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Phase 4 > Psychiatry > Flashcards

Psychiatry Flashcards

1
Q

describe the management of generalised anxiety disorder

A
  • education about GAD + active monitoring
  • low intensity psychological interventions (self-help)
  • high-intensity psychological interventions (CBT) or drug treatment

drug treatment
- sertraline as first-line SSRI
- if ineffective, alternative SSRI or SNRI e.g. duloxetine, venlafaxine
- offer pregabalin if not tolerated
- propranolol for acute anxiety

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2
Q

list the SSRIs of choice in the following patient populations
- breastfeeding women

A
  • breastfeeding women: sertraline or paroxetine
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3
Q

list different types of personality disorders

A

Cluster A: odd or eccentric
- paranoid “accusatory”
- schizoid “aloof”
- schizotypal “awkward”

Cluster B: dramatic, emotional or erratic
- antisocial “bad”
- borderline (emotionally unstable)
- histrionic “flamBoyant”
- narcissistic “best”

Cluster C: anxious and fearful
- obsessive-compulsive “compulsive”
- avoidant “cowardly”
- dependent “clingy”

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4
Q

describe paranoid personality disorder

A

cluster A: “accusatory”

  • Hypersensitivity and unforgiving attitude when insulted
  • Unwarranted tendency to question the loyalty of friends
  • Reluctance to confide in others
  • Preoccupation with conspirational beliefs and hidden meaning
  • Unwarranted tendency to perceive attacks on their character
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5
Q

describe schizoid personality disorder

A

cluster A: “aloof”

  • 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 or confidants other than family
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6
Q

describe schizotypal personality disorder

A

cluster A: “awkward”

  • Ideas of reference (differ from delusions in that some insight is retained)
  • Odd beliefs and magical thinking
  • Unusual perceptual disturbances
  • Odd, eccentric behaviour
  • Inappropriate affect
  • Odd speech without being incoherent
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7
Q

describe antisocial personality disorder

A

cluster B: “bad”

  • Failure to conform to social norms with respect to lawful behaviours
  • more common in men
  • deception: repeatedly lying, use of aliases, conning others for personal profit or pleasure
  • irritability and aggressiveness: physical fights / assaults
  • reckless disregard for the safety of self or others
  • Consistent irresponsibility: repeated failure to sustain consistent work behaviour or honour financial obligations
  • lack of remorse: indifferent to or rationalizing having hurt, mistreated, or stolen from another
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8
Q

describe borderline personality disorder

A

cluster B: borderline

  • efforts to avoid real or imagined abandonment
  • unstable interpersonal relationships which alternate between idealization and devaluation
  • unstable self image
  • impulsivity in potentially self damaging area (e.g. Spending, sex, substance abuse)
  • recurrent suicidal behaviour
  • affective instability
  • chronic feelings of emptiness
  • difficulty controlling temper
  • quasi psychotic thoughts

management: dialectical behavioural therapy

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9
Q

describe histrionic personality disorder

A

cluster B: “flamBoyant”

  • Inappropriate sexual seductiveness
  • Need to be the centre of attention
  • Rapidly shifting and shallow expression of emotions
  • Suggestibility
  • Physical appearance used for attention seeking purposes
  • Impressionistic speech lacking detail
  • Self dramatization
  • Relationships considered to be more intimate than they are
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10
Q

describe narcissistic personality disorder

A

cluster B: “best”

  • Grandiose sense of self importance
  • Preoccupation with fantasies of unlimited success, power, or beauty
  • Sense of entitlement
  • Taking advantage of others to achieve own needs
  • Lack of empathy
  • Excessive need for admiration
  • Chronic envy
  • Arrogant and haughty attitude
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11
Q

describe obsessive compulsive personality disorder

A

cluster C: “compulsive”

clinical features
- overly occupied with details, rules, lists, order, organization, or agenda

  • perfectionism that hampers with completing tasks
  • extremely dedicated to work and efficiency to the elimination of spare time activities
  • meticulous, scrupulous, and rigid about etiquettes of morality, ethics, or values

management: dialectical behavioural therapy

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12
Q

describe avoidant personality disorder

A

cluster C: “cowardly”

