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year 3 conditions > Psychiatry > Flashcards

Psychiatry Flashcards

1
Q

what is cotards syndrome

A

A rare syndrome seen in severe depression - patient’s believe that they are dead, decaying, or do not really exist (also known as ‘walking corpse syndrome’).

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2
Q

withdrawal from which drug causes piloerection (hairs standing on end), rhinorrhea and hyperreflexia

A

opioid

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3
Q

which symptoms of alcohol withdrawal distinguish it from withdrawal from other drugs

A

hallucinations, tremors

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4
Q

describe symptoms of phencyclidine withdrawal

A

mood disturbances - anxiety and depression
flashback phenomenon’ (where patients experience the effects of taking phencyclidine long after the drug has exerted its effects on the body)
delayed reflexes

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5
Q

what is hypochondriasis aka illness anxiety disorder

A

persistent fear or belief that one has a serious medical illness, despite medical evaluation and reassurance to the contrary. The focus in hypochondriasis is on the fear or belief of having a medical illness, rather than the presence of medically unexplained symptoms.

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6
Q

what is somatisation disorder / somatic symptom disorder

A

multiple medically unexplained physical symptoms across multiple organ systems, with the symptoms causing significant distress and impairment

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7
Q

what is malingering

A

intentionally feigning or exaggerating symptoms for some external gain, such as financial compensation or avoiding legal consequences

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8
Q

what is conversion disorder

A

a psychiatric disorder characterised by symptoms affecting sensory or motor function eg paralysis / seizures.

These signs and symptoms are inconsistent with patterns of known neurologic diseases or other medical conditions.

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9
Q

what are slurred speech and coarse tremor symptoms of

A

lithium toxicity - requires urgent medical attention

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10
Q

likely diagnosis:
muscle rigidity and rhabdomyolysis followed by a fever and mental state changes

A

neuroleptic malignant syndrome
(life-threatening neurologic emergency associated with the use of antipsychotic (neuroleptic) agents)

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11
Q

what is neuroleptic malignant syndrome a complication of

A

anti psychotic use

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12
Q

mech of action of naloxone

A

opioid antagonist

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13
Q

which drug can be used to help relieve diarrhoea in opiate withdrawal

A

loperamide

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14
Q

which drug can be sued to help relieve agitation in opiate withdrawal

A

benzodiazepines

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15
Q

what is lofexidine used for

A

can be used as a form of symptomatic relief for opioid withdrawal

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16
Q

which medications can be used in detox programmes for opiate withdrawal (to help with detoxification and maintenance therapy to prevent further use)

A

methadone
buprenorphine

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17
Q

effects of LSD

A

Labile mood
Hallucinations
Increased blood pressure
Increased heart rate
Increased temperature
Sweating
Insomnia
Dry mouth

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18
Q

effects of cannabis

A

Drowsiness
Impaired memory
Slowed reflexes
Slowed motor skills
Conjunctival injection
Increased appetite
Paranoia and psychotic symptoms (contrast with cannabinoid associated schizophrenia, which has a more insidious onset, over many years)
Tachycardia
Dry mouth

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19
Q

which receptor does cocaine work at

A

dopamine receptors

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20
Q

which receptor does methamphetamine work at

A

TAAR1 (trace amine - associated receptor 1) receptors

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21
Q

which medication could be used to treat anxiety / agitation in patients with heroin withdrawal

A

benzodiazepine

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22
Q

contrast the pupils and management of heroin intoxication and heroin withdrawal

A

heroin intoxication = constricted pupils -> naloxone for OD

heroin withdrawal = dilated pupils -> supportive Tx, symptom relief -»> methadone, buprenorphine

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23
Q

management of stimulant (cocaine, methamphetamine, or MDMA (ecstasy)) intoxication

A

Deaths can occur due to hyperpyrexia and hypertension, so cooling, use of antihypertensives such as nitroprusside or GTN, and benzodiazepines, is the mainstay of management.

  • nitroprusside
  • GTN
  • benzodiazepines
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24
Q

which condition causes personality / behaviour changes, seizures, short term memory impairment, altered conscious level, disorientation abruptly within days to weeks

A

limbic encephalitis

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25
Q

what should be confirmed before a lumbar puncture is performed

A

that there is no raised ICP

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26
Q

what is the order of investigations for a pt presenting with new seizures/confusion/memory impairment

A
  1. neurological exam
  2. MRI brain
  3. lumbar puncture (check for raised ICP before doing this)
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27
Q

what is Munchausen syndrome

A

patients fake illnesses to receive attention

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28
Q

what is la belle indifference

A

a syndrome where patients do not show any concern over the symptoms they are experiencing. An example is not worrying whether they cannot move a limb

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29
Q

what is wernickes syndrome caused by

A

thiamine deficiency in chronic alcoholism

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30
Q

what symptoms is wernickes encephalopathy characterised by

A

nystagmus
opthalmoplegia
confusion
ataxia

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31
Q

what is a nosocomial infection

A

infection originating in hospital

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32
Q

anterograde vs retrograde amnesia

A

Retrograde amnesia is when you can’t recall memories from your past.
Anterograde amnesia is when you can’t form new memories but can still remember things from before you developed this amnesia.

