
  1. Admission to the psychiatric ward
  2. investigations
  3. Treatment with SSRIs or SNRIs
    4, Augmentation with lithium with CBT
  4. If nothing works > ECT
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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)

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9
Q

High mood alone in the question (no mention of low mode at all)

A

> Hypomania

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10
Q

Low mode alone in the question (no mention of high mode at all)

A

Depression

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11
Q

High mode and low mode (depression) (no matter time in between

A

Bipolar

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12
Q

High mode with hallucinations and delusions >

A

Mania

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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
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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)

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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

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16
Q

Treatment for Bipolar affective disorder (Manic depression)

A

Mood stabilizers
Antipsychotics

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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

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18
Q

Primary agents of choice for the acute treatment of bipolar disorder (mania) after taking into account both efficacy and tolerability

A

Antipsychotics

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19
Q

What are the kinds of Mood stabilizers ?

A

Lithium,
Valproic acid,
Carbamazepine,
Lamotrigine

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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

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21
Q

Tetralogy of lithium

A

Ebstein anomaly of the heart
Floppy baby
Thyroid abnormalities

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22
Q

A lesser degree of mania with persistent mild elevation of mood and increased activity and energy

A

Hypomania

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23
Q

Abnormally elevated mood

A

Mania

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24
Q

Hallucinations or delusions

A

Mania

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25
Q

No hallucinations or delusions

A

Hypomania

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26
Q

No hallucinations or delusions

A
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27
Q

Significant impairment of the impairment of the patient’s day -to-day functioning

A

Mania

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28
Q

Significant impairment of the| No significant impairmentof the patient’s day

A
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29
Q

No significant impairment in the patient’s day
patient’s day-to-day functioning

A

Hypomania

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30
Q

What are the 4 elements of Schizophrenia?

A
  1. Auditory hallucinations
  2. Thought disorder
  3. Passivity phenomena
  4. Delusional perceptions
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31
Q

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

A

Auditory hallucinations

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32
Q

The delusional belief that thoughts are being placed in the patient’s head from outside

A

Thought insertion

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33
Q

The delusional belief that thoughts have been ‘taken out’ of his/her mind

A

Thought withdrawal

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34
Q

The delusional belief that one’s thoughts are accessible directly to others

A

Thought broadcasting

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35
Q

Thought blocking

A

a sudden break in the chain of thought

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36
Q

Bodily sensations being controlled by external influence

A

Passivity phenomena

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37
Q

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’

A

Delusional perceptions

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38
Q

1st line of management of antipsychotics

A

Olanzapine or Risperidone

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39
Q

A type of antipsychotic If rapid tranquillization is needed

A

Diazepam

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40
Q
  • 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
A

Tardive dyskinesia

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41
Q

Atypical antipsychotics have lower risk of TD

A
  1. Risperidone (tabs, injections)
  2. Olanzapine (tabs)
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42
Q

> better for incompliant patient (Depot, long-acting injections)

A

Risperidone

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43
Q

Tardive dyskinesia can be treated by

A

Tetrabenazine

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44
Q

1 week after starting anti-psychotic

A

Drug-induced parkinsonism

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45
Q

1 month after starting antipsychotics

A

Akathisia

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46
Q

months-years after starting antipsychotics

A

Tardive dyskinesia

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47
Q

© 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

A

Paranoid personality disorder

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48
Q

Onset Starts at two three days after birth and lasts 1-2 days

A

Postpartum blues

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49
Q

Peaks at 3 to 4 weeks postpartum

A

Postnatal depression

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50
Q

Peaks at 2 weeks postpartum

A

Postpartum psychosis

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51
Q

Yes Occasional thoughts of
baby harming baby

A

Postnatal depression

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52
Q

Thoughts of harming baby

A

Postpartum psychosis

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53
Q

Mother cares for baby - Yes

A

Postpartum blues

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54
Q

Mostly crying

A

Postpartum blues

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55
Q

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

A

Postnatal depression

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56
Q

Psychotic symptoms
E.g. hears voices saying
baby is evil

Insomnia
Disorientation
Thoughts of suicide

A

Postpartum Psychosis

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57
Q

Management of Postpartum Blues

A

Reassurance and explanation

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58
Q

Management of Postnatal depression

A

Antidepressant or cognitive behavioural therapy (CBT)