  • Avoidance of occupational activities which involve significant interpersonal contact due to fears of criticism, or rejection
  • Unwillingness to be involved unless certain of being liked
  • Preoccupied with ideas that they are being criticised or rejected in social situations
  • Restraint in intimate relationships due to the fear of being ridiculed
  • Reluctance to take personal risks due to fears of embarrassment
  • Views self as inept and inferior to others
  • Social isolation accompanied by a craving for social contact
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13
Q

describe dependent personality disorder

A

cluster C: “clingy”

  • Difficulty making everyday decisions without excessive reassurance from others
  • Need for others to assume responsibility for major areas of their life
  • Difficulty in expressing disagreement with others due to fears of losing support
  • Lack of initiative
  • Unrealistic fears of being left to care for themselves
  • Urgent search for another relationship as a source of care and support when a close relationship ends
  • Extensive efforts to obtain support from others
  • Unrealistic feelings that they cannot care for themselves
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14
Q

list risk factors and protective factors for suicide

A

increased risk of suicide
- male sex
- history of deliberate self-harm
- alcohol or drug misuse
- history of mental illness
- history of chronic disease
- advancing age
- unemployment or social isolation/living alone
- being unmarried, divorced or widowed

If a patient has actually attempted suicide, factors associated with an increased risk of completed suicide at a future date:
- efforts to avoid discovery
- planning
- leaving a written note
- final acts such as sorting out finances
- violent method

reduce the risk of a patient committing suicide
- family support
- having children at home
- religious belief

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15
Q

describe panic disorder and its management

A

diagnosis requires at least 1 month of symptoms

clinical features
- panic attacks

management
- CBT / drug therapy
- SSRIs are first-line, try imipramine or clomipramine if unsuccessful

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16
Q

describe depression and its management

A

features
- fatigue
- low mood
- anhedonia
- cognitive: poor concentration, poor memory, slow thoughts
- poor libido
- anxiety
- irritability
- hopelessness about future
- abnormal sleep (early morning wakening)

in elderly can be distinguished from dementia due to short history and rapid onset of global memory loss

dysthymia refers to persistent low mood not meeting criteria for depression

management
- active monitoring and self-help: first-line for less severe depression
- CBT
- pharmacological
> SSRIs
- fluoxetine or citalopram
- sertraline if useful post-MI
- ECT if severe/resistant

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17
Q

list adverse effects of SSRIs

A
  • GI symptoms: nausea, diarrhoea
  • increased risk of bleeding: gastrointestinal, intracranial, post-partum
  • headaches
  • sexual dysfunction
  • hyponatraemia (SIADH)
  • sometimes increased anxiety/agitation after starting SSRI or increased suicidal thoughts
  • citalopram: prolongs QT interval
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18
Q

list discontinuation symptoms of SSRIs

A

continue for at least 6 months after remission of symptoms to reduce risk of relapse

reduce dose over 4 weeks (not necessary with fluoxetine)

symptoms
- increased mood change
- restlessness
- difficulty sleeping
- unsteadiness
- sweating
- GI symptoms: pain, cramping, diarrhoea, vomiting
- paraesthesia

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19
Q

describe ADHD

A

diagnostic features
- inattention
> doesn’t follow instructions
> easily distracted
> difficult to organise tasks
> forgetful/loses things
> does not listen when spoken to directly

  • hyperactivity/impulsivity
    > unable to play quietly
    > talks excessively
    > spontaneously leaves seat
    > run/climb when inappropriate

management
- following presentation, 10 week watch and wait

  • if persistent refer to secondary care
    > positive approach, structured routines, clear boundaries, physical activity
  • drug therapy only if 5 years or more
    > methylphenidate first-line, then lisdexamfetamine
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20
Q

list monitoring and side-effects of ADHD drugs

A

both methylphenidate and lisdexamfetamine potentially cardiotoxic

methylphenidate
- abdominal pain
- nausea and dyspepsia
- stunted growth in children
> monitor height and weight every 6 months

