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AMC Key > Psychiatry > Flashcards

Psychiatry Flashcards

1
Q

Early manifestation of Schizophrenia

A

Prodromal symptoms
Then psychosis comes in

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2
Q

Schizophrenia criteria

A

> 6mths
Delusion
Hallucination
Speech disorder
Negative thinking
Gross behaviour/catatonia

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3
Q

Childhood schizophrenia vs
Early onset schizophrenia
Vs adult onset

A

<13yrs vs <18yrs vs >18yrs

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4
Q

Circumstantiality

A

Pusing2 come back to answer

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5
Q

Tangentiality vs derailment

A

Some linking but don’t come back
Vs
Lari topic habis

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6
Q

Post concussion syndrome

A

Having mood/cognitive/blood dysregulation/sensory related > 3 months

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7
Q

Defence mechanism

A

Reaction formation
Denial
Displacement
Projection
Rationalisation

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8
Q

Grief

A

Lasts upto 2 months
Sleeping difficulty, guilt,mild visual/auditory hallucinations, sadness, worthlessness , appetite change

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9
Q

SSRI initiated, but no improvement in 2 weeks-3weeks
Duration?

A

To continue the dosage till upto 6 weeks ( to reach optimal therapeutic range), if no improvement then consider changing

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10
Q

When to stop SSRI if no effect on patient

A

If the developed side effects or suicidal thoughts arises

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11
Q

Morbid jealousy

A

In psy conditions:Highest seen in schizophrenia
In personality disorders: highest in BPD

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12
Q

Borderline personality disorder

A

Impulsive,self harm, harm others, feeling empty, inability to control temper and cause harm in others, irritability over trivial issue

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13
Q

Antisocial personality disorders

A

Anger,past record of criminal violence,substance abuse,not remorseful

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14
Q

Highest risk suicide on depression

A

Upon discharge from hospital

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15
Q

Insomnia
Step wise approach

A
  1. Sleep HX, substance use
  2. CBT : good sleep hygiene , sleep restriction, stimulus control, relaxation,& cognitive therapy
  3. Hypnotic pharmacotherapy
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16
Q

Systematic desensitization

A
  1. Relaxation techniques
  2. Fear hierarchy ( least fear»> most feared)
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17
Q

Adjustment disorder
Eg. Breakup

A
  1. Psychotherapy 1st
  2. Pharmacotherapy
    Depression: SSRI
    Anxious/panic: BZD
    Insomnia: BZD+ sedative
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18
Q

Negative countertransference

A

Results in lack of empathy and communication form drs
(Negative feeling that the disease is self inflicted thus should be able to overcome by patient)

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19
Q

Anorexia nervosa features

A

AN is characterized by a markedly low body weight, intense fear of weight gain, and body image distortion

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20
Q

Anorexia nervosa additional character

A

Feeling of inferiority

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21
Q

Post stroke depression
Onset?
Treatment?
Duration of treatment?
Early onset , outcome?

A

6 -24 mth after stroke onset
CBT & SSRI (fluoxetine DOC)
4-6mth
Early onset less than 3 mth,good remission

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22
Q

St John wort tx: no improvement

A

Omit , start on SNRI
St John wort : mild to moderate depression MAY work

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23
Q

Depression 5/9 X 2 weeks
PAGISAPES

A

*Pervasive depressed mood
*Anhedonia
Guilt
Insomnia
Suicide
Appetite
Psychomotor retardation/agitation
Energy
Sleep
*: must be present

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24
Q

Sleep paralysis
What is ?
Link?
Rx?

A

•Muscle remain in paralysis while sudden awakening due to nightmare
•SSRI linked
•switch to SNRI

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25
Q

Delirium
What is?

A

Acute state of confusion, agitation and delusion usually due to organic cause

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26
Q

Schizotypal

A

Odd& eccentric, introverted,socially isolated

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27
Q

Schizoid personality

A

Social isolated, cold
No sense of humour
Poor reaction to stimuli
Minus the eccentric habit

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28
Q

Narcissistic personality

A

Sense of entitlement
Grandiose

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29
Q

Lewy body dementia

A

Fluctuations level of consciousness+ visual hallucinations+ social inhibition+ parkinsonism

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30
Q

Pick @ Fronto temporal dementia

A

Loss of personality 1st, agitation, disinhibition, social inhibition
Memory impairment comes later
Usually 50s-60s

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31
Q

Depression, refuse medications.
Advise?

A

Most patients with major depression will improve in 6 to 18 months even without treatment.

32
Q

Cocaine toxicity
Signs?
Contraindications?

A

CVS: tachycardia, hypertension,left ventricular failure, arrhythmias,embolus
CNS: psychomotor agitation,coma, convulsions, hyperthermia ,IVH

Beta blockers contraindicated !!!

33
Q

BPD
Is
BAD

A

B: Broken relationship
A: Abandonment fear
D: danger to self and others

34
Q

Lithium in pregnancy
Use?
Monitor for foetus?
Maternal monitor?

A

•Used in severe cases only
Recommend other anti psychotics in mild to moderate cases
• USG and fetal Echo at 16-20 wk look for Ebstein anomalies : tricuspid displaced downward into RV
•RFT and thyroid ,serum lithium

35
Q

Autism
Onset?
Features?
Rx

A

•Onset at 3 yrs old
•Poor eye contact, language disability,isolated, aggressive
• Risperidone or Aripiprazole if irritability+

36
Q

ADHD
Features?

A

Inattentive, hyperactivity, interferes daily activity
Age before 7, lasts > 6mths

37
Q

Rx for ADHD

A

Rx: Methylphenidate & Dextroamphetamine
SE : insomnia, appetite,GI disturbed, anxiety

2nd line Rx: atomoxetine
Clonidine, guanfacine

38
Q

Tourette disorder
Rx

A

Clonidine/haloperidol/pimoxide/Risperidone

39
Q

SSRI initiated with some improvement? Next?