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59
Q

Management of Postpartum Psychosis

A

Admit to specialist mother and baby unit if available

Antidepressant, mood stabilizers (i.e. carbamazepine), and electroconvulsive therapy (ECT)

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60
Q

In postpartum depression, 1° line SSRI

A

Sertraline

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61
Q

Postpartum psychosis usually starts with

A

postpartum depression

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62
Q

Postpartum psychosis

A

= Puerperal psychosis

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63
Q

Excessive worry and feelings of apprehension about everyday events, with symptoms of muscle and psychic tension, causing significant distress and functional impairment

A

Generalized anxiety disorder (GAD)

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64
Q

Symptoms of GAD

A

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,

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65
Q

GAD present most days for at least

A

6 months + 3 or more somatic symptoms

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66
Q

Management of GAD

A

CBT or applied relaxation or drug treatment
Sertraline (SSRI)
Alternative SSRIs = escitalopram or paroxetine

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67
Q

1:t line =>Management of GAD

A

Sertraline (SSRI)

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68
Q

Several sudden onset episodes (>2 panic attacks)
A panic attack peaks around 10 min then gradually resolves over the next 20min

A

Panic disorders

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69
Q

Features of panic attacks

A

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)

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70
Q

In a panic ATTACK, simple breathing exercises and reassurance is all what’s needed

A

TRUE

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71
Q

Numbness and circumoral paresthesia occur due to hyperventilation and wash of CO2 = respiratory alkalosis

A

high pH enhances binding between Ca and protein = decreased ionized Ca

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72
Q

Management of panic disorder

A

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

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73
Q

1° line Management of panic disorder

A

SSRIs (do NOT use fluoxetine)

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74
Q

Lasts hours-days

A

Acute stress disorder

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75
Q

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

A

Social anxiety disorder (Social phobia)

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76
Q

Anxiety-provoking situations

A

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

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77
Q

There are two forms of the condition:
Social anxiety disorder (Social phobia)

A
  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
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78
Q

Fear of open places or being in situations escape might be difficult or help wouldn’t be available if things go wrong

A

Agoraphobia

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79
Q

Examples of

A
  • Public transport
  • Shopping centers
  • Leaving home
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80
Q

Can be recognized at any age

A

Autism spectrum disorders

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81
Q

Autism spectrum disorders

A
  1. Severe difficulties communicating and forming relationships
  2. Difficulties in language
  3. Repetitive and obsessive behavior
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82
Q

Asperger

A
  • Autism spectrum disorder except language is normal + normal or high IQ
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83
Q

Develops following a traumatic event, usually after 6 months since the event

A

Post-traumatic stress disorder (PTSD)

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84
Q

Features of Post-traumatic stress disorder (PTSD)

A
  • 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
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85
Q

Features

A
  • 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
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86
Q

Management of Post-traumatic stress disorder (PTSD)

A
  • 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
Q

If you find all these names of SSRIs difficult to remember. Just remember these 3

A

Paroxetine, sertraline, and

fluoxetine

88
Q

» 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

A

Obsessive-compulsive disorder (OCD)

89
Q

Management of Obsessive-compulsive disorder (OCD)

A
  • 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
Q

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

A

Anorexia nervosa

91
Q

Anorexia nervosa Features

A
  • 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
Q

Management of Anorexia Nervosa if the
* BMI <15 OR rapid weight loss OR evidence of systemic failure (electrolyte disturbance as hypoglycemia or
bradycardia)

A
  • Refer to eating disorder unit (EDU), medical unit (MU)
93
Q

Management of Anorexia Nervosa if the:
* Moderate (BMI 15-17.5) + NO evidence of systemic failure

A

Refer to the local community mental health team or EDU if available

94
Q

Management of Anorexia Nervosa if the:
* Mild anorexia (BMI >17)

A
  • Building a trusting relationship + self-help books and a food diary
95
Q

Management of Anorexia Nervosa if the:

If BP< 90/60 =

A

Medical unit

96
Q

Reasons for admission in a psychiatric illness

A
  1. Lack of insight
  2. Danger to self
  3. Refusal of voluntary admission = mandatory admission under the mental health act
97
Q