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33
Q

what is confabulation

A

a neuropsychiatric disorder wherein a patient generates a false memory without the intention of deceit

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34
Q

what is korsakoff’s syndrome

A

an irreversible progression of Wernicke’s encephalopathy.
It has the same symptoms, with the addition of antero- and retrograde amnesia and confabulation

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35
Q

how does lithium toxicity present

A

Toxicity may be precipitated by dehydration or illness.
The acute phase often presents with predominantly gastrointestinal symptoms and then neurological features of ataxia, tremor, confusion and nystagmus.

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36
Q

how does digoxin toxicity present

A

confusion
nausea
diarrhoea
visual symptoms
palpitations

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37
Q

if suspect a UTI in a pt over 65 yrs, what is the best investigation

A

urine culture
urine dips are unreliable in those > 65

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38
Q

gold standard Ix for lithium toxicity

A

serum lithium levels

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39
Q

what is used to treat agitation and seizures n drug overdose

A

benzodiazepines

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40
Q

how to manage lithium toxicity

A

discontinue lithium
supportive care

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41
Q

first line Tx for autoimmune encephalitis

A

steroids + IV Ig

Plasma exchange can also be used as an adjunctive treatment in those who are not fully responding to steroids or immunoglobulin; it is rarely used alone.

Second-line treatment, if patients are not responding within 2 weeks, includes immunosuppressant therapy with agents such as Rituximab and Cyclophosphamide. First line therapy should be continued during this time.

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42
Q

common complications of plasma exchange

A

infection
hypotension
electrolyte imbalances

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43
Q

in which cases would you give naloxone full dose instead of naloxone titrated to an opiate overdose pt

A

if they’re having any apnoeic episodes give naloxone full dose

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44
Q

first vs second generation antipsychotics

A

first generation (typical) = dopamine receptor antagonists eg haloperidol

second generation (atypical) = serotonin-dopamine antagonists eg risperiodone

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45
Q

what is acamprosate used for

A

maintaining alcohol abstinence

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46
Q

paranoid delusions
auditory hallucinations
agitation
diaphoresis
likely diagnosis ?

A

delirium tremens

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47
Q

first line Tx for delirium tremens

A

lorazepam

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48
Q

what is a reducing regime of chlordiazepoxide used for

A

acute alcohol withdrawal

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49
Q

what is IM olanzapine used to manage

A

agitation and disturbed behaviour in schizophrenia or mania

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50
Q

what does NICE specifically advise against doing fro opiate withdrawal and what should be done instead

A

dont prescribe opiates
instead do symptomatic management eg loperamide for diarrhoea, benzodiazepines for agitation

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51
Q

what is clozapine used to treat

A

treatment-resistant paranoid schizophrenia

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52
Q

first thing to do with a distressed patient who has delirium

A

use de-escalation techniques (verbal and non verbal)
Examples of de-escalation techniques include communicating and negotiating with the patient to resolve the situation in a non-confrontational manner, providing reassurance and reorientating the patient to time and place.

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53
Q

if de escalation techniques don’t work for distressed delirious pt what can u give

A

oral/IM (if refuse IM or pt poses risk to others) haloperidol/respiradone (antipsychotics)
or if they have parkisnons give benzodiazepines instead

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54
Q

for serum lithium levels above 3.5, what intervention is required

A

haemodialysis

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55
Q

somatoform disorder vs conversion disorder

A

somatoform = presence of PHYSICAL symptoms that cannot be explained by an underlying physical condition
eg abdo pain

conversion disorder = presence of NEUROLOGICAL symptoms that cannot be exlaplained by an underlying neurological condition
eg paralysis, loss of motor function

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56
Q

first line tx for delirium tremens

A

lorazepam

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57
Q

which medication is often used amongst student populations to increase concentration for revision, but can result in drug abuse

A

methylphenidate (‘ritalin’) - used to treat ADHD

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58
Q

which drugs cause hypertensive crisis, raised HR, raised body temp, anxiety and diarrhoea

A

stimulants eg cocaine, methamphetamine, or MDMA (ecstasy)

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59
Q

what is the key difference between alcohol and heroin withdrawal

A

presence of tremors and seizures in alcohol withdrawal.
Patients who withdraw from opiates also often have a runny nose and yawn.

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60
Q

methadone and buprenorphine are used to support detoxification from heorin. how do you decide which ten to use

A

if a patient has had a previous overdose on methadone, then buprenorphine should be given.
However, if both drugs are equally suitable, then methadone should be prescribed first line.

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61
Q

if a pt has delirium due to a UTI what is the tx

A

ABX!! eg trimethoprim
treat the underlying cause first

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62
Q

for medically unexplained symptoms should u offer psychological support or mediation/pain relief first

A

psychological support

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63
Q

how does delirium tremens and hepatic encephalopathy symptoms compare

A

hepatic encephalopothy is usually hypoactive - more drowsy and confused,
delirium tremens = agitated and anxious

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64
Q

train of symptoms of wernickes enceophalpathy

A

encephalopathy, oculomotor dysfunction and gait ataxia

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65
Q

lithium causes tremors. contrast the tremors caused by a therapeutic dose and an overdose

A

A fine tremor is a common side effect of therapeutic lithium medication. Importantly, a coarse tremor is seen in lithium toxicity.

