Psychiatry Flashcards
For what time period must symptoms be seen before a diagnosis of depression can be made?
Two weeks
Refeeding syndrome electrolyte imbalances?
Hypophosphataemia, Hypomagnaesiumia and Hypokalaemia
When does Postpartum psychosis occur?
Within the first two weeks postpartum
What is the first line treatment of mild to moderate dementia?
Donepezil, Rivastigmine or Galantamine
What treatment may be offered in severe dementia?
NMDA inhibitor, Memantine
What are the pharmacotherapeutic options for postpartum psychosis?
Antipsychotics - Olanzapine and Quetiapine are safe to take whilst breastfeeding
Mood stabilisers in some instances
What would you see on examination of a patient with Anorexia Nervosa?
- BMI <17.5 kg/m2 (contrast with bulimia nervosa, where there may be many similar features, but the BMI is normal‚ a key distinguishing feature)
- Hypotension
- Bradycardia
- Enlarged salivary glands
- Lanugo hair (fine hair covering the skin)
- Amenorrhoea (hypogonadotropic hypogonadism)
- Additional features in the ‘bulimic’ subtype may include hypokalaemic hypochloraemic metabolic alkalosis, pitted teeth, parotid swelling, and scarring of the dorsum of the hand (Russell’s sign).
What blood results would you expect for a patient with anorexia nervosa?
Deranged electrolytes - typically low calcium, magnesium, phosphate and potassium
Low sex hormone levels (FSH, LH, oestrogen and testosterone)
Leukopenia
Raised growth hormone and cortisol levels (stress hormones)
Hypercholesterolaemia
Metabolic alkalosis, either due to vomiting or use of diuretics
What is the Tetrad of Neuroleptic Malignant Syndrome
Hypertonia, hyperthermia, autonomic instability and mental state change.
What investigations would you do for neuroleptic malignant syndrome?
FBC - Monitoring for potential leukocytosis or signs of infection.
Creatine Kinase (CK) Levels: Markedly elevated CK levels are often observed due to muscle breakdown.
Renal and Liver Function Tests: monitoring organ function due to the potential systemic effects.
What is the mechanism of action for typical antipsychotics?
Dopamine D2 receptor antagonists, blocking dopaminergic transmission in the mesolimbic pathways
What is the mechanism of action for Atypical antipsychotics?
Act on a variety of receptors (D2,D3, D4, 5-HT)
What is an acute dystonic reaction and how do you manage it?
- Sustained muscle contraction (e.g. torticollis, oculogyric crisis)
- Managed with procyclidine
What is Tardive Dyskinesia?
Late onset of choreoatheoid movements, abnormal, involuntary, may occur in 40% of patients, may be irreversible, most common is chewing and pouting of jaw
A woman presents to her male family doctor wearing a low-cut top and a short skirt. She tries to flirt with the doctor. The consultation is filled with drama and she becomes annoyed with the centre of attention shifts from her is a stereotypical history of:
Histrionic Personality disorder
What symptoms might you get in SSRI discontinuation?
- Increased mood change
- Restlessness
- Difficulty sleeping
- Unsteadiness
- Sweating
- GI Symptoms
- Paraesthesia
What is the risk of using SSRIs in the third trimester of pregnancy?
Risk of persistent pulmonary hypertension of the newborn
When should patients <25 years who have started on SSRIs be reviewed?
After 1 week due to the increased risk of suicidality
When would you expect the peak incidence of delirium tremens in acute alcohol withdrawal?
48-72 hours; Coarse tremor, confusion, delusions, auditory and visual hallucinations, fever, tachycardia
When would you expect the peak incidence of seizures in acute alcohol withdrawal?
36 hours
What is the first-line talking therapy in Schizophrenia?
CBT
What is Circumstantiality?
The inability to answer a question without giving excessive, unnecessary detail
What is Tangentiality?
Refers to wandering from a topic without returning to it
What are clang associations?
When ideas are related to each other only by the fact they sound similar or rhyme
What is word salad?
Describes completely incoherent speech where real words are strung together into nonsense sentences
What is echolalia?
Repetition of someone else’s speech, including the question that was asked
What are some common features if PTSD?
- re-experiencing e.g. flashbacks, nightmares
- avoidance e.g. avoiding people or situations
- hyperarousal e.g.hypervigilance, sleep problems
- emotional numbing - lack of ability to experience feelings or feeling detached
How long should antidepressants be continued after remission of symptoms?
6 months
What medications should be avoided when taking SSRIs?
Triptans
What is the antidepressant of choice for children and adolescents?
Fluoextine
What is included in type 1 bipolar?