» 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

A

Bulimia nervosa

98
Q

Bulimia nervosa Examination

A
  • 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
Q

Alcohol drinking questionnaires
AUDIT
CAGE

A

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
Q

» 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

A

Neuroleptic malignant

101
Q

Features of Neuroleptic Malignant

A
  • High fever
  • Confusion or alerted consciousness
  • Variable blood pressure
  • Extrapyramidal symptoms (e.g. Rigidity, tremors)
  • Tachycardia
102
Q

Management of Neuroleptic Malignant

A
  • Stop offending medication
  • Rapid cooling
  • Dopaminergic agents =» Bromocriptine
103
Q

» Life threatening iatrogenic disorder that’s characterized by triad of autonomic, cognitive and somatic effects

» Precipitated shortly after use of SSRls

A

Serotonin syndrome

104
Q

Autonomic effects

A
  • Pyrexia

¢ Tachycardia

  • Nausea
  • Diarrhea
105
Q

Cognitive effects

A

+ Confusion

  • Agitation
  • Hallucinations
106
Q

Somatic effects

A
  • Tremors
  • Muscle spasms
107
Q

Cocaine overdose

A

Arrhythmias
Both tachycardia and bradycardia may occur
Hypertension
Seizures
Mydriasis
Hypertonia
Hyperreflexia
Agitation
Psychosis
Effects include necrosis of nasal septum

108
Q

Cocaine withdrawal =

A

depression

109
Q

Heroin withdrawal =

A

increasing body secretions (sweating,
runny nose), muscle aches, agitation, and sleep disturbance

110
Q

Benzo withdrawal =

A

features of a panic attack

111
Q

Heroin

A

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
Q

Acute management of opiates (heroin) overdose =

A

Naloxone IV

113
Q

Chronic management/detoxification/addiction/
withdrawal symptoms =

A

Methadone

114
Q

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.

A

Naloxone

115
Q

2”line in detoxification =

A

Buprenorphine

116
Q

3 line or for shorter detoxification period =

A

Lofexidine

117
Q
  • Used as an adjuvant to prevent relapses =
A

Naltrexone

118
Q
  • Naloxone has a short half-life this often recur after its effect wears off
A

= coma and respiratory depression

119
Q

Ecstasy (MDMA)

A
  • 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
Q

® Visual hallucinations when eyes open =»

A

Ecstasy

121
Q

Visual hallucinations when eyes closed =

A

LSD

122
Q

LSD (Lysergic acid diethylamide)

A
  • 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
Q

LSD (Lysergic acid diethylamide) can be treated with

A

benzodiazepines

124
Q

Lithium poisoning
Causes

A
  • Therapeutic overdosage = common
  • Drug interactions with either a diuretic or NSAIDs - common
  • Deliberate self-harm (less common)
125
Q

Mild Lithium poisoning

A
  • Nausea
  • Altered taste
  • Diarrhea
  • Blurred vision
  • Polyuria
  • Fine resting tremors
126
Q

Moderate Lithium Poisoning

A
  • Increasing confusion
  • Increased deep tendon reflexes
  • Myoclonic twitches and jerks
  • Increasing restlessness followed by stupor
127
Q

Severe Lithium Poisoning

A
  • Coma
  • Convulsions
  • Cardiac arrythmias
  • Cerebellar signs
128
Q

With lithium
- Therapeutic dose =>

A

fine tremors

129
Q

With lithium
- 0D —=>

A

N, drowsiness & coarse tremors

130
Q

Before commencing on lithium

A
  • Kidney function tests
  • TFTs, thyroid disturbance can mimic mania or depression
  • ECG, BP, pulse, FBC, U&E and PT if sexually active
131
Q

After commencing on lithium

A

Serum lithium every 3 months
TFTs and renal function tests every 6 months

132
Q

Lithium duration of monitoring

A
  • 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
Q
  • Low mood, anhedonia, guilt, can’t concentrate (for at least 2 weeks) =
A

