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Psychiatry Flashcards

1
Q

What is Charles Bonnet syndrome?

A

Persistent or recurrent hallucinations, generally against a background of visual impairment. Insight is often preserved. (must be in absence of any other neuropsychiatric disturbance)

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2
Q

What are the protective factors against suicide?

A
  • children at home
  • family support
  • religious beliefs
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3
Q

If someone has previously attempted suicide, what features increase risk of a further attempt?

A
  • violent method
  • making efforts to not be found out
  • planning
  • leaving a written note
  • final acts e.g. sorting out finances
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4
Q

How to assess risk to self

A
  • deliberate self harm, thoughts or carried out
  • suicide risk
  • ability to maintain health: substance abuse, concordance and neglect
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5
Q

What 3 risks should be assessed in psych review?

A
  • risk to self
  • risk to others: thoughts of harming others or hallucinations telling them to harm others
  • risk from others
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6
Q

Features of Schizophrenia

A
  • auditory hallucinations: voices discussing in 3rd person, voices commentating on behaviour, thought echo
  • thought disorder: thought insertion/deletion/broadcast
  • delusional perceptions: normal object is first perceived then delusional insight into the object’s meaning
  • passivity phenomena
  • other: impaired insight, negative symptoms, catatonia
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7
Q

What is the management of schizophrenia?

A
  • anti-psychotics
  • CBT
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8
Q

What are the factors associated with a poorer prognosis for schizophrenia?

A
  • strong family onset
  • prodrome of social withdrawal
  • low IQ
  • gradual onset
  • lack of precipitating factor
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9
Q

What is the most common type of schizophrenia?

A

Paranoid schizophrenia

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10
Q

What are the positive symptoms of schizophrenia?

A
  • thought echo (hearing thought out loud)
  • thought broadcast
  • thought insertion or withdrawal
  • 3rd person auditory hallucination
  • delusional perception
  • passivity and somatic passivity
  • thought disorder
  • lack of insight
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11
Q

What are the negative symptoms of schizophrenia?

A
  • blunted affect
  • apathy
  • social isolation
  • poverty of speech
  • poor self care
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12
Q

Investigations to rule out causes of schizophrenia/psychosis

A
  • Baseline blood tests: including FBC, TFTs, U&Es, LFTs, CRP and a fasting glucose
  • Urine culture: to rule out urinary tract infection causing delirium
  • Urine drug screen: to rule out drug intoxication
  • HIV testing if applicable
  • syphilis serology
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13
Q

What is the management of acute psychosis?

A
  • consider oral benzodiazepine
  • refer to a specialist to start anti-psychotic
  • family intervention/cbt
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14
Q

Name two typical antipsychotics

A
  • haloperidol
  • chlorpromazine
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15
Q

Name two atypical antipsychotics

A
  • clozapine
  • risperidone
  • aripiprazole
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16
Q

What is anxiety-panic disorder

A
  • panic attack: sudden onset of discrete period of severe anxiety in which at leat 4 of the following are experienced: palpitations, sweating, shaking, sensation of shortness of breath, feeling of choking, nausea dizziness, derealisation/depersonalisation, fear of losing control or dying or going crazy, paraesthesia, chills or hot flushes
  • at least 3 panic attacks in 3 weeks: no objective danger, comparative freedom from anxiety symptoms between attacks, without being confined to known/predictable situations
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17
Q

What is the first line medication for generalised anxiety disorder?

A

Sertraline

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18
Q

At what point would you need to titrate clozapine slowly?

A

if doses have been missed for a period of over 48 hours

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19
Q

What is tangentiality?

A

wandering from a topic without returning to it

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20
Q

What is knights move?

A

severe type of loosening of associations, where there are unexpected and illogical leaps from one idea to another. It is a feature of schizophrenia.

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21
Q

What is Circumstantiality?

A

inability to answer a question without giving excessive, unnecessary detail. However, this differs from tangentiality in that the person does eventually return to the original point.

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22
Q

What electrolyte imbalances can be seen with long term lithium use?

A
  • hypercalcaemia
  • hyperparathyroidism
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23
Q

What is the mechanism of benzodiazepines?