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66
Q

methadone and buprenorphine can be used as opioid substitution therapy to assist in opioid dependence. which is more commonly used

A

methadone

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67
Q

effects of lithium on thyroid

A

hypothyroidism - raised TSH, low T3/4

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68
Q

which drug causes mood changes and hallucinations, as well as hypertension, tachycardia and hyperthermia

A

LSD

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69
Q

what do abscesses in a heroin user suggest

A

dependency - from where injected
“The abscess in this man’s antecubital fossa suggests that he continues to use heroin despite harmful physical side effects, one of the ICD-11 criteria for diagnosis of dependence syndrome”

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70
Q

which drug causes hypertension, tachycardia and hyperthermia, but no hallucinations

A

methamphetamine

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71
Q

which drug causes elevated mood, tachycardia and hyperthermia, but no hallucinations

A

ecstasy

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72
Q

false beliefs around the ownership of your thoughts. They can be subdivided into insertion, withdrawal, and broad-casting. They are classically seen in schizophrenia.

what type of delusion is this

A

delusion of thought possession

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73
Q

Patients believe they are being followed, spied on, or conspired against. This is classically seen in schizophrenia.

what type of delusion is this

A

delusion of persecution

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74
Q

exaggerated beliefs about one’s self-worth, power, or identity - for example, believing one is a king or queen. It is classically associated with mania.

what type of delusion is this

A

delusion of grandeur

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75
Q

the belief that one deserves to be punished. Usually, the ‘sin’ is an innocent error out of proportion to the guilt felt.

A

delusion of guilt

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76
Q

in which pts is venlefaxine / other SNRI’s contraindicated

A

pts with uncontrolled hypertension

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77
Q

what should be monitored in pts on venlefaxine / other SNRI’s

A

blood pressure - can cause hypertension

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78
Q

what medication is used for treatment resistant schizophrenia (failure of treatment of 2 other antipsychotic medications)

A

clozapine

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79
Q

side effects of clozapine

A

agranulocytosis, neutropenia, reduced seizure threshold, myocarditis, slurred speech (due to hypersalivation), constipation (most common cause of mortality when related to clozapine use).

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80
Q

what is carbamazepine used to treat

A

bipolar disorder

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81
Q

haloperidol side effects

A

neuroleptic malignant syndrome, QTc prolongation, extrapyramidal symptoms, tardive dyskinesia and antimuscarinic side effects.

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82
Q

which dementia is caused by multiple infarcts in the brain

A

vascular dementia - caused by multiple infarcts in the brain secondary to chronic cerebrovascular disease which disrupts the blood supply to the brain and affects cognitive function.

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83
Q

what does puerperal psychosis mean

A

postpartum psychosis

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84
Q

what is picks disease

A

frontotemporal dementia causing an accumulation of TAU proteins in neurones - usually identified post-mortem, and atrophy of the frontal and temporal lobes

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85
Q

what does lewy body dementia show on post mortem

A

alpha-synuclein cytoplasmic inclusions (Lewy Bodies)

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86
Q

early morning waking is pathognomonic of which condition

A

depression

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87
Q

contrast lewy body dementia and Parkinson’s disease dementia

A

Lewy body: cognitive impairments and parkisnonism present together

Parkinson’s disease dementia: presents with cognitive impairments years (or at least a year) after the development of the symptoms of Parkinson’s disease

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88
Q

pt who recently started anti psychotic medications that block dopamine, begins to experience hyperthermia, altered mental state, autonomic dysregulation, rigidity
diagnosis?

A

neuroleptic malignant syndrome

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89
Q

pt who recently started serotinergic medication begins to experience hyperthermia, autonomic dysregulation, and altered mental status.
diagnosis?

A

serotonin syndrome

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90
Q

what investigation is used for neurolpptic malignant syndrome

A

creatine kinase - CK will be elevated due to muscle rigidity

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91
Q

which specific questionnaire can be used for alcohol abuse

A

CAGE
(Cut down? Annoyed? Guilty? Eye opener?)

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92
Q

what is myalgic encephalomyelitis another word for

A

chronic fatigue syndrome

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93
Q

what is the AUDIT questionnaire used for

A

used to assess whether there is a need for a specialist evaluation concerning alcohol consumption. It is carried out by a skilled physician in the specialty.

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94
Q

definition/criteria for chronic fatigue syndrome

A
  • at least 4 months
  • disabling fatigue
  • affecting mental and physical function
  • more than 50% of the time
  • absence of other disease which may explain symptoms
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95
Q

symptoms of chronic fatigue syndrome

A

Persistent Disabling Fatigue → may be present for >6 months

Post-Exertional Fatigue –> Significant exhaustion and impairment following minimal physical or cognitive effort
PEM = Post exertion malaise)

Short-Term Memory or Concentration Impairment

Sore Throat

Arthralgia

Headache

Unrefreshing sleep

Flu-Like Symptoms (may preceed fatigue) → malaise, myalgia, feverness

Painful Lymph Nodes (NON PALPABLE)

