Psychiatry Flashcards
what is cotards syndrome
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’).
withdrawal from which drug causes piloerection (hairs standing on end), rhinorrhea and hyperreflexia
opioid
which symptoms of alcohol withdrawal distinguish it from withdrawal from other drugs
hallucinations, tremors
describe symptoms of phencyclidine withdrawal
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
what is hypochondriasis aka illness anxiety disorder
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.
what is somatisation disorder / somatic symptom disorder
multiple medically unexplained physical symptoms across multiple organ systems, with the symptoms causing significant distress and impairment
what is malingering
intentionally feigning or exaggerating symptoms for some external gain, such as financial compensation or avoiding legal consequences
what is conversion disorder
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.
what are slurred speech and coarse tremor symptoms of
lithium toxicity - requires urgent medical attention
likely diagnosis:
muscle rigidity and rhabdomyolysis followed by a fever and mental state changes
neuroleptic malignant syndrome
(life-threatening neurologic emergency associated with the use of antipsychotic (neuroleptic) agents)
what is neuroleptic malignant syndrome a complication of
anti psychotic use
mech of action of naloxone
opioid antagonist
which drug can be used to help relieve diarrhoea in opiate withdrawal
loperamide
which drug can be sued to help relieve agitation in opiate withdrawal
benzodiazepines
what is lofexidine used for
can be used as a form of symptomatic relief for opioid withdrawal
which medications can be used in detox programmes for opiate withdrawal (to help with detoxification and maintenance therapy to prevent further use)
methadone
buprenorphine
effects of LSD
Labile mood
Hallucinations
Increased blood pressure
Increased heart rate
Increased temperature
Sweating
Insomnia
Dry mouth
effects of cannabis
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
which receptor does cocaine work at
dopamine receptors
which receptor does methamphetamine work at
TAAR1 (trace amine - associated receptor 1) receptors
which medication could be used to treat anxiety / agitation in patients with heroin withdrawal
benzodiazepine
contrast the pupils and management of heroin intoxication and heroin withdrawal
heroin intoxication = constricted pupils -> naloxone for OD
heroin withdrawal = dilated pupils -> supportive Tx, symptom relief -»> methadone, buprenorphine
management of stimulant (cocaine, methamphetamine, or MDMA (ecstasy)) intoxication
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
which condition causes personality / behaviour changes, seizures, short term memory impairment, altered conscious level, disorientation abruptly within days to weeks
limbic encephalitis
what should be confirmed before a lumbar puncture is performed
that there is no raised ICP
what is the order of investigations for a pt presenting with new seizures/confusion/memory impairment
- neurological exam
- MRI brain
- lumbar puncture (check for raised ICP before doing this)
what is Munchausen syndrome
patients fake illnesses to receive attention
what is la belle indifference
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
what is wernickes syndrome caused by
thiamine deficiency in chronic alcoholism
what symptoms is wernickes encephalopathy characterised by
nystagmus
opthalmoplegia
confusion
ataxia
what is a nosocomial infection
infection originating in hospital
anterograde vs retrograde amnesia
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.
what is confabulation
a neuropsychiatric disorder wherein a patient generates a false memory without the intention of deceit
what is korsakoff’s syndrome
an irreversible progression of Wernicke’s encephalopathy.
It has the same symptoms, with the addition of antero- and retrograde amnesia and confabulation
how does lithium toxicity present
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.
how does digoxin toxicity present
confusion
nausea
diarrhoea
visual symptoms
palpitations
if suspect a UTI in a pt over 65 yrs, what is the best investigation
urine culture
urine dips are unreliable in those > 65
gold standard Ix for lithium toxicity
serum lithium levels
what is used to treat agitation and seizures n drug overdose
benzodiazepines
how to manage lithium toxicity
discontinue lithium
supportive care
first line Tx for autoimmune encephalitis
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.
common complications of plasma exchange
infection
hypotension
electrolyte imbalances
in which cases would you give naloxone full dose instead of naloxone titrated to an opiate overdose pt
if they’re having any apnoeic episodes give naloxone full dose
first vs second generation antipsychotics
first generation (typical) = dopamine receptor antagonists eg haloperidol
second generation (atypical) = serotonin-dopamine antagonists eg risperiodone
what is acamprosate used for
maintaining alcohol abstinence
paranoid delusions
auditory hallucinations
agitation
diaphoresis
likely diagnosis ?
delirium tremens
first line Tx for delirium tremens
lorazepam
what is a reducing regime of chlordiazepoxide used for
acute alcohol withdrawal
what is IM olanzapine used to manage
agitation and disturbed behaviour in schizophrenia or mania
what does NICE specifically advise against doing fro opiate withdrawal and what should be done instead
dont prescribe opiates
instead do symptomatic management eg loperamide for diarrhoea, benzodiazepines for agitation
what is clozapine used to treat
treatment-resistant paranoid schizophrenia
first thing to do with a distressed patient who has delirium
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.
if de escalation techniques don’t work for distressed delirious pt what can u give
oral/IM (if refuse IM or pt poses risk to others) haloperidol/respiradone (antipsychotics)
or if they have parkisnons give benzodiazepines instead
for serum lithium levels above 3.5, what intervention is required
haemodialysis
somatoform disorder vs conversion disorder
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
first line tx for delirium tremens
lorazepam
which medication is often used amongst student populations to increase concentration for revision, but can result in drug abuse
methylphenidate (‘ritalin’) - used to treat ADHD
which drugs cause hypertensive crisis, raised HR, raised body temp, anxiety and diarrhoea
stimulants eg cocaine, methamphetamine, or MDMA (ecstasy)
what is the key difference between alcohol and heroin withdrawal
presence of tremors and seizures in alcohol withdrawal.