A
  • Enhance effect of GABA (inhibitory neurotransmitter)
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24
Q

What is the difference between type 1 and type 2 bipolar disorder?

A
  • type 1 associated with mania
  • type 2 associated with hypomania
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25
Q

What is wernike’s encephalopathy?

A
  • acute neurological disorder due to lack of b1
  • Triad: ophthalmoplegia (often a lateral rectus palsy and/or horizontal nystagmus), confusion and ataxia (though any cerebellar signs can be present)
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26
Q

What is Korsakoff’s syndrome?

A

complication of Wernicke’s encephalopathy.

Its features include: anterograde amnesia, retrograde amnesia, and confabulation

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27
Q

What is conversion disorder?

A

psychiatric condition where psychological stress is unconsciously manifested as physical, neurological symptoms

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28
Q

What electrolyte imbalance can be caused by SSRIs?

A

Hyponatraemia

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29
Q

Risperidone

A

Atypical antipsychotic

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30
Q

Clomipramine

A

Tricyclic

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31
Q

Haloperidol

A

Typical antipsychotic

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32
Q

Escitalopram

A

SSRI

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33
Q

What are the SSRI discontinuation symptoms?

A
  • increased mood change
  • restlessness
  • difficulty sleeping
  • unsteadiness
  • sweating
  • gastrointestinal symptoms: pain, cramping, diarrhoea, vomiting
  • paraesthesia
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34
Q

When should lithium levels be checked?

A

12 hours post dose

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35
Q

What is the management of acute dystonia secondary to antipsychotics?

A

Procyclidine

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36
Q

Venlafaxine

A

SNRI

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37
Q

What antidepressant can cause urinary retention?

A

Tricyclic antidepressants e.g. amitriptyline

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38
Q

What is the most effective antipsychotic in dealing with negative symptoms?

A

Clozapine

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39
Q

Akathisia

A

Restlessness and inability to sit still

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40
Q

What are the risk factors for depression?

A
  • female
  • strong family history of depression/anxiety
  • teen to age 40
  • ACE or childhood abuse
  • substance misuse
  • Issues with physical health
  • poor socio-economic group
  • separated/divorced
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41
Q

What are the clinical features of depression?

A

Lasting at least 2 weeks, impairing daily life or causing distress, no organic or substance cause

Typical core symptoms:
- low mood
- anhedonia
- lack of energy

Other core:
- weight change
- disturbed sleep
- psychomotor retardation or restlessness
- reduced libido
- guilt/worthlessness
- decreased concentration
- thoughts of death/suicide/self harm

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42
Q

What are the organic causes of depression?

A
  • hypothyroidism
  • Cushing’s
  • B12 deficiency
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43
Q

Mild depression

A

2 core + 2 other

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44
Q

Moderate depression

A

2 core + 3 other

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45
Q

Severe depression

A

all 3 typical + at least 4 others

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46
Q

Recurrent depressive disorder

A

2+ episodes

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47
Q

Investigations for depression

A
  • PHQ-9
  • TFTs
  • FBC
  • B12
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48
Q

What are the peaks of bipolar presentation?

A

-15-24
- 45-54

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49
Q

Risk factors for bipolar

A
  • genetic
  • prenatal toxoplasma gondii infection
  • born premature <32 weeks
  • childhood maltreatment
  • post partum period
  • cannabis use
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50
Q

What is the difference between type 1 and 2 bipolar?

A

Type 1= mania, type 2= hypomania

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51
Q

Mania symptoms

A
  • elevated mood outwith circumstances
  • elation leading to increased energy, decreased need for sleep, pressure of speech
  • inability to maintain attention
  • grandiosity and increased confidence
  • loss of social inhibition
  • lasting at least 7 days with severe negative impact on social functioning
  • may have psychotic symptoms (mood-congruent)
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52
Q

Hypomania symptoms

A
  • persistent, mild elevation of mood
  • increased energy and activity
  • increased sociability, talkativeness, libido and over familiarity
  • decreased need for sleep
  • irritability
  • absence of psychotic symptoms
  • at least 4 days, some functional impairment but not as severe as mania
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53
Q

Investigations for bipolar

A
  • FBC, UEs, LFTs, CRP, B12, Foalte, Vit D, Ferritin
  • HIV
  • Toxicology
  • neurological exam
  • CT head
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54
Q

Differentials for bipolar

A
  • Schizophrenia
  • Frontal lobe pathology
  • Drug use
  • Recurrent depression
  • Emotionally unstable personality or borderline personality disorder
  • cyclothymia
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55
Q

What is the management for bipolar?

