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AMC MCQ > Psychiatry > Flashcards

Psychiatry Flashcards

1
Q

DEPRESSION
If a patient, who has successfully been stable on prophylactic dose of a particular mood stabilizer, develops acute depression, what is the next best step in management?

A
  • Adding an antidepressant to the prophylactic mood stabilizer: the choices of the drug would be the same as for major depression. SSRls first line.
  • Increasing the dose of prophylactic mood stabilizer (ONLY if the patient’s psychosis is indicated in coming back, otherwise continue same dose)
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2
Q

DEPRESSION
Antidepressants alone are ________ effective in patients with severe depression

A

50% to 60%

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3
Q

DEPRESSION
Effect size of most treatments of depression

A

ECT (0.8) > CBT (0.5) > Anti-depressants (0.4)

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4
Q

SSRI

A

Fluoxetine
Paroxetine
Sertraline
Citalopram/escitalopram

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5
Q

Which SSRI is contraindicated in pregnancy

A

Paroxetine

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6
Q

Which SSRI is safe for MI

A

Fluoxetine

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7
Q

SNRI

A

Venaflaxine
Desvenaflexine
Duloxetine

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8
Q

Indications for SNRI

A

For treating depression AS WELL AS anxiety (75% depression 25% anxiety)

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9
Q

Venlafaxine contraindication

A
  • Diastolic Hypertension
  • Breast feeding
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10
Q

Antipsychotics

A

Order from lowest to highest potency

Aripiprazole
Quetiapine
Olanzapine
Risperidone
Clozapine

Amisulpride??

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11
Q

Common adverse effect of Antipsychotics

A

Hyperprolactinemia (>2000 mIU/L)
galactorrhea
gynaecomastia
sexual dysfunction
infertility
amenorrhoea

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12
Q

Examples of Overvalued Ideas

A

Body dysmorphic disorder
Anorexia Nervosa
Hypochondriasis

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13
Q

Schizophrenia DX

A

2 Sx for at least 6 months
(at least ONE POSITIVE sx)

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14
Q

Schizophrenia - POSITIVE Sx
(should not be present, but are)

A

‘HD BS’

  • Hallucinations (auditory most common)
  • Delusions (paranoid or persecutory)
  • Thought Disorganisation = Behaviour (disorganised) + Speech (disorganised)
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15
Q

Schizophrenia - features of the auditory hallucination

A
  • comes outside of the head (as opposed to inside)
  • RIGHT side
  • commentary between speakers (as opposed to one voice)
  • mix of male and female voices
  • intermittent (rather than continuous)

Person will find specific REDUCING BEHAVIOURS (e.g. listening to radio/watching TV/talk to others very loud, wear headphones)
Person may seen reacting to what the voices are telling them (“RESPONDING TO INTERNAL STIMULI”)

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16
Q

SCHIZOPHRENIA
examples of Disorganised Behaviour

A
  • Motor perseveration (repeating same motions over and over)
  • echopraxia (copying someone’s movements)
  • Catatonia
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17
Q

SCHIZOPHRENIA
examples of Disorganised Speech

A
  • clang association ( words based on its sound/phonetics, like rhyming, rather than the actual meaning)
  • neologism
  • echolalia
  • perseveration (say the same word repeatedly w/o a purpose)
  • word salad (non-sense words)
  • concrete thinking (inability to think in abstract terms)
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18
Q

Schizophrenia - NEGATIVE Sx
(should be present but aren’t)

A

The 5 A’s

  • Affect (flat/blunted)
  • Ambivalence/Avolition (difficulty making decisions/executing commands/poverty of thoughts)
  • Alogia (decreased or even absent speech)
  • Anhedonia
  • Asociality (social withdrawal)
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19
Q

Schizophrenia - EPIDEMIOLOGY/PROGNOSIS

A
  • incidence general population 1/100 (1%)
  • men more affected than women 3/2 (1.5x)
  • earlier in men (18-25) than for in women (25-35)
  • men tend to exhibit more severe form and worse outcome
  • earlier onset
  • chances of recurrence after first episode (90% - similar to bipolar disorder)
  • SUICIDE: when it occurs, tends to happen in early stages when the insight is still preserved
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20
Q

Schizophrenia - RISK FACTORS

A
  • Monozygotic twin 50% chance of developing
  • Dizygotic twin has a 15% chance.
  • There is 48% chance if both parents are affected
  • There is 12 -13% chance if one birth parent is affected
  • There is increased risk with advanced paternal age, where the parent was aged over 55
  • Winter birth
  • Foetal hypoxia (Pre-eclampsia and emergency c-section)
  • use of illicit drugs (cannabis, amphetamines, cocaine, LSD)
  • Urban areas
  • stressful life experiences/migrants
  • physical/sexual abuse in childhood
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21
Q

Schizophrenia - Symptoms and different age groups

A

YOUNG PATIENTS (15-35 yo)
- spontaneous remission more common
- requires higher doses
- more likely to have “negative symptoms”