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96
Q

screening tool for chronic fatigue syndrome

A

DePaul Symptom Questionnaire

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97
Q

management of chronic fatigue syndrome

A

Cognitive Behavioural Therapy → very effective

Graded Exercise Programme

Mindfulness, Sleep Hygeine, Occupational Therapy

Referral to a pain management clinic if pain is a predominant feature

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98
Q

describe pathology of alzheimers

A

degeneration of the cerebral cortex: cortical atrophy
hippocampal atrophy
reduction in acetylcholine production
build up of APP (due to beta and gamma secretase)

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99
Q

what is seen on neuroimaging in alzheimers

A

cortical atrophy
hippocampal atrophy

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100
Q

describe disease progression in alzheimers

A

slowly progressive,
episodic impairment of memory

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101
Q

describe pathology of vascular dementia

A

brain damage due to several incidents of cerebrovascular disease

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102
Q

what is seen on neuroimaging in vascular dementia

A

lacunar infarcts (white areas on MRI)

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103
Q

describe disease progression in vascular dementia

A

abrupt cognitive decline
stepwise deterioration

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104
Q

describe pathology of lewy body dementia

A

deposition of abnormal proteins (Lewy bodies) within the brain stem and neocortex

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105
Q

what form of neuroimaging is used in lewy body dementia

A

SPECT (DAT scan)

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106
Q

describe disease progression and features in lewy body dementia

A

steady decline,
fluctuating levels of consciousness,
visual hallucinations
parkinsonian motor disorders

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107
Q

which medications can cause irreversible Parkinsonism so should be avoided in Lewy body dementia

A

anti psychotics

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108
Q

describe pathology of frontotemporal dementia

A

specific degeneration of the frontal and temporal lobes caused by pick bodies

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109
Q

what is seen on neuroimaging in frontotemporal dementia

A

frontal and temporal lobe atrophy

110
Q

describe disease progression and features in frontotemporal dementia

A

early changes in personality (eg. Impulsivity, aggressiveness)
metabolic disorders
Often has a family history
Starts slightly earlier than other dementias (50-60).

111
Q

order of prevalence of the types of dementia

A

alzheimers
vascular
Lewy body
frontotemporal

112
Q

depression in elderly vs dementia

A

depression has:
shorter history
rapid onset
biological symptoms (eg. sleep disturbance).

113
Q

which test is used for dementia

A

MMSE

114
Q

normal, mild and severe scores for MMSE

A

24-30 (no cognitive impairment)
18-23 (mild cognitive impairment)
0-17 (severe cognitive impairment)

115
Q

what is done during dementia Ix to look for reversible causes

A

Neuroimaging: subdural haematoma
Blood screen

116
Q

1st line / mild-moderate alzheimers Tx

A

acetylcholinesterase inhibitors (donepezil, rivastigmine)
- if hallucinations one of main symptoms, galantamine

117
Q

in which pts are acetylcholinesterase inhibitors C/I for mild-moderate alzheimers

A

pts with prolonged QT

118
Q

2nd Line / severe alzheimer’s Tx

A

memantine (NMDA receptor antagonist, leading to decreased glutamate induced excitotoxicity)

119
Q

Non-Pharmacological Treatment for dementia

A

Cognitive Stimulation Therapy → improve memory and problem solving skills
Cognitive Rehabilitation

120
Q

what is the aetiology behind depression

A

lack of monoamines (serotonin, noradrenaline, dopamine)

121
Q

diagnosis of MDD

A

≥5/9 criteria met
⇒ Depressed Mood OR Anhedonia + 4 other symptoms of depression (for min. 2 weeks)

criteria: D SIGE CAPS

Depressed mood

Sleep disturbance
Interest diminished (anhedonia)
Guilt
Energy loss (fatigue)

Concentration difficulties
Appetite loss –> causes weight loss
Psychomotor retardation/agitation
Suicide ideation

122
Q

2 depression questionnaires

A

Patient Health Questionnaire-9 (PHQ-9)

Hospital Anxiety and Depression (HAD) Scale

123
Q

first line and alternative meds for depression

A

SSRIs (eg. citalopram or sertraline)

Alternatives include
SNRIs (venlafaxine, duloxetine),
MAO inhibitors,
TCAs (amitriptyline)

124
Q

what type of med are venlafaxine / duloxetine

A

SNRIs

125
Q

what type of med is amitryptiline

A

TCA

126
Q

SSRIs side effects

A

GI side effects,
erectile dysfunction,
hyponatraemia (SIADH),
citalopram prolongs QT interval,
if used with NSAIDs have high risk of GI bleeding (co-prescribe PPI)

127
Q

what should you coprescribe with SSRIs if they’re being used with NSAIDS, and why

A

co prescribe PPI, high risk of GI bleed

128
Q

what is the SSRI of choice in children and adolescents for depression

A

Fluoxetine

129
Q

what is the SSRI of choice post myocardial infarction, for depression

A

sertraline

130
Q

describe how a patient should stop taking antidepressants when their symptoms are improved

A

Antidepressants should be continued for at least 6 months after remission of symptoms to decrease risk of relapse.

When stopping antidepressants, doses should be reduced gradually over a four week period

131
Q

pt has triad of gait disturbance, dementia and urinary incontinence
diagnosis?