A
  • Referral to specialist mental health team for diagnosis
  • for acute mania: haloperidol/risperidone/olanzapine
  • for depressive episode: Fluoxetine + olanzapine
  • long term: lithium, if not working add sodium valproate
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56
Q

Symptoms of generalised anxiety

A
  • several months, more days than not, resulting in significant impairment and not a manifestation of another condition or substance
  • subjective nervousness
  • difficulty maintaining concentration
  • muscular tension or motor restlessness
  • sympathetic autonomic over-activity
  • irritability
  • sleep disturbance
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57
Q

Agoraphobia

A

Fear of crowds, public places, leaving home

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58
Q

Social phobia

A

low self esteem, fear of criticism

59
Q

Panic disorder symptoms

A
  • recurrent, unpredictable episodes of severe, acute anxiety not restricted to stimuli/situations
  • crescendo of anxiety resulting in exit
  • somatic symptoms
  • secondary fear of dying or losing control
60
Q

first line drug for generalised anxiety

A

SSRI

61
Q

Features of PTSD

A
  • hyperarousal
  • Avoidance
  • Re-experiencing
  • Distress
62
Q

Management of PTSD

A
  • trauma focused CBT
  • eye movement desensitisation and reprocessing
  • SSRI or venlafaxine
63
Q

What is an obsession?

A

Unwanted, intrusive thought, image or urge

64
Q

What is a compulsion?

A

Repetitive behaviour or act a person feels driven to act upon

65
Q

management of OCD

A
  • Mild: CBT including exposure and response prevention
  • moderate: SSRI
  • severe : (>3 hours of compulsions), referral to secondary mental health team for assessment
66
Q

What is ADHD?

A

Persistent features relating to inattention and/or hyperactivity/impulsivity

67
Q

What are the inattention symptoms of ADHD?

A
  • Forgetful
  • loses things
  • easily distracted
  • doesn’t seem to listen
  • doesn’t follow through on instructions
68
Q

What are the hyperactivity/impulsivity symptoms of ADHD?

A
  • unable to play quietly
  • talks excessively
  • often ‘on the go’
  • often interruptive or intrusive
  • answers prematurely
69
Q

What is the management of ADHD?

A
  • 10 week watch and wait period for children, if the symptoms persist them referral to secondary care
  • consider methylphenidate in children over the age of 5 and adults
70
Q

What must you do before prescribing methylphenidate?

A

ECG as it is cardiotoxic

71
Q

What are the risk factors for ASD?

A
  • male
  • genetic variants e.g. PTEN
  • chromosomal abnormalities
  • strong family history
72
Q

What are the clinical features of ASD?

A
  • Social interaction: inability to interpret social cues or form social attachments, lack of response to emotion
  • Communication: delayed/minimally expressive speech, impairment in make believe or fantasy play, lack of social gestures, one way conversation skills
  • Resisted, repetitive behaviour: resist change with a rigid daily routine, pre-occupations with specific interests, inability to adapt to new environments
73
Q

What is the management of ASD?

A
  • specialist education
  • clinical psychiatry
  • occupational therapy
  • speech therapist
  • sleep hygiene
74
Q

DSM diagnosis of anorexia nervosa

A
  • Restriction of energy intake relative to requirements leading to significantly low body weight
  • intense fear of gaining weight/becoming fat, even though underweight
  • undue influence of body weight on self-evaluation, or denial of the seriousness of the current low body weight
75
Q

What is the management of anorexia nervosa?

A
  • CBT-ED
  • In children: anorexia focused family therapy
76
Q

anorexia signs

A
  • bradycardia
  • hypotension
  • enlarged salivary glands
  • hypokalaemia
  • impaired glucose tolerance
  • low oestrogen, testosterone, FSH, and LH
  • raised cortisol and growth hormone
  • hypercholesterolaemia
  • low T3
77
Q

What is bulimia nervosa?