Mania and depression (most common)
What is included in Type 2 bipolar disorder?
Hypomania and depression
What is Mania?
Severe functional impairment or psychotic symptoms for 7 days or more
What is hypomania?
Describes decreased or increased function for 4 days or more
What is Malingering?
Fraudulent simulation or exaggeration of symptoms with the intention of financial or other gain
What is Pick’s Disease?
It is a cause of frontotemporal dementia where there is an accumulation of TAU proteins within the neurons.
What is Acute Stress reaction?
An immediate and intense psychological response following exposure to a traumatic event.
Can occur within the initial three days to four weeks post trauma.
What are the clinical features of Acute stress reaction?
- Rapid onset of intense psychological distress post- trauma
- Symptoms: intrusive memories, dissociation, heightened arousal, avoidance and negative mood alterations
- Emotional reactions: Overwhelming anxieties, sense of unreality
- Psychological manifestations: Palpitations, hypervigilance
- Behavioural responses: efforts to escape reminders
- Duration: 3 days to 4 weeks
What is the first-line management of Acute Stress Disorder?
Trauma-focused CBT
What are some examples of typical antipsychotics?
- Haloperidol
- Chlorpromazine
- Flupentixol
What are some examples of atypical antipsychotics?
- Risperidone
- Quetiapine
- Olanzapine
- Aripiprazole
- Clozapine
What are the clinical features of Neuroleptic Malignant Syndrome?
- HYPERthermia
- Altered Mental Status
- Autonomic Dysregulation (Fluctuating in blood pressure, tachycardia and diaphoresis)
- Rigidity
What investigations would you do in NMS?
- FBC
- CK: Markedly elevated levels are often observed due to muscle breakdown
What is the management of NMS?
- Discontinuation of Causative Agent
- Supportive Care
- Benzodiazepines
- Dantrolene
What are the investigations for Transient Global Amnesia?
- Neuroimaging: Brain CT or MRI to exclude stroke or other structural brain abnormalities
- Electroencephalogram (EEG): To exclude seizure activity
- Neuropsychological tests: To assess cognitive function and exclude other types of amnesia or cognitive impairment
- Blood tests: To exclude metabolic causes such as hypoglycemia or electrolyte imbalance
What genes give a predisposition to Alzheimer’s disease?
Mutations in specific genes, such as the Apolipoprotein E gene, increases the risk of developing Alzheimer’s disease.
Down Syndrome patients are at a high risk due to triplication of chromosome 21 which carries the amyloid precursor protein gene.
What is an early feature of Alzheimer’s disease?
Amnesia for recent memories
What is the ICD-11 criteria for anorexia nervosa?
- Significantly low body weight
- Fear of gaining weight
- Distorted body image
- Restrictive eating
What is adjustment disorder?
A state of emotional distress and disturbance usually interfering with social functioning arising in a period of adaptation to a significant life change or stressful life event such as bereavement or separation.
What are the clinical signs of Cocaine Overdose?
Agitation, confusion, delirium, hyperthermia, Tachycardia, hypertension, arrhythmias, ACS and Strokes.
What are the clinical signs of Benzodiazepine overdose?
Low GCS
Respiratory depression
Hypothermia
What are the clinical signs of Spice Overdose?
Low GCS
Respiratory Depression
What are the clinical signs of Hallucinogenics (LSD, Magic Mushrooms)>
Visual Hallucinations
Psychosis
Dilated pupils
Name some symptoms associated with mania?
- Mood symptoms: irritability, euphoria, emotional lability.
- Cognitive symptoms: pressine of speech, confusion, flight of ideas,
poor concentration, easily distracted. - Behavioural symptoms: hyperactivity, reduced sleep, extravagant
spending, promiscuity. - Psychotic symptoms: delusions of grandeur, hallucinations.
What are some symptoms of atypical depression?
- Vegetative symptoms: weight increase, increase of appetite,
hypersomnolence. - Catatonic symptoms: leaden limbs, social impairment.
- Mood: mood may lighten with positive events,
What are the characteristics of Korsakoff’s psychosis?
- Retrograde amnesia
- Anterograde amnesia
- Confabulation
What are the positive symptoms of Schizophrenia?
Auditory Hallucinations
Delusions
Thought disorders such as thought broadcast
What are the negative symptoms of Schizophrenia?
Alogia
Anhedonia
Avolition
Affective incongruity or blunting
What would you see in Tardive Dyskinesia?
- Involuntary, repetitive movements, especially of the face
What are the 5 key principles of the Mental Capacity Act?