A

normal pressure hydrocephalus (NPH)
(NPH is a rare condition characterised by excessive fluid building up in the ventricles of the brain)

(“Wet, Wobbly, Weird”)

132
Q

which SSRIs are preferred in breastfeeding

A

paroxetine and sertraline

133
Q

baby blues vs post natal depression

A

baby blues = few days after giving birth due to fall in hormone levels

post natal depression = presents a couple months after giving birth has more symptoms of classic depression eg. guilt, anhedonia, and lasts for 2 weeks at least

134
Q

what kind of medication is paroxetine

A

SSRI

135
Q

treatment for baby blues

A

reassurance and observation.

136
Q

what should patients be monitored for when starting antidepressants or having a change of dose of their current antidepressant

A

suicidal thoughts
(All antidepressants, including sertraline, have been associated with an increase in suicidal thoughts in adolescents and young adults, as well as in those with a history of suicidal behaviour)

137
Q

main symptoms of vascular dementia

A

focal neurological deficits, such as weakness or paralysis, rather than the gradual cognitive decline seen in Alzheimer’s disease

138
Q

what is the maximum number of months after birth in which depression is classed as post part depression

A

within the first 12 months

139
Q

Tx for transient global amnesia

A

no action needed

140
Q

treatment for recurrent depression

A

antidepressant + lithium

141
Q

treatment for severe depression and poor oral intake/psychosis/stupor(almost unconscious)

A

ECT - Electroconvulsive therapy

142
Q

Tx for pts with persistent subthreshold depressive symptoms or mild-to-moderate depression

A

psychological therapy

143
Q

side effect of memantine

A

constipation

144
Q

what are the 6S side effects of SSRIs

A

Stomach ulcers
Sexual dysfunction
Sodium low
Sleep disturbance
Suidical ideations
serotonin syndrome

145
Q

what does agnosia mean

A

inability to recognise people, objects or places that were once known to a person

146
Q

what does apraxia mean

A

inability to carry out skilled motor function, despite normal motor function

147
Q

what does abolition mean

A

loss of motivation

148
Q

side effect of ECT (electroconvulsive therapy)

A

memory loss

149
Q

woman has been on galantamine max dose for a year and her depression is not getting better
which medication should it be changed to, added with

A

add memantine

Donepezil, galantamine and rivastigmine are in the same class of drugs. There is no evidence that galantamine is not tolerated or ineffective in this woman. Hence, there is no indication to change the current drug to another drug in the same class. Offering memantine in addition to galantamine is the most appropriate management option for disease progression.

150
Q

what kind of antidepressant is venlafaxine

A

SNRI (serotonin and noradrenaline reuptake inhibitor)

151
Q

what are SNRIs C/I in

A

controlled HTN - can cause increased bp

152
Q

1st 2nd and 3rd line medications for depression

A
  1. SSRIs
  2. NaSSA eg mirtazapine
    SNRI eg venlafaxine
  3. MAOI eg moclobemide
    TCA (Clomipramine)
153
Q

which medications should SSRIs not be prescribed with

A

anticoagulants, esp among elderly - increases the risk bleeding
NSAIDS - increases risk of GI bleed, co prescribe PPI

154
Q

which SSRIs can be used whilst breastfeeding

A

sertraline
paroxetine

155
Q

why should TCAs be avoided in pts with coronary heart disease

A

can cause arrhythmias

156
Q

what kind of antidepressant is clomipramine

A

TCA

157
Q

what kind of antidepressant is imipramine

A

TCA

158
Q

which part of brain does flight or fight response

A

amygdala

159
Q

normal AMTS

A

8 and above = normal cognitive function

160
Q

pt on haloperidol begins to feel restless feeling of tension, low mood and suicidal ideation
what is the problem

A

akathisia

This man most likely has akathisia secondary to the antipsychotic haloperidol. Akathisia is characterised by the feeling of inner restlessness and tension, an urge to constantly move parts of the body, especially the legs, and difficulty maintaining a posture for a few minutes.
Due to its distressing nature, akathisia is associated with aggression, low mood and suicidal ideations

161
Q

which factor increases risk of a pt going on to complete suicide

A

previous PLANNED suicide attempts
(not unplanned - that just shows impulsivity)

162
Q

how does panic disorder affect calcium levels

A

causes hypocalcaemia

A sudden feeling of intense anxiety can cause hyperventilation, which in turn reduces arterial CO2 and increases blood pH. Alkalosis promotes calcium binding to albumin, reducing the levels of free calcium and thus causing hypocalcaemia.
hypocalcaemia causes numbness and tingling

163
Q

what is tardive dyskinesia

A

repetitive movements often affecting the face and jaw, but can also affect the limbs too
(side effect of typical first generation antipsychotics)

164
Q

what is the effect of hypo and hyperthyroidism on periods

A

Hyperthyroid - Amenorrhoea
Hypothyroid - Menorrhagia

165
Q

A 60-year-old patient presents with behavioural changes, social disinhibition, and loss of empathy.

What is the most likely diagnosis?