LATE ONSET (> 40-45 yo)
- less likely to remit spontaneously
- respond to lower doses
- persecutory delusions is most common symptom, along with accusative or abusive auditory hallucinations
- less likely to have thought disorder and negative symptoms

> 60 yo
- less likely to remit spontaneously
- visual hallucinations
- less likely to have thought disorder and negative symptoms

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22
Q

SCHIZOPHRENIA DDx

A
  • Brief Psychotic disorder: > 1 day & < 1 month
  • Schizophreniform Disorder: > 1m & < 6 m
  • Schizoaffective Disorder
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23
Q

SCHIZOPHRENIA vs Schizoaffective Disorder

A

HATS:
- H: HALF or more of the time ill must be spent with mood sx
- A: psychotic sx must also occur ALONE (i.e. w/o mood sx)
- T: psychotic sx must occur TOGETHER (i.e during an episode of mood disorder)
- S: exclude effect of SUBSTANCES or other medical conditions

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24
Q

SCHIZOPHRENIA vs BPD

A
  • stable or improving level of disfunction after early adulthood (as opposed to progressive decline over time seen in Schizophrenia)
  • affect instability of BPD involves rapidly emotional shifting (as opposed to weeks to months changes)
  • psychotic sx tend to be an sign of distress (experienced during times os stress)
  • Auditory hallucinations- if present - are described as inside (as opposed to outside) and vague/unclear (as opposed to clear/vivid)
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25
Q

SCHIZOPHRENIA vs Dementia

A
  • late onset
  • lack of prior psychiatric sx or signs
  • match average population in social milestones (school, work, marriage)
  • visual hallucinations
  • loss of recall of learnt information and visuospatial ability (schizophrenic patients have these intact)
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26
Q
A
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27
Q

Drug of choice for Bipolar disorder

A

Lithium
Haloperidol (Emergency, if uncooperative)

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28
Q

Eating disorders are commonly associated with what patient profiles (history)

A

– Female Adolescent
– Low self-esteem
– Personal or family history of depression
– Family history of obesity
– High personal expectations
– Family history of eating disorders
– Disturbed family interactions
- Social factors
- Childhood sexual abuse
- Perfectionism and obssessionality

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29
Q

Common clinical features of Anorexia Nervosa

A
  • < 16 BMI
  • Significant electrolyte disturbance (K < 3.0 or Na < 130)
    – Amenorrhoea
    – Constipation.
    – Cold intolerance.
    – Cachexia.
    – Hypothermia.
    – Bradycardia. (< 40bpm)
    – Hypotension (< 90mmHg)
  • Raised liver enzymes and Albumin < 35g/L
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30
Q

Complications of Anorexia Nervosa

A

– low level of LH, FSH and TSH
- secondary amenorrhoea due to low levels of LH and FSH
-Depression
-Obsessive-compulsive disorder
- increased risk of developing bone fractures in later life due to osteoporosis

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31
Q

Causes of Serotonin Syndrome

A

Serotonin antagonist
SSRI
MAOi
TCA (perhaps)

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32
Q

Symptoms of Serotonin Syndrome

A

features that differ from NMS
– Muscle weakness, clonus and hyperreflexia
- Rapid Onset (<24hrs)
- Dose dependant
- Nausea and vomiting
- Increased bowel sounds
- Dilated pupils

features shared with NMS
- High grade fever (>40 degrees)
– Autonomic instability (hypertension, tachycardia, diarrhoea, muscle spasms & red skin, sweating).
– Mental state change (agitation, confusion, hypomania, seizure).
- Hypersalivation
-Use of benzodiazepines

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33
Q

Treatment of Serotonin Syndrome

A
  • Cyproheptadine
  • Chlorpromazine
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34
Q

St John’s Wort with antidepressant causes

A

Serotonin syndrome

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35
Q

Causes of Neuroleptic Malignant Syndrome (NMS)

A
  • anti-emetics
  • anti-psychotics
  • Dopamine antagonists
  • cessation of a dopamine agonist
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36
Q

Medications that cause Neuroleptic Malignant Syndrome (NMS)

A
  • quetiapine
  • olanzapine
  • risperidone
  • paliperidone
  • domperidone
  • metoclopramide
    -promethazine
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37
Q

Symptoms of Neuroleptic Malignant Syndrome (NMS)

A

Features that differ from SS
-Slow onset
- Not dose dependant
- pupils are normal
- No nausea and vomiting
-severe muscle rigidity with hyporeflexia

Features share with SS
- High grade fever (>40 degrees)
– Autonomic instability (hypertension, tachycardia, diarrhoea, muscle spasms & red skin, sweating).
– Mental state change (agitation, confusion, hypomania, seizure).
- Hypersalivation
- Use of benzodiazepines

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38
Q

Treatment of NMS

A

Bromocriptine

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39
Q

Difference between dementia & pseudodementia?