Mild depression

134
Q

Mild depression + poor sleep + poor libido + easy fatigue =

A

Moderate depression

135
Q

Moderate depression + suicidal thoughts =

A

Severe depression

136
Q

Severe depression + hallucinations + delusions =

A

Psychotic depression

137
Q

Increase in fatigue, appetite, weight and sleep with low mood but remains reactive, leaden paralysis (feeling of heaviness in the limbs) may occur =

A

Atypical depression

138
Q

Persistent depressive state, milder than MDD and persists more than 2 years =

A

Dysthymia

139
Q

Milder form of bipolar lasting 2 years, fluctuating from mild depressive and hypomanic symptoms =

A

Cyclothymic disorder

140
Q

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
=

A

Adjustment disorder

141
Q

Lack of interest in social relationships + tendency towards a solitary lifestyle =

A

Schizoid personality disorder

142
Q

Mood swings, marked impulsivity, unstable relationships, fear of abandonment and inappropriate anger,
usually attention seekers and may have multiple self-inflicted scars =

A

Borderline personality disorder
(Emotionally unstable personality disorder) (EUPD)

143
Q

Mild degree of mania where there’s elevated mood but no significant impairment of daily activities =

A

Hypomania

144
Q

Antihypertensive drugs when administered with lithium can cause psoriasis =

A

ACEls

145
Q

Antihypertensive drug causes hypokalemia + high lithium level =

A

Thiazide diuretics

146
Q

Other causes of lithium toxicity =

A

Metronidazole, Dehydration, renal failure

147
Q

Inability to resist impulses to deliberately start fires, in order to relieve tension or for instant gratification =

A

Pyromania

148
Q

Delusional belief that a famous person is secretly in love with them =

A

Erotomania (De Clerambaut §)

149
Q

Impulsive urge to pull out one’s hair leading to noticeable hair loss =

A

Trichotillomania

150
Q

Inability to refrain from stealing =

A

Kleptomania

151
Q

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) =

A

Delusion of reference

152
Q

Delusional belief that one’s life is being interfered with in a harmful way =

A

Persecutory delusion

153
Q

Fantastical beliefs that one’s famous, wealthy or powerful =

A

Grandiose delusions

154
Q

False belief that one’s thoughts, feelings, impulses or behavior is being controlled =

A

Delusion of control

155
Q

Delusional belief that patient died or the world has ended and nothing matter =

A

Nihilistic delusions

156
Q

Nihilistic delusions + psychotic depression =

A

Cotard’s

157
Q

Feeling guilty or remorse with no valid reason, one believes they deserve punishment =

A

Delusions of guilt

158
Q

When the person believes that different people are in fact a single person that changes appearances or in
disguise =

A

Fregoli delusion (delusion of doubles)

159
Q

Patient believe that a person known to them has been replaced by a double =

A

Capgras

160
Q

Feigning physical or mental illness, most frequently in prison inmates, they produce “approximate answers” or sometimes wrong however still hold some relevance to them =

A

Ganser $ [Gangster]

161
Q

Perceptual distortions of the size and shape of objects and altered body images, they might feel their body is
expanding or getting smaller =

A

Todd’s

162
Q

Delusional jealousy, marked by suspecting a faithful partner of infidelity like cheating, adultery or having an
affair, patient may attempt monitoring his partner =

A

Othello

163
Q

Delusional parasitosis/infestation where they believe their skin/body is infected with parasites =

A

Ekbom’s

164
Q

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 =

A

Folie & deux (madness of two)

165
Q

Persistent belief in the presence of an underlying serious disease (e.g. cancer or HIV), patient refuses to
accept reassurance or negative test results =

A

Hypochondriasis (illness anxiety disorder)

166
Q

Multiple symptoms, multiple investigations, never reassured =

A

Somatization disorder

167
Q

Feigning symptoms NOT for secondary gain but medical attention =

A

Munchausen’s $ (factitious disorder)

168
Q

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 =

A

Munchausen’s § by proxy

169
Q

Feigning symptoms for secondary gain (e.g. for compensation, to avoid military service or to obtain an opiate prescription) =

A

Malingering

170
Q

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 =

A

Conversion (dissociative) disorders
(functional neurological symptom disorder)

171
Q

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
—>

A

Antisocial Personality disorder (Antisocial behavioral disorder)