- A person is assumed to have capacity unless proven otherwise
- Steps must be taken to help a person to have capacity
- An unwise decision does not mean someone lacks capacity
- Any decisions made under the MCA must be in the patient’s best interests
- Any decisions made should be the least restrictive to a persons rights and freedoms
When would you dialyse a patient with lithium toxicity?
Guidelines recommend dialysis for asymptomatic patients if the lithium is >4mmol/L, or >2.5mmol/L with renal dysfunction, or otherwise on a case by case basis depending on presence of symptoms.
What is Cyclothymia?
Similar to Bipolar but features milder fluctuations in mood
When does Postpartum psychosis most commonly start?
Generally develops within the first 2 weeks of giving birth
How long does a section 2 last?
28 days
Who can perform a section 2?
An Approved mental health professional on the recommendation of 2 doctors (one of whom is ‘approved’ under section 12(2) of thwe MHA
How long does a section 3 last?
6 months
Can be renewed
How long does a Section 4 last?
72 hour assessment order
What is a section 17a?
Supervised Community Treatment (Community Treatment Order)
can be used to recall a patient to hospital for treatment if they do not comply with conditions of the order in the community, such as complying with medication
What is a section 135?
a court order can be obtained to allow the police to break into a property to remove a person to a Place of Safety
What is a section 136?
someone found in a public place who appears to have a mental disorder can be taken by the police to a Place of Safety
can only be used for up to 24 hours, whilst a Mental Health Act assessment is arranged
How often should Lithium level be checked when starting or changing dose?
Weekly
When checking Lithium levels, when should the blood sample be taken?
12 hours post-dose
List some biological features of depression
Loss of appetite
Overeating
Early morning wakening
Poor memory
Concentration loss
Loss of libido
Insomnia
Constipation
Diarrhoea
Menstrual disturbance
List some cognitive features of depression?
Feeling of being a failure
Negative thoughts
Reduced self-esteem
Reduced confidence
Anhedonia
What assessment tool can be used to assess severity of depression?
PHQ-9
What are the two main types of alcohol or drug dependence?
- Physical dependence: body adapts to presence of the substance over time needs more and more for the same effect
- Psychological dependence: feeling that life is impossible/challenges cannot be faced without the drug OR emotional effect
What is the alcohol harm paradox?
Refers to observations that lower socioeconomic status (SES) groups consume less alcohol than higher SES groups but experience greater alcohol-related harm/problems
What are some possible differential diagnoses for depression?
Bipolar disorder, psychotic disorders, premenstrual syndrome, substance misuse, hypothyroidism, anaemia
How long after starting a new therapy could NMS occur?
4-14 days 90% of cases occur within 10 days. However, NMS can occur years into therapy.
What is De Clerambault’s syndrome?
A form of paranoid delusion with an amorous quality. The patient, often a single woman, believes that a famous person is in love with her.
What is Cotard syndrome?
A rare mental disorder where the affected patient believes that they are dead or non-existent.
What are the indications for ECT?
It is useful treatment option for patients with severe depression refractory to medications those with psychotic syndrome
What are the short term side-effects of ECT?
headache
nausea
short term memory impairment
memory loss of events prior to ECT
cardiac arrhythmia
What are the long term side effects of ECT?
Some patients report impaired memory
What is Othello’s syndrome?
Othello’s syndrome is pathological jealousy where a person is convinced their partner is cheating on them without any real proof. This is accompanied by socially unacceptable behaviour linked to these claims.
What is Capgras Delusion?
Refers to a delusion that either oneself or another person has been replaced by an exact clone. It may be part of psychotic illness or as a result of trauma to the brain
What is Ekbom’s syndrome?
Ekbom’s syndrome is a delusional belief where a patient feels that they are infested with parasites. They often complain of feeling “crawling” in the skin. It can appear as part of a psychotic illness or a secondary organic disease such as B12 deficiency, hypothyroidism and neurological disorders.
What is Freigoli syndrome?
Freigoli syndrome is when a patient is having persecutory beliefs and believes strangers are their persecutors in disguise.
What is ADHD?
Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder characterised by persistent patterns of inattention, impulsivity, and hyperactivity that are inappropriate for the individual’s developmental level.
What is the first line medical management for ADHD?
Methylphenidate
What are illusions?
Stimuli from perceived objects are combined with a mental image to produce a false perception
What is a hypnapompic hallucination?
Occurs when waking up
What is a hypnagognic hallucination?
Occurs when falling asleep
What is schizophrenia characterized by?
A distortion to thinking, perception and inappropriate or blunted affect
What is the first line treatment for children and adolescents with anorexia nervosa?
Family therapy