A

Cognitive impairment due to the presence of a mood-related mental health concern, most often depression (giving up).

Pseudodementia have INSIGHT

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40
Q

Long-term use of haloperidol

A

Tardive Dykinesia

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41
Q

Clinical features of Obsessive Compulsive Disorder

A
  • obsessive thoughts and compulsive rituals
  • Compulsions are repetitive purposeful, intentional behaviours conducted to prevent an adverse outcome
  • Mild obsessional or compulsive behaviour can be considered as a reasonable response to stress
  • SSRIs are the treatment of choice
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42
Q

Patients suffering from BPD are at high risk of

A

Suicide

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43
Q

Capgras syndrome

A
  • Also called delusional misidentification syndrome
  • Disorder in which a person believes that an identical-looking has replaced a friend, spouse, parent, or other close family member impostor
  • commonly occurs in patients with paranoid schizophrenia,
    dementia and brain injury
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44
Q

CAGE questionnaire:

A

C- Have you ever felt you should Cut down on your drinking?
A- Have people Annoyed you by criticizing your drinking?
G- Have you ever felt bad or Guilty about your drinking?
E- Have you ever had a drink first thing in the morning to steady your nerves or to get rid of a hangover? (Eye-opener)

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45
Q

How much time needs to progress until regular grief becomes pathological?

A

Complicated: > 6 months in stage 2

Complex: < 6 months with stages alternation

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46
Q

Difference between Complicated Grief Disorder & Avoidant personality disorder?

A

Complicated grief:
- symptoms persist longer than six months
- Avoidance of situations that serve as reminders of the loss is also common

Avoidant Personality Disorder:

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47
Q

Initial treatment for Hoarding personality disorder?

A

CBT and SSRI

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48
Q

Which of the following disorders warrant CBT PLUS medication

A

Obsessive Compulsive Disorder (CBT in the form of exposure & response prevention)

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49
Q

Prolonged excessive cannabis abuse initial treatment

A

CBT

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50
Q

Most common side-effect of Clozapine?

A
  • Low WBC (agranulocytosis)
  • recurrent infections
  • metabolic syndrome
  • hypersalivation
  • sedation
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51
Q

OCD patients are egosyntonic or egodystonic with how they view their disorder?

A

Egodystonic

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52
Q

CATATONIA symptoms

A
  • lmmobility or excessive purposeless activity
  • Mutism, stupor (decreased alertness & response to stimuli)
  • Negativism (resistance to instructions & movement)
  • Posturing (assuming positions against gravity)
  • Waxy flexibility (initial resistance, then maintenance of new posture)
  • Echolalia, echopraxia (mimicking speech & movements)
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53
Q

CATATONIA most often develops in
the context of??

A

a mood disorder (eg, bipolar disorder, major depressive disorder)

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54
Q

1st line treat for malignant catatonia?

A

ECT

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55
Q
A
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56
Q

Hypochondriacs come for cause in relation to their…?

A

Diagnosis

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57
Q

Criteria for Somatic Symptom Disorder

A

-1 or more somatic symptoms that are distressing or result in significant disruption of daily life
- Excessive thoughts, feelings, or behaviors related to the somatic symptoms or associated health concerns as manifested by at least one of the following:
1. Disproportionate and persistent thoughts about the seriousness of one’s symptoms.
2. Persistently high level of anxiety about health or symptoms.
3. Excessive time and energy devoted to these symptoms or health concerns.
C. Although any one somatic symptom may not be continuously present, the state of being symptomatic is persistent (typically more than 6 months)

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58
Q

Difference between hypochondriasis & Illness anxiety disorder

A

hypochondriasis: already have a diagnosis failure to respond to reassurance is an explicit criterion
illness anxiety disorder: has as its primary focus preoccupation with having or acquiring a serious (and undiagnosed) medical illness (think general overall health)

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59
Q

Diagnostic criteria for Conversion Disorder

A

A. One or more symptoms of altered voluntary motor or sensory function.
B. Clinical findings provide evidence of incompatibility between the symptom and recognized neurological or medical conditions.
C. The symptom or deficit is not better explained by another medical or mental disorder.
D. The symptom or deficit causes clinically significant distress or impairment in social, occupational, or other important areas of functioning or warrants medical
evaluation.
Individuals with conversion disorder conversion disorder have symptoms that simulate or mimic
neurological illness. Typical symptoms include paralysis, abnormal movements, inability to speak (aphonia), blindness, and deafness. Pseudoseizures are also
common and may occur in individuals with genuine epileptic seizures. Individuals with conversion disorders are commonly seen on neurology wards and on psychiatry consultation-liaison services at general hospitals

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60
Q

Methamphetamine antidote

A

Wait it out?
Activated charcoal of option is given history of patient ingesting within 2 hours

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61
Q

Methamphetamine withdrawal treatment of choice?