A

front-temporal dementia

166
Q

what is the first investigation to do for a pt on antipsychotics who presents with amenorrhoea or oligomenorrhoea, decreased libido, galactorrhoea, infertility and osteoporosis

A

prolactin (most antipsychotics increase prolactin)

167
Q

what is the triad of confusion, ataxia and ophthalmoplegia

A

wernickes syndrome

168
Q

what needs to be given to a pt with wernickes syndrome to prevent it becoming Korsakoff’s syndrome

A

vit B1

169
Q

what is confabulation

A

making up things

170
Q

what features does korsakoffs syndrome consist of

A

disorientation, anterograde and retrograde amnesia and confabulation

171
Q

which dementia presents as a stepwise deterioration

A

vascular

172
Q

main TCA side effects

A

dry mouth
urinary retention

173
Q

Tx for normal pressure hydrocephalus (wet, wobbly, weird)

A

first line investigation/treatment would be a lumbar puncture and if relieving the pressure resolves the symptoms a ventriculoperitoneal shunt would be inserted

174
Q

what type of dementia is semantic dementia

A

a form of frontotemporal dementia

175
Q

what is semantic dementia

A

defect in semantic memory (the ability to associate meaning to objects presented via visual or auditory modalities) –> is a type of frontotemporal dementia

176
Q

what kind of medication is quetiapine

A

antipsychotic - can be used to treat postpartum psychosis

177
Q

lines of treatment for anxiety

A
  1. psychoeducation
  2. self help eg online workbooks
  3. CBT
  4. pharmacological therapies –> SSRIs (sertraline)
  5. another SSRI / SNRI (duloxetine or venlafaxine) / pregabalin
178
Q

what are lesions in mamillary bodies a sign of

A

wernickes encephalopathy - due to thiamine deficiency

179
Q

what does apathetic mean

A

showing or feeling no interest, enthusiasm, or concern

180
Q

likely cause for sudden onset memory loss

A

transient global amnesia

181
Q

what type of dementia can affect hippocampus

A

alzheimers
(affects cerebral cortex and hippocampus)

182
Q

first symptoms of alzheimers

A

amnesia for recent memories
(amnesia for childhood memories and procedural memory loss are more later stage Alzheimer’s)

183
Q

most significant side effects of antipsychotics

A

stroke (cause weight gain and abnormal lipid profiles)

184
Q

what blood test is most appropriate to do in a pt presenting with depressive symptoms

A

TFT

185
Q

how long after delivery does postpartum psychosis present

A

2 weeks after delivery

186
Q

intellectual disability, macrodactyly, macro-orchidism, long face and large ears, autism
likely diagnosis

A

fragile X syndrome (caused by a trinucleotide repeat in the Fragile X Mental Retardation 1 (FMR1) gene)

187
Q

pathology of parkisnons

A

caused by build up of alpha-synuclein, starting in the substantia nigra and then progressing often to include the majority of the cerebral cortex

188
Q

which genetic condition causes early onset alzheimers

A

down syndrome

189
Q

which condition causes protruding tongue, prominent epicanthal folds and a single transverse palmar crease

A

Down syndrome

190
Q

what is risperidone

A

antipsychotic used for schizophrenia

191
Q

which medication can be used to manage tremor and akathisia, the extra pyramidal side effects of antipsychotics

A

procyclidine

192
Q

which medication can be used to manage the parkinsonsonian and dystonic side effects of antipsychotics

A

benztropine

193
Q

which medication can be used to treat the metabolic and prolactin elevation side effects of antipsychotics

A

metformin

194
Q

which dementia can present with history of falls, sleep walking and talking to pets which are dead

A

lewy body dementia

triad of REM sleep disorder, a history of falls (secondary to motor problems- Parkinsonism), and hallucinations. The hallucinations are often of small, non-threatening people and animals (Lilliputian hallucinations).

195
Q

what kind of medication is citalopram

A

SSRI

196
Q

which medications can be used to manage the somatic symptoms vs the cognitive aspect of anxiety

A

somatic symptoms eg tremors, sweating = beta blockers - PROPANOLOL (not bisoprolol)

cognitive aspect = SSRIs

197
Q

first line management for pt with dementia and Qt prolongation

A

cognitive stimulation therapy

198
Q

what should you check for on ECG before starting as pt on Acetylcholinesterae inhibitors

A

prolonged QT,
second or third degree heart block in an unpaced patient
sinus bradycardia <50 bpm

–> all of these are contraindications for Acetylcholinesterae inhibitors

199
Q

how long can uncomplicated grief persist, after which it could be prolonged grief disorder depression

A

no longer than 6 months

200
Q

what is the initial questionnaire for alcohol intake, and then the further questionnaire done after this to assess if there’s need for specialist evaluation

A

initial = CAGE
further questionnaire = AUDIT

201
Q

pt on antipsychotic medication presents with hypertonia, hyperthermia, autonomic instability and mental state change
likely diagnosis and investigation required?