A

Increase the dosage

40
Q

Conduct disorder
Risk?
Onset?
Features ?
Rx?

A

•Parents of antisocial personality
• below 18 years of age, boys
•Substance dependence, violence, theft, fire setting
• antipsychotic drugs

41
Q

Oppositional defiant disorder

A

Fight with everyone esp Authorities (my friend Michael Chong)

42
Q

Disruptive mood Dysregulation disorder (DMDD)

A

6-10 years,boys
Chronic, temper, anger, irritability , moments of good behaviour

43
Q

Bipolar disorders

A

Mania>7 days, warrants hospital
Hypomania>4 days ,less severe, no need hospital

44
Q

Acute mania
Rx options

A

Lithium, Valproic acid, atypical antipsychotics 1st line
Severe: atypical antipsychotics i.e faster onset of action!!!

45
Q

Bipolar depression
Rx

A

Lithium, Quetiapine,lurasidone

46
Q

Cyclothymia
What is?

A

Hypomania with mild depression for > 2 yrs

47
Q

SSRI
Side effects?

A

Headache, wt ∆, sexual effects,GI disturbed

48
Q

SNRI
Side effects?

A

HPT, sexual effects,GI disturbed,wt ∆, blurry vision

49
Q

Serotonin syndrome
What is?
Effects? CAS
Rx?

A

Interaction btw SSRI s with other drugs
Cognitive : hallucinations, hypomania, agitation
Autonomic : hyperthermia, tachycardia, diarrhoea, sweating
Somatic
Rx? Stop SSRI
Cyproheptadine+ symptomatic Rx

50
Q

Schizophrenia in acute psychosis

A

Hospitalize !!!
Use atypical antipsychotics
* clozapine never used anytime as 1st line !

51
Q

Side effects of antipsychotics

A

Pines: weight gain, metabolic syndrome, DM
Dones: cardiac conduction, movement disorders

52
Q

Panic attack
Rx

A

BZD

53
Q

Panic disorder ( 1 mth persistent worry/fear of panic attack +/-significant maladaptive behaviour)
Rx

A

SSRI

54
Q

Phobia

A

Systematic desensitization

55
Q

Performance anxiety

A

Beta blockers 30-60 mins before performance

56
Q

OCD
Rx

A

Exposure and response prevention 1st
+ SSRI

57
Q

Hoarding disorder
Rx

A

CBT
SSRI

58
Q

Body dysmorphic disorder

A

Individual psychotherapy
SSRI

59
Q

PTSD {> 1 month} symptoms
Rx

A

SSRI
Relaxation techniques
Psychotherapy: coping strategies

60
Q

Acute stress disorders {> 2days but <1mth}
Rx

A

Same as PTSD

61
Q

Generalised anxiety disorder (> 6 mth)
Rx

A

SSRI

62
Q

Duration for some psy conditions

A
63
Q

Post partum psychosis HX
Risk FX?
Treatment?

A
  1. Family HX of post partum psychosis
  2. Past personal HX of post partum psychosis or Bipolar
  3. HX of discontinuation of antipsychoticc/mood stabilisers
  4. 1st pregnancy
    Rx: start Risperidone immediately after delivery !!!
64
Q

Best treatment for acute mania

A

recent metanalysis, the antipsychotics risperidone and olanzapine are superior to lithium or carbamazepine for treatment of acute mania

65
Q

Acute mania in BF women
Choice of Rx?

A

Risperidone, sodium valproic

66
Q

Obsessive Compulsive Disorder in post partum

A

O: Repeated thinking of baby is harmed/ contaminated but has insight of those thoughts
C: counter habits like avoid baby/repeated washing or cleaning

67
Q

Sexual side effects of SSRI
PELE

A

Painful ejaculations
Erectile dysfunction
Libido loss
Ejaculatory delay

68
Q

Treatment of SSRI induced sexual side effects

A
  1. Drug holiday
  2. Drug change
  3. Dose reduction
  4. Add PDE (-) Sildenafil
69
Q

Psychiatric illness in ESRF patients on HD

A

Depression the MCC
If acute with fever: delirium and disorientation are symptoms to look for as cause is not psychiatric

70
Q

Alcohol withdrawal syndrome
Duration?
Symptoms?
Rx

A

•24-72 hrs after cessation
•Agitation, headache, tremor, sweating, nausea, vomiting , tachycardia ,hypertension
• Short acting BZD : lorazepam
Haloperidol add on if not adequate

71
Q

Diazepam in AWS with liver problem

A

Not recommended as long acting and unfavorable side effects

72
Q

ECT
S/effects

A

Acute confusion
Anterograde amnesia: new info
Retrograde amnesia: recent memories, more anxiety provoking

73
Q

Agitated patients approach

A

De-escalation ( verbal/medical)
Observe character
Collateral information from cops, family members or those accompanied

74
Q

Bipolar depression vs unipolar depression

A

Hyperphagia , hypersomnia
Psychomotor retardation
Delusion
Hallucinations
Age onset < 25 yrs old
Family HX of Bipolar

75
Q

Antidepressants for 5 years

A

•Previous 3 MDD
•2 episodes of Major Depression in 5 yrs
•Suicide attempt
• add on psychotic features

76
Q

Antipsychotics have bimodal effects

A

Treat mania and depression.
If patients have depressive predominant features:
√ add antidepressant and continue antipsychotic
Or
√increase antipsychotic dose & wait for the effect

77
Q

NMS
Rx

A

Dantrolene
Bromocriptine
Lorazepam

AMC Key (11 decks)

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