A

No proper medication to treat withdrawal. but to treat symptoms that arise such as mood disorders in which case : TCA

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62
Q

Methamphetamine overdose can cause what fatal symptoms?

A
  • Stroke
    -seizures
    -hyperthermia
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63
Q

how to treat sympathomimetic symptoms?

A

Agitation: benzodiazepines (lorazepam IV if not cooperative, diazepam oral if patient cooperative)
Hypertension: nitrates (nitroprusside), beta blockers (metoprolol 2-5mg IV)
Hyperthermia: evaporative cooling, icepacks and maintenance of intravascular volume and urine flow with IV normal saline solution.
Seizures: Phenothiazines as last resort

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64
Q

Drug-induced extra-pyramidal disease features

A
  • common in the elderly
  • due diminished brain dopamine stores
  • caused by neuroleptic drugs
  • Tardive dyskinesia is the primary symptom
  • Treatment is to cease offending neuroleptic
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65
Q

Tardive dyskinesia vs Parkinsons disease

A

identical symptoms:
- rigidity
- bradykinesia
- postural instability

Differentiating symptoms:
- involuntary movements of face and tongue (tardive)
- Stiffness

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66
Q

Projection

A

attribution of one’s feelings or beliefs to another

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67
Q

Idealization

A

the exaggeration of an individual’s qualities by an admirer

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68
Q

Conversion

A

transformation of psychologic stressors into physical complaints

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69
Q

Symbolization

A

the selection of a particular object or event to represent other meanings

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70
Q

Splitting

A

psychologic separation of all good qualities into one
individual and all bad qualities into another

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71
Q

Sertraline and ecstasy drug interaction

A

They are synergistic
(increase concentration of serotonin in the
body)

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72
Q

Main characteristic of BPD

A

Difficulty/Inability to main personal relationships (close friend or romantic partner)

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73
Q

Difference between BPD and Cyclothymic disorder?

A

BPD:
- impulsivity in at least two areas that are potentially self-damaging
- A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation
Dialectical behaviour therapy

Cyclothymic:
- many periods of depressed mood and many
episodes of hypomanic mood for at least 2 years
- During the above 2-year period (1 year in children and adolescents), the hypomanic and depressive periods have been present for at least half the time and the individual has not been without the symptoms for more than 2 months at a time

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74
Q

Saint John’s Wort combined with COCP

A
  • SJW reduces the effectiveness of COCs and increases the risk of unintended pregnancy
  • SJW’s extracts have been reported to induce the cytochrome P450 enzymes CYP1A2, CYP2C9 and CYP3A4, and increase intestinal P-glycoprotein expression. stimulating the liver to break down the oestrogen and progestogen constituents of the COC pill more rapidly, making COCs less effective and increasing chance of unintended pregnancy
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75
Q

St John’s Wort and warfarin

A

SJW reduces the effectiveness of warfarin and increases the risk of stroke, ischaemia, arterial blockage etc.
- SJW’s extracts have been reported to induce the cytochrome P450 enzymes CYP1A2, CYP2C9 and CYP3A4, therefore metabolising warfarin at a faster rate therefore decreasing its effectiveness.

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76
Q

What MMSE score would indicate cognitive decline?

A

< 25

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77
Q

If patient has scored just below the normal threshold of MMSE due to sight impairment. What should be done?

A

Correct sight impairment and redo test, or perform other cognitive tests that do not require sight (Six-item Cognitive Impairment Test)

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78
Q

After MMSE is done to determine cognitive decline (<25), what investigation is best indicated?

A

CT scan (to see if there’s any degeneration of brain tissue, such as atrophy)

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79
Q

Lithium in pregnancy

A
  • Cause of Ebstein anomaly
  • in cases of severe bipolar disorder, benefits may outweigh the risks
  • Lithium use during the first trimester of pregnancy has been reported to be associated with fetal cardiovascular
    anomalies (e.g. Ebstein’s anomaly) and midfacial and other defects.
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80
Q

Risk of developing Ebstein’s anomaly on patients on lithium?

A

approximately 1 in 1000 to 2000
compared with 1 in 20000 in the general population.

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81
Q

If patient continues to use lithium during pregnancy, what should be investigated?

A

Ultrasound and echocardiogram at 16-20 weeks gestation to exclude foetal anomalies, especially cardiac anomalies

82
Q

In relation to lithium dosage during pregnancy, what should be done in each trimester?

A

1st trimester: keep same dose as before pregnancy but heavily monitor foetus by US at 16-20 weeks.
2nd trimester: continue same lithium dosage.
3rd trimester: decrease lithium dosage by 25% to avoid floppy baby syndrome due to neonatal toxicity.
After delivery immediately increase lithium dosage due to
increased risk of relapse in postpartum period.