172
Q

A young patient <18y with similar features as Antisocial Personality disorder =

A

Conduct disorder => Tx:
juvenile detention

173
Q

Young children with negative, defiant behavior WITHOUT serious violation of social norms, are more common with interaction with adults =

A

Oppositional defiant disorder = Tx: parenting

174
Q

Inattention + hyperactivity + impulsiveness =

A

Attention deficit hyperactivity disorder (ADHD)

175
Q

An incompliant patient in need for antipsychotics =

A

Depot haloperidol

176
Q

An incompliant patient + tardive dyskinesia =

A

Depot risperidone

177
Q

Pinpoint pupils, confusion, agitation and copious secretions =

A

Organophosphate poisoning

178
Q

To avoid anxiety before a certain event =

A

Beta-blocker

179
Q

If the patient is having an attack = Rebreathe into paper bags, if very severe >

A

Benzodiazepines

180
Q

For long-time management and to prevent further attacks =

A

CBT or SSRIs

181
Q

SSRs are the first line medical management in =

A

GAD, OCD, PTSD and Panic disorders

182
Q

Drugs that interact with SSRIs =

A

NSAIDs, Aspirin, Heparin, Warfarin, Triptan [TWHAN]

183
Q

Preferred SSRIs with MI patients =

A

Sertraline then, Citalopram

184
Q

Preferred SSRIs with no relevant medical history =

A

Citalopram then, Fluoxetine

185
Q

Preferred SSRI in young kids =

A

Fluoxetine

186
Q

For rapid tranquillization in an aggressive NOT-psychotic patient =

A

oral lorazepam, then IM

187
Q

For rapid tranquillization in a psychotic patient

A

1st Lorazepam IM, haloperidol IM

188
Q

For rapid tranquilization in a psychotic episode in elderly =

A

Haloperidol IM

189
Q

1% line for status epilepticus =

A

IV Lorazepam

190
Q

Binge eating followed by compensatory weight loss behaviors =

A

Bulimia nervosa

191
Q

Low weight, food restriction, fear of gaining weight and strong desire to be thin =

A

Anorexia nervosa

192
Q

Ability to recognize one’s own mental illness (OCD, phobias)

A

Insight

193
Q

A very fast and accelerated speech without a pause, hard to follow, cannot be interrupted, seen in mania =

A

Pressure of speech

194
Q

Thought and words leap from topic to another with frequent shifts abruptly =

A

flight of ideas

195
Q

Irrational fear of confined spaces =

A

Claustrophobia

196
Q

Fear of spiders =

A

Arachnophobia

197
Q

Fear of heights =

A

Acrophobia

198
Q

Hallucinations hours after heavy drinking (12-24h) =

A

Alcohol hallucinosis

199
Q

Hallucinations/tremors/disorientation/diaphoresis in a chronic alcoholic following a day of abstinence =

A

Delirium termens

200
Q

Transient false perception experienced when the person is on the verge of falling asleep =

A

Hypnagogic
hallucinations [go to sleep]

201
Q

Transient false perception experienced while waking up =

A

Hypnopompic hallucinations

202
Q

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) =

A

Mood incongruence

203
Q

A psychotic feature of bipolar where the belief or action is consistent with the mood =

A

Mood congruence

204
Q

Encourage women with a mental health problem to breastfeed unless they’re taking =

A

Carbamazepine, clozapine or lithium,

205
Q

Everything is decreased + miosis =

A

Heroin

206
Q

Everything is increased + mydriasis =

A

Cocaine

207
Q

Colors when eyes open + increased thirst + uncontrolled body movements + hyperthermia, tachycardia,
tachypnea, insomnia =

A

Ecstasy

208
Q

Colors when eyes closed + heightened senses + flushing, sweating =

A

LSD

209
Q

Antidote for benzodiazepines (e.g. drowsiness after benzo)

A

Flumazenil

210
Q

Blood findings that support chronic alcoholism =

A

High GGT, high MCV

211
Q

The first line in delirium tremens =

A

Lorazepam, diazepam

212
Q

If de-escalation techniques failed in delirium =

A

Olanzapine, haloperidol

213
Q

may precipitate mania and should be ceased if patients have manic episodes

A

Antidepressants

PlusM (6 decks)

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