Patients who withdraw from opiates also often have a runny nose and yawn.
methadone and buprenorphine are used to support detoxification from heorin. how do you decide which ten to use
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.
if a pt has delirium due to a UTI what is the tx
ABX!! eg trimethoprim
treat the underlying cause first
for medically unexplained symptoms should u offer psychological support or mediation/pain relief first
psychological support
how does delirium tremens and hepatic encephalopathy symptoms compare
hepatic encephalopothy is usually hypoactive - more drowsy and confused,
delirium tremens = agitated and anxious
train of symptoms of wernickes enceophalpathy
encephalopathy, oculomotor dysfunction and gait ataxia
lithium causes tremors. contrast the tremors caused by a therapeutic dose and an overdose
A fine tremor is a common side effect of therapeutic lithium medication. Importantly, a coarse tremor is seen in lithium toxicity.
methadone and buprenorphine can be used as opioid substitution therapy to assist in opioid dependence. which is more commonly used
methadone
effects of lithium on thyroid
hypothyroidism - raised TSH, low T3/4
which drug causes mood changes and hallucinations, as well as hypertension, tachycardia and hyperthermia
LSD
what do abscesses in a heroin user suggest
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”
which drug causes hypertension, tachycardia and hyperthermia, but no hallucinations
methamphetamine
which drug causes elevated mood, tachycardia and hyperthermia, but no hallucinations
ecstasy
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
delusion of thought possession
Patients believe they are being followed, spied on, or conspired against. This is classically seen in schizophrenia.
what type of delusion is this
delusion of persecution
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
delusion of grandeur
the belief that one deserves to be punished. Usually, the ‘sin’ is an innocent error out of proportion to the guilt felt.
delusion of guilt
in which pts is venlefaxine / other SNRI’s contraindicated
pts with uncontrolled hypertension
what should be monitored in pts on venlefaxine / other SNRI’s
blood pressure - can cause hypertension
what medication is used for treatment resistant schizophrenia (failure of treatment of 2 other antipsychotic medications)
clozapine
side effects of clozapine
agranulocytosis, neutropenia, reduced seizure threshold, myocarditis, slurred speech (due to hypersalivation), constipation (most common cause of mortality when related to clozapine use).
what is carbamazepine used to treat
bipolar disorder
haloperidol side effects
neuroleptic malignant syndrome, QTc prolongation, extrapyramidal symptoms, tardive dyskinesia and antimuscarinic side effects.
which dementia is caused by multiple infarcts in the brain
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.
what does puerperal psychosis mean
postpartum psychosis
what is picks disease
frontotemporal dementia causing an accumulation of TAU proteins in neurones - usually identified post-mortem, and atrophy of the frontal and temporal lobes
what does lewy body dementia show on post mortem
alpha-synuclein cytoplasmic inclusions (Lewy Bodies)
early morning waking is pathognomonic of which condition
depression
contrast lewy body dementia and Parkinson’s disease dementia
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
pt who recently started anti psychotic medications that block dopamine, begins to experience hyperthermia, altered mental state, autonomic dysregulation, rigidity
diagnosis?
neuroleptic malignant syndrome
pt who recently started serotinergic medication begins to experience hyperthermia, autonomic dysregulation, and altered mental status.
diagnosis?
serotonin syndrome
what investigation is used for neurolpptic malignant syndrome
creatine kinase - CK will be elevated due to muscle rigidity
which specific questionnaire can be used for alcohol abuse
CAGE
(Cut down? Annoyed? Guilty? Eye opener?)
what is myalgic encephalomyelitis another word for
chronic fatigue syndrome
what is the AUDIT questionnaire used for
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.
definition/criteria for chronic fatigue syndrome
- 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
symptoms of chronic fatigue syndrome
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)
screening tool for chronic fatigue syndrome
DePaul Symptom Questionnaire
management of chronic fatigue syndrome
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
describe pathology of alzheimers
degeneration of the cerebral cortex: cortical atrophy
hippocampal atrophy
reduction in acetylcholine production
build up of APP (due to beta and gamma secretase)
what is seen on neuroimaging in alzheimers
cortical atrophy
hippocampal atrophy
describe disease progression in alzheimers
slowly progressive,
episodic impairment of memory
describe pathology of vascular dementia
brain damage due to several incidents of cerebrovascular disease
what is seen on neuroimaging in vascular dementia
lacunar infarcts (white areas on MRI)
describe disease progression in vascular dementia
abrupt cognitive decline
stepwise deterioration
describe pathology of lewy body dementia
deposition of abnormal proteins (Lewy bodies) within the brain stem and neocortex
what form of neuroimaging is used in lewy body dementia
SPECT (DAT scan)
describe disease progression and features in lewy body dementia
steady decline,
fluctuating levels of consciousness,
visual hallucinations
parkinsonian motor disorders
which medications can cause irreversible Parkinsonism so should be avoided in Lewy body dementia
anti psychotics
describe pathology of frontotemporal dementia
specific degeneration of the frontal and temporal lobes caused by pick bodies