83
Q

Sodium Valproate in pregnancy

A

1st trimester: decrease dose to prevent neural tube defects
2nd semester: continue decreased dosage through to 3rd semester
3rd trimester: increase the dosage to prevent seizures

84
Q

List of anxiety disorders

A
  • OCD
  • GAD
85
Q

List of personality disorder

A

Divided by Clusters:
-A
-B
-C
-Other

86
Q

Cluster A personality disorder

A
  • Paranoid Personality Disorder
  • Schizoid Personality Disorder
  • Schizotypal Personality Disorder
87
Q

Cluster B personality disorder

A
  • Antisocial Personality Disorder
  • Borderline Personality Disorder
  • Histrionic Personality Disorder
  • Narcissistic Personality Disorder
88
Q

Cluster C personality disorder

A
  • Avoidant Personality Disorder
  • Dependent Personality Disorder
  • Obsessive-Compulsive Personality Disorder
89
Q

Other personality disorders

A

Personality Change:
- Labile type
- Masochistic
- Disinhibited type
- Aggressive type
- Passive Aggressive type
- Apathetic type
- Combined type
- Unspecified type

90
Q

List of eating disorders

A
  • Anorexia Nervosa
  • Bulimia Nervosa
91
Q

Timeline for Brief psychotic disorder

A

> 1 day and < 1 month

92
Q

Timeline for Schizophreniform disorder

A

> 1 month and < 6 months

93
Q

Timeline for Schizophrenia

A

> 6 months

94
Q

Criteria for Schizoaffective/ psychogenic
disorder

A

Schizophrenia + major affective disorder

95
Q

According to Freud’s theory of psychosexual development, how many stages?

A

six stages between birth and adolescence:
-oral
- anal
- phallic
- oedipal
- latency
- genital

96
Q

Cognitive behavioural therapy is useful in many psychiatric conditions including

A

– Psychosis.
– Phobias.
– Depression.
– Insomnias.
– Eating disorders

97
Q

symptoms seen in early pre-psychotic Prodrome of schizophrenia/psychosis

A

Recurrent depressive symptoms over the course of 3-5 years

98
Q

Symptoms seen in late stage prodrome period of psychosis

A

Paranoid ideation
odd beliefs

99
Q

2nd earliest symptoms seen in pre-psychotic prodrome of schizophrenia/psychosis

A

Loss of motivation and social disability developing within 12 to 18 months of first recurrent depressive symptoms

100
Q

PTSD characterisation

A

a set of symptoms which persist for more than four weeks after exposure to traumatic experience

101
Q

Symptoms of PTSD

A
  • Hypererosal phenomenon:
  • poor concentration and memory, irritability, anger, insomnia etc.
    – Re-experiencing symptoms-such as intrusive thoughts, dreams, nightmares, flashbacks, lashing out in sleep.
    – Avoidance and numbing-loss of interest in activities which previously brought enjoyment, restricted emotional response, detachment from others, deliberate
    attempt to keep traumatic experience out of mind.
    – Reckless or self-destructive behaviour with loss of occupational and social functioning
102
Q

Diagnostic criteria for delirium

A
  • disturbance of consciousness (over a short period of time that tends to fluctuate over the course of a day)
  • change in cognition
103
Q

At least ______% of patients with major depression will respond to AT LEAST one antidepressant medication

A

80%

104
Q

In patients with severe depression or suicidal ideation taking HCV treatment (interferon). Management should be

A

Stop interferon, start SSRI. deal with depression and once the depression is managed, start interferon again

105
Q

Pyromania is a one of _______ disorder

A

Several impulse control disorders

106
Q

Leukopenia with or without clinical symptoms in a schizophrenic patient with 3000-3500 WBC on clozapine

A

Continue clozapine
Start twice per week CBCs with differential counts

107
Q

Agranulocytosis without signs of infection in a schizophrenic patient, next appropriate management?

A
  • discontinue clozapine
  • place patient in protective isolation
  • bone marrow specimen to see if progenitor cells being suppressed.
  • Do not restart Clozapine
108
Q

Leukopenia with or without clinical symptoms in a schizophrenic patient with 2000-3000 WBC on clozapine

A

Stop Clozapine
Start daily CBCs
Clozapine can be restarted after leukopenia is addressed and managed

109
Q

Antidote to benzodiazepine toxicity

A

LAAM (flumazenil)

110
Q

Bupropion in contraindicated in patients suffering from seizures

A

it reduces seizure threshold

111
Q

Contraindication to venlafaxine

A

Hypertension

112
Q

Contraindication to nefazodone

A

liver disease
hypersomnia
motor retardation

113
Q

Contraindication to mirtazapine

A

hypersomnia
motor retardation

114
Q

Criteria for avoidant personality disorder

A
  • alone but wants connection
  • too scared to start and maintain new relationships
115
Q

Criteria for schizoid personality disorder

A

Alone and prefers to be alone (the happy loner)

116
Q

Depression diagnosis

A

2 core symptoms (depressed mood, low energy, anhedonia) + 2 or more of the other symptoms for at least 2 weeks

117
Q

Depression symptoms?

