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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
Delirium What is?
Acute state of confusion, agitation and delusion usually due to organic cause
26
Schizotypal
Odd& eccentric, introverted,socially isolated
27
Schizoid personality
Social isolated, cold No sense of humour Poor reaction to stimuli Minus the eccentric habit
28
Narcissistic personality
Sense of entitlement Grandiose
29
Lewy body dementia
Fluctuations level of consciousness+ visual hallucinations+ social inhibition+ parkinsonism
30
Pick @ Fronto temporal dementia
Loss of personality 1st, agitation, disinhibition, social inhibition Memory impairment comes later Usually 50s-60s
31
Depression, refuse medications. Advise?
Most patients with major depression will improve in 6 to 18 months even without treatment.
32
Cocaine toxicity Signs? Contraindications?
CVS: tachycardia, hypertension,left ventricular failure, arrhythmias,embolus CNS: psychomotor agitation,coma, convulsions, hyperthermia ,IVH Beta blockers contraindicated !!!
33
BPD Is BAD
B: Broken relationship A: Abandonment fear D: danger to self and others
34
Lithium in pregnancy Use? Monitor for foetus? Maternal monitor?
•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
Autism Onset? Features? Rx
•Onset at 3 yrs old •Poor eye contact, language disability,isolated, aggressive • Risperidone or Aripiprazole if irritability+
36
ADHD Features?
Inattentive, hyperactivity, interferes daily activity Age before 7, lasts > 6mths
37
Rx for ADHD
Rx: Methylphenidate & Dextroamphetamine SE : insomnia, appetite,GI disturbed, anxiety 2nd line Rx: atomoxetine Clonidine, guanfacine
38
Tourette disorder Rx
Clonidine/haloperidol/pimoxide/Risperidone
39
SSRI initiated with some improvement? Next?
Increase the dosage
40
Conduct disorder Risk? Onset? Features ? Rx?
•Parents of antisocial personality • below 18 years of age, boys •Substance dependence, violence, theft, fire setting • antipsychotic drugs
41
Oppositional defiant disorder
Fight with everyone esp Authorities (my friend Michael Chong)
42
Disruptive mood Dysregulation disorder (DMDD)
6-10 years,boys Chronic, temper, anger, irritability , moments of good behaviour
43
Bipolar disorders
Mania>7 days, warrants hospital Hypomania>4 days ,less severe, no need hospital
44
Acute mania Rx options
Lithium, Valproic acid, atypical antipsychotics 1st line Severe: atypical antipsychotics i.e faster onset of action!!!
45
Bipolar depression Rx
Lithium, Quetiapine,lurasidone
46
Cyclothymia What is?
Hypomania with mild depression for > 2 yrs
47
SSRI Side effects?
Headache, wt ∆, sexual effects,GI disturbed
48
SNRI Side effects?
HPT, sexual effects,GI disturbed,wt ∆, blurry vision
49
Serotonin syndrome What is? Effects? CAS Rx?
Interaction btw SSRI s with other drugs Cognitive : hallucinations, hypomania, agitation Autonomic : hyperthermia, tachycardia, diarrhoea, sweating Somatic Rx? Stop SSRI Cyproheptadine+ symptomatic Rx
50
Schizophrenia in acute psychosis
Hospitalize !!! Use atypical antipsychotics * clozapine never used anytime as 1st line !
51
Side effects of antipsychotics
Pines: weight gain, metabolic syndrome, DM Dones: cardiac conduction, movement disorders
52
Panic attack Rx
BZD
53
Panic disorder ( 1 mth persistent worry/fear of panic attack +/-significant maladaptive behaviour) Rx
SSRI
54
Phobia
Systematic desensitization
55
Performance anxiety
Beta blockers 30-60 mins before performance
56
OCD Rx
Exposure and response prevention 1st + SSRI
57
Hoarding disorder Rx
CBT SSRI
58
Body dysmorphic disorder
Individual psychotherapy SSRI
59
PTSD {> 1 month} symptoms Rx
SSRI Relaxation techniques Psychotherapy: coping strategies
60
Acute stress disorders {> 2days but <1mth} Rx
Same as PTSD
61
Generalised anxiety disorder (> 6 mth) Rx
SSRI
62
Duration for some psy conditions
63
Post partum psychosis HX Risk FX? Treatment?
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
Best treatment for acute mania
recent metanalysis, the antipsychotics risperidone and olanzapine are superior to lithium or carbamazepine for treatment of acute mania
65
Acute mania in BF women Choice of Rx?
Risperidone, sodium valproic
66
Obsessive Compulsive Disorder in post partum
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
Sexual side effects of SSRI PELE
Painful ejaculations Erectile dysfunction Libido loss Ejaculatory delay
68
Treatment of SSRI induced sexual side effects
1. Drug holiday 2. Drug change 3. Dose reduction 4. Add PDE (-) Sildenafil
69
Psychiatric illness in ESRF patients on HD
Depression the MCC If acute with fever: delirium and disorientation are symptoms to look for as cause is not psychiatric
70
Alcohol withdrawal syndrome Duration? Symptoms? Rx
•24-72 hrs after cessation •Agitation, headache, tremor, sweating, nausea, vomiting , tachycardia ,hypertension • Short acting BZD : lorazepam Haloperidol add on if not adequate
71
Diazepam in AWS with liver problem
Not recommended as long acting and unfavorable side effects
72
ECT S/effects
Acute confusion Anterograde amnesia: new info Retrograde amnesia: recent memories, more anxiety provoking
73
Agitated patients approach
De-escalation ( verbal/medical) Observe character Collateral information from cops, family members or those accompanied
74
Bipolar depression vs unipolar depression
Hyperphagia , hypersomnia Psychomotor retardation Delusion Hallucinations Age onset < 25 yrs old Family HX of Bipolar
75
Antidepressants for 5 years
•Previous 3 MDD •2 episodes of Major Depression in 5 yrs •Suicide attempt • add on psychotic features
76
Antipsychotics have bimodal effects
Treat mania and depression. If patients have depressive predominant features: √ add antidepressant and continue antipsychotic Or √increase antipsychotic dose & wait for the effect
77
NMS Rx
Dantrolene Bromocriptine Lorazepam

AMC Key (11 decks)

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