A

Recurrent episodes of binge eating associated with a lack of control over eating, with purging behaviour to prevent weight gain

78
Q

What are the symptoms of bulimia nervosa?

A
  • recurrent episodes of binge eating
  • loss of control over eaitng during these episodes
  • recurrent inappropriate compensatory behaviours to prevent weight gain e.g. self induced vomiting
  • binge and compensatory behaviours both occur on average once a week for 3 months
  • self evaluation is unduly influenced by body shape/weight
  • disturbance does not exclusively occur during episodes of anorexia nervosa
79
Q

What is the management of bulimia nervosa?

A
  • Referral to mental health
  • bulimia-nervosa focused guided self help for adults
80
Q

Target of typical antipsychotics

A

Dopamine D2 antagonists

81
Q

Target of atypical antipsychotics

A

Variety of receptors: D2, D3, D4, 5HT3

82
Q

What are the typical antipsychotics?

A
  • Haloperidol
  • Chlorpromazine
83
Q

What are the atypical antipsychotics

A
  • Risperidone
  • Clozapine
  • Olanzipine
84
Q

What is the difference in the side effect profiles of the antipsychotics?

A

Typical are more likely to have extrapyramidal side effects and hyperprolactinaemia, atypical less commonly have extrapyramidal and prolactinaemia, but have metabolic effects

85
Q

What are the extra pyramidal side effects?

A
  • Parkinsonism
  • Acute dystonia
  • Tardive dyskinesia (chewing, pouting)
  • Akanthisia (severe restlessness)
86
Q

What are the side effects of antipsychotics?

A
  • Anti muscarinic
  • sedation, weight gain
  • raised prolactin
  • impaired glucose tolerance
  • neuroleptic malignant syndrome
  • reduced seizure threshold
  • prolonged QT (particularly haloperidol)
87
Q

What do antipsychotics increase the risk of (especially in elderly)

A
  • VTE
  • Stroke
88
Q

What is akathisia?

A

Severe restlessness

89
Q

What is tardive dyskinesia?

A
  • chewing
  • pouting
    involuntary movements
90
Q

Signs of neuroleptic malignant syndrome

A
  • fever
  • muscle rigidity
  • tachycardia/tachypnoea
91
Q

Name 3 SSRIs

A
  • citalopram
  • fluoxetine
  • sertraline
92
Q

What are the side effects of SSRIs?

A
  • GI effects
  • increased risk of GI bleeding
  • Increased anxiety and agitation
  • Citalopram can increased QT interval
  • hyponatraemia
93
Q

What are the interactions of SSRIs?

A
  • NSAIDs, if used prescribe proton pump inhibitor
  • Triptans - increased risk serotonin syndrome
  • Monoamine Oxidase inhibitors, increased risk of serotonin syndrome
  • aspirin
  • warfarin/heparin
94
Q

What period of time should you stop SSRIs over?

A

4 weeks

95
Q

What are the discontinuation symptoms of SSRIs?

A
  • increased mood changes
  • restlessness
  • difficulty sleeping
  • unsteadiness
  • sweating
  • GI symtpoms- pain, cramping, diarrhoea
  • paraesthesia
96
Q

What are the risks of SSRIs in pregnancy?

A
  • increased risk of congential heart defects if used in 1st trimester
  • increased risk of persistent pulmonary hypertension if used in 3rd trimester
  • paroxetine increases risk of congenital malformation
97
Q

When should you review someone after starting them on an anti-depressant?

A
  • Review in 2 weeks
  • Review in 1 week if under 25 years or if they have an increased suicide risk
98
Q

Mechanism of tricyclic antidepressants

A
  • inhibit uptake of noradrenaline and serotonin
  • also affect histamine, muscarinic and adrenergic receptors
99
Q

What are the side effects of tricyclic antidepressants?