A

neuroleptic malignant syndrome (NMS)
measure creatinine kinase - will be very high

202
Q

first lien investigation for new onset palpitations that are exercise induced or pt has history of syncope/near syncope

A

48 hour Holter monitor ECG

203
Q

INITIAL screening for confusion / memory loss

A

TFTs/bloods
cognitive questionnaires

THEN can begin neuroimaging eg MRI

204
Q

what is Creutzfeldt–Jakob disease (CJD) caused by

A

prions (misfolded proteins)

205
Q

management of behavioural and psychological symptoms of FTD

A

behavioural interventions and lifestyle modifications

  • if these don’t work can use atypical antipsychotics, but are generally not recommended as first-line treatment due to their side effect profile and the increased risk of mortality in elderly patients with dementia.
206
Q

preferred TCAs for breastfeeding women

A

Imipramine and nortriptyline

207
Q

what is pseudodementia caused by

A

severe depression can lead to psycho-motor slowing, memory impairment and difficulties in concentration similar to dementia in appearance

208
Q

haloperidol ecg changes

A

prolonged QT interval

209
Q

serious side effect of clozapine

A

agranulocytosis

210
Q

common side effect of clozapine

A

constipation

211
Q

what is clozapine used to treat

A

treatment resistant schizophrenia

212
Q

speech disturbance, vertical gaze dysfunction, dementia
diagnosis?

A

progressive supra nuclear palsy

213
Q

psychosis, extrapyramidal symptoms, jaundice, Kayser-fleischer rings, dementia, young age onset
diagnosis ?

A

Wilsons disease

214
Q

low levels of which neurotransmitter are associated with developing anxiety

A

GABA
(GABA is inhibitory so low levels of it allow neurones to activate at an increased rate)

215
Q

in which dementia is haloperidol C/I

A

Lewy body
- shouldn’t give antipsychotics as can worsen parkinsonism and cause fall

216
Q

first line managment of post partum depression

A

CBT
- if mother/babys safety is at risk, admit to baby and mother unit

217
Q

in which type of antipsychotics are extrapyramidal symptoms seen

A

typical antipsychotics - in particular dopamine receptor blockers

218
Q

in which type of antipsychotics is weight gain a very common side effect

A

atypical antipsychotics

219
Q

pt is taking SSRI, amphetamines and has restlessness, diaphoresis, clonus, hyperthermia, rigidity, hyperreflexia
diagnosis?

A

serotonin syndrome

220
Q

pt is taking antipsychotic olanzapine and has altered mental state, diaphoresis, tachycardia, rigidity and hyperthermia, normal pupils, hyporeflexia and does not have clonus
diagnosis?

A

Neuroleptic malignant syndrome (NMS)

221
Q

NMS vs serotonin syndrome

A

NMS:
antipsychotics
altered mental state, diaphoresis, tachycardia, rigidity and hyperthermia
HYPOreflexia
NORMAL pupils

serotonin syndrome:
SSRIs / amphetamines
restlessness, diaphoresis, clonus, hyperthermia, rigidity
HYPERreflexia
DILATED pupils

222
Q

olanzapine common side effect

A

weight gain

223
Q

which antidepressants can cause blurred vision

A

TCAs eg imipramine

224
Q

what type of antidepressant is imipramine

A

TCA

225
Q

TCA side effects

A

Urinary retention
Drowsiness
Blurred vision
Constipation
Dry mouth

226
Q

A 52-year-old man with a history of chronic alcoholism presents with ataxia and confusion. He has nystagmus, ophthalmoplegia and short-term memory loss on examination.

What is the most likely diagnosis?

A

Wernicke’s encephalopathy

(Korsakoffs syndromen is a chronic memory disorder often seen in patients with chronic alcoholism, following Wernicke’s encephalopathy - MEMORY LOSS AND CONFABULTION)

227
Q

first line pharmacological Tx for panic disorder

A

SSRis: escitalopram, sertraline, citalopram and paroxetine
and Venlafaxine (a serotonin and noradrenaline reuptake inhibitor)

228
Q

risk factors for opiate overdose

A

mental health conditions,
alcoholics,
renal impairment (can’t excrete drug)

229
Q

what kind of drug is fentanyl

A

opiate

230
Q

what kind of drug is loperamide

A

opiate

231
Q

features of opiate overdose

A

bilateral miosis (’pinpoint pupils’),
respiratory depression (bradypnoea),
altered mental status,
constipation,
needle track marks,
Rhinorrhoea

232
Q

Ix for opiate overdose

A
  • Toxicology Screen
  • Opiate
    → therapeutic trial of naloxone.
    May show reversal of overdose signs.
233
Q

management of opiate overdose

A

Airway Management + Oxygen

IV Naloxone

234
Q

max dose of paracetamol

A

2x 500mg tablets, 4x in 24 hours

235
Q

2 types of paracetamol overdose

A

acute overdose or staggered overdose
(staggered is worse than acute)

236
Q

risk factors for developing hepatotoxicity due to paracetamol overdose

A

chronic alcohol use,
HIV,
p450 inducers
malnourished patients (eg. anorexia)

237
Q

most important prognostic factor for paracetamol overdose

A

arterial pH (<7.30)

238
Q

features of paracetamol overdose

A

nausea & vomiting,
RUQ pain,
jaundice (may signify acute liver failure),
hepatomegaly,
altered conscious level

239
Q

Ix for paracetamol overdose

A

serum paracetamol concentration (whether treated or not based on nomogram),
LFTs (ALT may be elevated),
PT (may be prolonged).
pH (<7.30 is bad).