A

Depressed mood (CORE) + SIGECAPS

– S = Sleep
– I = Interest/Enjoyment/
Anhedonia (low) (CORE)
– G = Guilt/Hopelessness
– E = Energy (low) (CORE)
– C = Concentration
– A = Appetite (low)
– P = Psychomotor retardation
– S = Suicidal thoughts

118
Q

Sleep disturbance type in depression

A
  • early wakening and having trouble going back to sleep (also referred as middle insomnia)
  • if successful [in going back to sleep], broken sleep thereafter
  • early morning wakening and being unable to get back to sleep at all (also referred as terminal insomnia)
  • increased sleep latency (i.e. difficulty falling asleep)
  • increased REM stage
  • Decreased stage 3 non-REM stage (less stage 3 means less restorative periods => day light tiredness)
119
Q

Features of major depression with atypical features?

A

mental retardation
memory impairment
dementia

120
Q

Patient on lithium stable for years but recently is not effective, depressed and shows signs of suicidal ideation, what to do

A

continue lithium and add SSRI (bupropion)

121
Q

Contraindications to benzodiazepine

A

severe hepatic insufficiency
alcohol abuse
opioids
old age
COPD

122
Q

Eriksonian stage

A
123
Q

Adult ADHD main features

A

Symptoms are more subtle, and are subject to change:
Hyperactivity may be replaced with restlessness, and impulsivity may be replaced with inability to control emotions or social inappropriateness.

60% will continue to exhibit symptoms into
adulthood

124
Q

Mechanism of action of ADHD medication

A

Inhibition of dopamine and norepinephrine
reuptake

125
Q

clinical features of Postpartum Psychosis

A

Suicide (20%) rule out by psych eval first (notify child services & consult psychiatrist)
-child harm
-Infanticide (4%)

126
Q

Features of Adjustment Disorder

A

-occurring within 3 months of the onset of the stressor
- disturbance may not have persisted for longer than 6 months after the termination of the stressor
- Stressor is severe but not life-threatening
- no symptoms when going through the stressor (not re-experiencing the event)

127
Q

Features of PTSD

A
128
Q

Criteria of Diagnosis for Somatoform Disorder

A
  1. History of many physical complaints beginning before the age of 30
  2. Each of the following criteria must be met:
    - 4 Pain symptoms:
    Headaches, abdominal pains, back and joint pain, pain during
    menstruation or sexual intercourse, chest pain.
    - 2 GI symptoms:
    Nausea, bloating, vomiting other than during pregnancy,
    diarrhoea or intolerance to several foods.
    - 1 sexual symptom:
    Erectile dysfunction, irregular menses, excessive menstrual
    bleeding, vomiting throughout the pregnancy.
    - 1 Pseudo-neurologic symptoms: Conversion symptoms such as impaired
    coordination or balance, paralysis or localized weakness, difficulty in
    swallowing, lump in throat, aphonia, hallucinations, loss of sensations, visual problems, urinary retention
129
Q

Post Natal Depression

A
  • between 6-12 months after the delivery,
    with a peak at 12 weeks
    Symptoms:
  • marked mood swings
    -anxiety
  • agitation
  • poor memory and concentration
  • depressed mood and weight loss
130
Q

Differential diagnosis of Post Natal Depression

A
  • Hypothyroidism
131
Q

Depression Disorder risks

A

– Family history of depression.
- Family history of Autism
– Substance Misuse.
– Unemployment
– Low socioeconomic status.
– Elderly person with cognitive decline or bereavement.
– All family members who have experienced family violence.
– Experience of child abuse
- intellectual development delay
- Perfectionism and obssessionality

132
Q

clinical symptoms of cannabis abuse disorder

A
  • anger management issues
  • depression
  • anxiety
  • poor sleep
133
Q

Treatment for positive symptoms of Schizophrenia

A

first-generation (typical) antipsychotics:
-haloperidol
- chlorpromazine

134
Q

Treatment for negative symptoms of Schizophrenia

A

second generation (atypical) antipsychotics:
- olanzapine
- quetiapine
-clozapine,
- amisulpride
- aripiprazole
- risperidone

135
Q

Risks of developing Obsessive Compulsive Disorder

A
  • Anxiety
  • Depression
  • Alcohol or substance misuse
  • Eating disorders
  • Body dysmorphic disorders
  • Chronic physical health problems (skin problems due to excessive
    hand washing)
136
Q

Treatment for insomnia

A

1st line:
-CBT
-Brief behavioural therapy
- Exercise
2nd line:
- sleep onset insomnia: short acting benzodiazepine temazepam
- sleep maintenance: Zolpidem up to 4 weeks
Chronic long term: melatonin

137
Q

Diagnosis of chronic insomnia

A
  1. A self-reported complaint of poor sleep quality
  2. Sleep difficulties occur despite adequate sleep opportunity.
    Impaired sleep produces deficits in daytime function.
  3. Sleep difficulty occurs three nights per week and is present for three months
138
Q