A
  • drowsiness
  • anti -muscarinic effects: dry mouth, blurred vision, constipation, urinary retention
  • postural hypotension
  • lengthens QT interval
100
Q

Name 4 tricyclics, 2 more sedative, 2 less sedative

A

More sedative: amitriptyline, clomipramine
less: imipramine, lofepramine

101
Q

What are the serotonin syndrome symptoms?

A
  • neuromuscular excitation
  • hyperreflexia
  • myoclonus
  • rigidity
  • autonomic nervous system:
  • excitation
  • hyperthermia
  • sweating
  • altered mental state
  • confusion
102
Q

What is the management of serotonin syndrome?

A
  • benzodiazipines
  • IV fluids
  • more severe cases are managed using serotonin antagonists such as cyproheptadine and chlorpromazine
103
Q

Name 3 MAO inhibitors

A
  • Moclobemide ( depression_
  • selegiline, rasagiline (parkinsons)
104
Q

What are the side effects of MAO- inhibitors?

A
  • anti-cholinergic effects
  • Avoid tyramine containing foods: cheese, marmite, broad beans
105
Q

What are the uses of benzodiazepines?

A
  • sedation
  • hypnotic
  • anxiolytic
  • anti-convulsant
  • muscle relaxant
106
Q

Why should you only prescribe a benzodiazepine for a short time

A

Because you can easily develop a tolerance

107
Q

What are the symptoms of benzodiazepine withdrawal?

A
  • insomnia
  • irritability
  • anxiety
  • tremor
  • perspiration
  • seizure
108
Q

Where is lithium excreted?

A

Kidneys

109
Q

What are the adverse effects of lithium?

A
  • nausea, vomiting, diarrhoea
  • nephrotoxicity -> polyuria secondary to nephrogenic diabetes
  • fine tremor
  • weight gain
  • thyroid enlargement -> hypothyroidism
  • leucocytosis
  • hyperparathyroidism
  • hypercalcaemia
110
Q

Describe the monitoring of lithium doses

A
  • sample should be taken 12 hours post dose
  • when starting dose or changing the dose, check the levels weekly until stable
  • once levels are stable check once every 3 months
  • check thyroid and renal function every 6 months
111
Q

what can precipitate lithium toxicity

A
  • dehydration
  • renal failure
  • diuretics
  • ACEi
  • ARBs
  • NSAIDs
  • metronidazole
112
Q

what are the features of lithium toxicity?

A
  • coarse tremor
  • hyperreflexia
  • acute confusion
  • polyuria
  • seizure
  • coma
113
Q

What is the management of lithium toxicity?

A
  • normal saline fluid resuscitation if mild/moderate
  • haemodialysis if severe
114
Q

What is the mechanism of alcohol withdrawal?

A

chronic alcohol consumption enhances GABA mediated inhibition in the CNS and inhibits NMDA-type glutamate receptors, withdrawal is the opposite

115
Q

What are the features of alcohol withdrawal?

A
  • symptoms at 6-12 hours: tremor, sweating, tachycardia, anxiety
  • peak incidence of seizure is at 36 hours
  • delirium tremens at 48-72 hours: coarse tremor, confusion, delusions, auditory and visual hallucinations, fever, tachycardia
116
Q

What is the management of alcohol withdrawal?

A
  • admit if complex history from alcohol withdrawal
  • long acting benzodiazepine e.g. chlordiazepoxide or diazepam
117
Q

ICD-10 alcohol excess

A

3 or more:
- compulsion to drink
- difficulties controlling alcohol consumption
- physiological withdrawal
- tolerance to alcohol
- neglect of alternative activities to drinking
- persistent use of alcohol despite evidence of harm

118
Q

Management of alcohol excess

A
  • oral thiamine
  • benzodiazepines for acute withdrawal
  • disulfram: causes severe reaction from alcohol intake
  • acamprostate reduces the craving
119
Q

Cluster A personality disorders

A

Odd or eccentric:
- paranoid
- schizoid
- schizotypal

120
Q

Cluster B personality disorders

A

Dramatic, emotional, or erratic
- antisocial
- borderline
- histrionic
- narcissistic

121
Q

cluster c personality disorder

A

anxious and fearful
- obsessive compulsive
- avoidant
- dependent

122
Q

Paranoid personality disorder

A
  • hypersensitivity and unforgiving attitude
  • unwarranted tendency to question loyalty of friends
  • reluctance to confide in others
  • conspirational beliefs
  • perceive attacks on their character
123
Q