240
Q

management of paracetamol overdose based on type of overdose and hours

A

not staggered < 1hr
= activated charcoal

not staggered < 4hrs
= wait till 4 hrs, take level, treat with Nacetylcysteine based on level

not staggered 4-15 hrs
= take level, treat with Nacetylcysteine based on level

staggered > 1hr / not staggered > 15 hrs / timing uncertainty
= IV Nacetylcysteine

241
Q

which medication has been overdose in salicylate toxicity

A

aspirin

242
Q

ABG results of salicylate toxicity

A

mixed respiratory alkalosis
(due to hyperventilation)

raised anion gap metabolic acidosis
(due to toxicity + acute renal failure)

243
Q

features of salicylate toxicity

A

tinnitus,
N&V,
lethargy,
tachypnoea (hyperventilation),
diaphoresis,
hyperthermia,
agitation,
seizures,
Coma

244
Q

Ix and classification for salicylate overdose

A

ABG (mixed respiratory alkalosis and metabolic acidosis),

Salicylate Levels (repeat every 2 hours until peak level).
○ Classified according to peak salicylate levels
mild (<300 mg/L),
moderate (300-700 mg/L),
severe (>700 mg/L)

245
Q

management for for salicylate overdose

A

Activated Charcoal → can be used within an hour of opiate overdose

Sodium Bicarbonate → alkalizes urine, hence increasing elimination of aspirin in urine

Haemodialysis → indicated if pulmonary oedema and severe metabolic acidosis

246
Q

indications for haemodialysis in salicylate toxicity

A

pulmonary oedema
severe metabolic acidosis

247
Q

features of TCA overdose

A

blurred vision,
dilated pupils,
dry mouth/skin
convulsions
agitation,
ECG: broad QRS, prolonged QT (arrhythmias)

248
Q

ECG changes in TCA overdose

A

broad QRS, prolonged QT (arrhythmias)

249
Q

Tx for TCA overdose

A

IV sodium bicarbonate

250
Q

time frame needed for anxiety diagnosis

A

Excessive worry for at least 6 months

251
Q

6 core symptoms of anxiety, and how many are needed for diagnosis

A

(at least 3 for diagnosis)

muscle tension, 
sleep disturbance, 
fatigue, 
restlessness, 
irritability, 
poor concentration
252
Q

what must be ruled out with a blood test if a pt presents with anxiety symptoms

A

must rule out hyperthyroidism with TFTs

253
Q

3 steps of anxiety management

A

Step 1 (education + monitoring)

Step 2 (low-intensity psychological intervention)

Step 3 (CBT or Pharmacology)

pharmacology 1st line = SSRI sertraline
- If ineffective, try another SSRI or an SNRI (duloxetine or venlafaxine).
- If can’t tolerate SSRIs and SNRIs, offer pregabalin.

254
Q

main causes of delirium

A

metabolic causes
(hypercalcaemia, hypoglycaemia, hyponatraemia, dehydration),

infections
(UTIs, pneumonia),

255
Q

how long after alcohol cessation does delirium tremens develop

A

72 hours after ceasing alcohol intake

256
Q

Tx for delirium tremens

A

chlordiazeproxide, pabrinex, lorazepam, diazepam

257
Q

main factor which differentiates delirium and dementia

A

Impairment of consciousness: consciousness is affected in delirium not dementia

258
Q

2 types of delirium and which is more common

A

May be hypoactive (25% - decreased psychomotor activity) or hyperactive (75% - increased psychomotor activity)

(Hypoactive ⇒ withdrawn, lethargic, slow to respond)

259
Q

how do severity of symptoms of delirium change through the day and when is it worse

A

severity of symptoms fluctuates throughout the day and worsens in the evening

260
Q

delirium vs dementia: onset

A

sudden vs insidious

261
Q

delirium vs dementia: course

A

rapid and fluctuating vs slowly progressive deterioration

262
Q

delirium vs dementia: consciousness and attention

A

decreased/fluctuating vs intact

263
Q

delirium vs dementia: memory

A

recent memory loss only vs recent then remote memory loss

264
Q

delirium vs dementia: hallucinations

A

present vs present in advanced disease

265
Q

delirium vs dementia: psychomotor activity

A

increased/decreased vs normal

266
Q

delirium vs dementia: EEG

A

abnormal vs normal

267
Q

delirium vs dementia: reversibility

A

reversible vs irreversible

268
Q

Ix for delirium

A

Confusion Screen
- TFTs (Hypothyroidism),
B12,
Folate,
Glucose (Hypoglycaemia),
Bone Profile (Hypercalcaemia)

Look for underlying cause
- urinalysis (UTI),
chest x-ray (infection),
CRP/WCC,
serum glucose (hypoglycaemia),
bladder scan (urinary retention),
Electrolytes

Cognitive Impairment Screening
- AMTS or MMSE or MoCA
AMTS (6 or less suggests delirium or dementia)

269
Q

AMTS score which indicates delirium/dementia

A

6 or less

270
Q

management of delirium and more specifically hyperactive delirium

A

treat underlying cause
patient comfort and symptom control
Reducing Confusion → reorient patient to time, place and person a few times a day

Treatment of Agitation (Hyperactive Delirium)

→ 1st line antipsychotics (haloperidol/respiradone)

Antipsychotics contraindicated in parkinson’s as they worsen symptoms → Lorazepam (benzodiazepine) may be used instead

Offer oral initially, if refused and patient poses immediate physical risk to other patient, IM route is justified.

year 3 conditions (17 decks)

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