Antipsychotic increases the risk of

A

type 2 diabetes
- raises the level of triglycerides in the blood
BUT no effect on serum cholesterol level

  • Aripiprazole is a substitute
139
Q

2 questions that MUST be asked to assess suicidal ideation

A
  1. Do you feel hopeless?
  2. Have you felt that you’ve lost interest in your usual activities?
140
Q

Treatment of alcohol withdrawal

A

Benzodiazepine (Diazepam)

141
Q

Onset of alcohol withdrawal

A

6 and 24 hours after the last drink

142
Q

Side effects of Lithium

A

-Alopecia/hair thinning
-acne
-nephrogenic diabetes insipidus
- weight gain
- hypothyroidism
- difficulty sleeping

143
Q

Lithium intoxication

A

Seizures
Tremors
Fever
Hyperreflexia

144
Q

Criteria for Histrionic Personality Disorder

A
  1. Uncomfortable when not the center of attention
  2. Seductive or provocative behavior
  3. Shifting and shallow emotions
  4. Uses appearance to draw attention
  5. Impressionistic and vague speech
  6. Dramatic or exaggerated emotions
  7. Suggestible
  8. Considers relationships more intimate than they are
145
Q

Symptoms of Bipolar Disorder

A

Elevated Mood + 3 of DIG FAST
or
Irritability + 4 of DIG FAST

FOR 1 week or more
1- DISTRACTIBILITY
2- IMPULSIVITY (please seeking behaviours)
3- GRANDIOSITY (can border on the psychotic delusions and hallucinations.
4- FLIGHT OF IDEAS
5- ACTIVITY (psychomotor agitation/goal direct activity)
6- SLEEP = decreased need
7- TALKATIVINESS

146
Q

Features more commonly seen in Bipolar Depression than in Unipolar Depression

A
  • Psychomotor retardation.
  • Increased appetite or hyperphagia
  • Increased sleep or hypersomnia
  • Positive family history of bipolar disorder
  • Early onset of first depression before 25 years of age.
  • Delusions and hallucinations (psychotic features)
147
Q

MANIA is differentiated from HYPOMANIA by following features

A
  • Minimum 7 days of symptoms (4 days for hypomania).
  • Marked functional impairment (no functional impairment in hypomania)
  • Delusions and hallucinations (absent in hypomania)
  • Patient often requires hospitalisation (hospitalisation is less commonly required in hypomania).
148
Q

Harmful side effects of the cannabis abuse

A

– Chronic cough
– Increased risk of stroke and heart disease
– Poorer academic achievement
– Increased risk of suicide attempts
– Drug-induced Psychosis

149
Q

How long to wait before reevaluating if prescribed medication is working in a schizophrenic patient?

A

3 weeks. Increase dose of the initial medication first, and wait until 4-6 weeks

after 4-6 weeks change to another antipsychotic of the same generation (depending on positive/negative symptoms)

150
Q

Symptoms of Social Anxiety Disorder

A

– Excessive perspiration
– Trembling
– Blushing when trying to speak
– Nausea or diarrhoea
– The person fears others will take notice
– The person fears that they would make a mistake, and that would lead to
embarrassment

151
Q

Treatment for Oppositional Defiant Disorder

A

Family therapy

152
Q

Features of Oppositional Defiant Disorder

A

– Persistent stubbornness and refusal to comply with instructions or unwillingness
to compromise with adults or peers.
– Deliberate and persistent testing of the limits.
– Failing to accept responsibility for one’s own actions and blaming others for one’s
own mistakes.
– Deliberately annoying others.
– Frequently losing one’s temper

153
Q

How much time should infants exposed to SSRI’s be observed for

A

3 days (monitoring for serotonin syndrome)

154
Q

Criteria for Adjustment Disorder

A

behavioural and emotional symptoms that develop within 3
months of exposure to an identifiable stressor and these rarely last more than 6
months after the stressor has ended.

155
Q

Difference between Adjustment Disorder & Depression

A

Presence of an identifiable stressor

156
Q

Difference between Adjustment Disorder & Regular Grief

A

Grief usually occurs after loss of something like any close relative or property, however, there are l**ess behavioural symptoms **and it is a self-limiting
condition

157
Q

Symptoms for opiate withdrawal

A

– Headaches
– Insomnia
– Muscle aches
– Fever
– Nausea and vomiting
– Sweating
– Stomach pains
– Diarrhoea
– Craving

158
Q

Opiate intoxication symptoms

A

pinpoint pupils
respiratory depression
decreased level of consciousness

159
Q

Treatment of opiate withdrawal

A
  • codeine detoxication and rehabilitation programme
  • methadone programme as an outpatient
160
Q

Opiate withdrawal diagnosis

A

psychosis lasting at least 1 day but less than 1 month

161
Q

Drug of choice for alcohol withdrawal syndrome

A

Diazepam (unless px has severe liver disease)