Schizoid personality disorder

A
  • indifference to praise and criticism
  • preference for solitary activities
  • lack of interest in sexual interactions
  • lack of desire for companionship
  • emotional coldness
  • few interests
  • few friends
124
Q

schizotypal personality disorder

A
  • odd beliefs and magical thinking
  • unusual perceptual disturbances
  • paranoid ideation and suspiciousness
  • odd, eccentric behaviour
  • lack of close friends
  • inappropriate affect
  • odd speech but still coherent
125
Q

antisocial personality disorder

A
  • more common in men
  • failure to conform to social norms e.g. breaking law
  • deception e.g. lying, conning people
  • impulsive
  • irritable and aggressive
  • disregard for safety of others
  • irresponsibility e.g. cant keep consistent work
  • lack of remorse
126
Q

Borderline personality disorder

A

also known as emotionally unstable
- efforts to avoid abandonment
- unstable interpersonal relationships which alternate between idealization and devaluation
- unstable self image
- impulsivity
- recurrent suicidal behaviour
- affective instability
- chronic feelings of emptiness
- difficulty controlling temper

127
Q

obsessive compulsive perosnality

A
  • Is occupied with details, rules, lists, order, organization, or agenda to the point that the key part of the activity is gone
  • Demonstrates perfectionism that hampers with completing tasks
  • Is extremely dedicated to work and efficiency to the elimination of spare time activities
  • Is rigid about morality, ethics, or values
  • Is not capable of disposing worn out or insignificant things even when they have no sentimental meaning
  • Is unwilling to pass on tasks or work with others except if they surrender to exactly their way of doing things
  • Takes on a stingy spending style towards self and others; and shows stiffness and stubbornness
128
Q

Management of personality disorders

A

dialectical behaviour therapy

129
Q

What is conversion disorder?

A
  • loss of motor or sensory function
  • patient doesn’t consciously feign the symptoms
130
Q

Hypochrondrial disorder

A
  • persistent belief in the presence of an underlying serious disease e.g. cancer
  • patient refuses to accept reassurance or negative test results
131
Q

What is somatisation disorder?

A

Presence of multiple, recurrent and clinically significant somatic complaints
- pain is most common symptom including migraine like or tension type headaches, abdominal pain

132
Q

Section 2 mental health act

A
  • admission for assessment for up to 28 days, not renewable
  • an approved mental health professional makes the application on recommendation of 2 doctors, one of which shoul dbe approved under section 12(2) of the mental health act (usually consultant psychiatrist)
  • treatment can be given against a patients wishes
133
Q

How many days section 2 MHA

A

28, not renewable

134
Q

Section 3 mental health act

A
  • admission for treatment for up to 6 months, can be renewed
  • AMHP along with 2 doctors who must have seen the patient within the past 24 hours
  • treatment can be given against a patient’s wishes
135
Q

section 4 MHA

A
  • 72 hour assessment order
  • used when section 2 would involve an unacceptable delay
  • a GP and AMHP/Nearest relative
  • often then changed to a section 2 on arrival at hospital
136
Q

section 5 (2) MHA

A

a patient who is a voluntary patient in hospital can be legally detained by a doctor for 72 hours

137
Q

section 17a MHA

A
  • supervised community treatment
  • can be used to recall a patient to hospital for treatment if they dont comply with conditions of the order in the community such as complying with medication
138
Q

section 135 MHA

A

Court order can be obtained to allow the police to break into a property to remove a person to a place of safety

139
Q

section 136 MHA

A
  • someone 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
140
Q

What are the adverse effects of clozapine?

A
  • agranulocytosis and neutropaenia
  • reduced seizure threshold
  • constipation
  • myocarditis
  • hypersalivation
141
Q

When should you use clozapine for schizophrenia

A

if not controlled despite the sequential use of two or more antipsychotic drugs, each for at last 6-8 weeks

142
Q

What should be checked when starting venlafaxine?

A

blood pressure

143
Q
A

Finals (37 decks)

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