162
Q

Aute PTSD range

A

<3 months

163
Q

Chronic PTSD

A

> 3months

164
Q

Clinical features of PTSD

A

– Recollections, nightmares, flashbacks about the trigger event.
– Avoiding the event that resembles the traumatic event.
– Insomnia.
– Irritability.
– Hypervigilance.
Difficulty in concentrating

165
Q

Smoking cessation drug of choice

A

Bupropion

166
Q

Types of immature defence mechanism

A

Passive aggression
Acting out
Dissociation
Projection
Autistic fantasy: Devaluation, Idealization, Splitting

167
Q

Types of Neurotic defence mechanism

A

Intellectualization
Isolation
Repression
Reaction formation
Displacement
Somatization
Undoing
Rationalization

168
Q

Types of Mature defence mechanism

A

Suppression
Altruism
Humour
Sublimation

169
Q

Types psychotic defence

A

Denial (of external reality)
Distortion (of external reality)

170
Q

Treatment for Acute insomnia

A
  • CBT
  • benzodiazepine (temazepam)
171
Q

Treatment for Chronic insomnia

A
  • CBT (gold standard)
  • Melatonin (>55)
    -Zolpidem (case dependant)
172
Q

Criteria for Chronic Insomnia

A

Insomnia for more than 4 weeks

173
Q

symptoms of long term use of SSRI is elderly patients

A

Hyponatremia
muscle aches/cramps lethargy
tiredness
confusion
seizures

174
Q

Timeline for postpartum blues becoming postpartum depression?

A

2 weeks

175
Q

Conduct disorder age range

A

10-16

176
Q

Mood - Definition?

A

mood reflects person’s INTERNAL emotional experience (e.g. good, ok, frustrated, angry)

177
Q

Affect - Definition

A

affect reflects the person’s EXTERNAL emotional expression - which can be evaluated by the interviewer. It can be described as:
- EUTHYMIC (normal, well-balanced mood)
- DYSTHYMIC (sullen, flat)
- EUPHORIC (intensely elated mood)

178
Q

Types of Thought Process

A
  • Circumstantiality
  • Tangentiality
  • flight of ideas
  • poverty of thought
  • disorganised (word salad)
179
Q

Circumstantiality

A

patient veers off into unrelated topics before eventually answering the question

180
Q

Tangentiality

A

patient never answers the original question

181
Q

Flight of ideas

A

patient has so many thoughts that they cannot keep track of them (e.g. manic state)

182
Q

Poverty of thought

A

patient has complete lack of spontaneous thinking (e.g depression, psychosis)

183
Q

Disorganised

A

words said make no sense (word salad)

184
Q

Thought Content - definition?

A

specific ideas and beliefs that a patient has in mind. can only be assessed through what patient says
- suicidal ideation
- homicidal ideation
- preoccupations
- delusions

185
Q

Preoccupations - definition?

A

thoughts that command the entirety of the person’s attention to the point where they cannot focus on anything else)

186
Q

Perception - definition?

A

one’s ability to accurately take in information about the world. Most common:
- illusions
- Hallucinations

187
Q

Delusions - definition?

A

false beliefs that are inconsistent with patient’s background and cannot be corrected by reasoning

188
Q

Illusions

A

misperceptions of genuine stimuli

189
Q

Hallucinations

A

false perceptions in the absence of any external stimuli (e.g. auditory, visual)

190
Q

Risk Factors for suicide?

A
  • Guns
  • Recent suicide attempts
  • Ongoing thoughts of suicide
  • Self-harm
  • Ethanol
  • Substances

mnemonic “Guns & ROSES”

191
Q

Define Diogenes syndrome

A
  • squalor and decline in personal hygiene
  • sometimes hoarding useless items
  • significant frontal lobe impairment
192
Q

Define Charles Bonnet syndrome

A
  • formed visual hallucinations in blind or partially sighted elderly who are not delirious
  • always ocular or occipital disease not psychiatric
  • vivid, colourful, and well-organised hallucinations
  • experience may last for seconds or hours at a time
  • patient has good insight
  • hallucinations are not distressing, but may be quite engaging
193
Q

Define Ekbom syndrome

A

2 forms:
1. ‘/restless legs’ syndrome
2. delusional infestation with parasites or worms in schizophrenic patients

194
Q

Define Cotard syndrome

A

patient believes they have lost important body parts, blood, internal organs, or even their soul
- prevalent in schizophrenia, bipolar disorder, non-dominant temporoparietal lesions and migraine.

195
Q

BMI formula

A

kg/height^2

196
Q

Healthy BMI

A

20=25

197
Q

Underweight BMI

A

18

198
Q

Overweight BMI

A

25-29

199
Q

Obese BMI

A

30-39

200
Q

Morbidly obese BMI

A

< 40

201
Q

ECT contraindications

A
  • Benzodiazepines (lower seizure threshold)
  • Water (amitriptyline)

AMC MCQ (55 decks)

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