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21
Q

describe seasonal affective disorder

A

recurrent episodes of depression occurring during the same season every year, usually winter

at least 2 consecutive winters for diagnosis

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22
Q

describe cyclothymic disorder

A

alternating periods of hypomanic symptoms and depressive symptoms that do not meet the criteria for major depressive episodes

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23
Q

describe atypical depression

A

distinguished from other types of depression by

  • mood reactivity (mood brightens in response to positive events)
  • increased appetite / weight gain
  • hypersomnia
  • leaden paralysis (heavy feeling in arms/legs)
  • sensitivity to interpersonal rejection
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24
Q

describe schizophrenia

A

symptoms
- auditory hallucinations
- delusions (commonly persecutory)
- thought insertion / removal / broadcasting
- passivity phenomena: bodily sensations controlled by external influences
- ideas of reference
- impaired insight
- catatonia
- neologisms: made-up words
- disorganised thinking or behaviour
- sleep disturbance

  • negative symptoms
    > social withdrawal
    > flattened affect
    > anhedonia
    > avolition
    > alogia

management
- first-line: atypical antipsychotic e.g. olanzapine
- trial of at least 2 antipsychotics before clozapine
- if poor compliance opt for depot antipsychotic

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25
Q

describe anorexia nervosa

A

features
- weight loss (BMI <17.5)
- amenorrhoea
- lanugo hair
- parotidomegaly
- hypotension
- hypothermia
- mood changes (anxiety, depression)

biochemical:
- raised growth hormone, cortisol, glucose, cholesterol, carotinaemia
- low FSH, LH
- hypokalaemia

forms
- restrictive: restricting food intake
- binge-purge: excessive use of diuretics, laxatives, excessive exercise, induced vomiting

complications
- cardiac: arrhythmias, sudden cardiac death
- refeeding syndrome
- low bone mineral density

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26
Q

describe bulimia nervosa

A

features
- normal BMI
- binge eating followed by purging which leads to
> erosion of teeth
> swollen salivary glands
> mouth ulcers
> GORD
> calluses on knuckles (Russell’s sign)
> alkalosis may occur due to repeated vomiting

management
- CBT-ED, self-help resources

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27
Q

describe binge eating disorder

A

features
- episodes of binge eating not followed by purging due to psychological distress
- usually high BMI
- binges may be planned or unplanned
- eating very quickly with loss of control
- unrelated to hunger, becoming uncomfortably full

management
- CBT-ED, self-help resources

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28
Q

describe refeeding syndrome

A

occurs when someone with an extended severe nutritional deficit resumes eating

features
- hypogmagnesaemia
- hypokalaemia
- hypophosphataemia
- fluid overload

complications
- arrhythmias
- heart failure

management
- slow reintroduction of food with limited calories
- magnesium, phosphate, potassium, glucose and fluid balance monitoring (ECG monitoring in severe cases)
- supplementation particularly B vitamins and thiamine

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29
Q

describe ARFID

A

avoidant restrictive food intake disorder

features
- unrelated to body image
- may occur in individuals with ASD due to distress regarding food texture/taste
- may occur due to fear of choking
- low BMI

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30
Q

Describe OSFED

A

other specified food or eating disorder

features
- eating disorder which does not fit the typical features of other eating disorders

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31
Q

describe the management of drug addiction

A

management
- detoxification (home/inpatient)
- medication to maintain abstinence
- CBT
- ongoing support e.g. support groups

opioid dependence
- methadone, buprenorphine: bind to opioid receptors
- naltrexone: helps prevent relapse

nicotine dependence
- bupropion
- varenicline
- nicotine replacement therapy: patches, gum, lozenges

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32
Q

describe the management of alcohol dependence

A

acute:
- benzodiazepines:
> chlordiazepoxide
> lorazepam (if liver disease)
> diazepam

  • IM or IV high dose B vitamins i.e. Pabrinex
  • scoring systems: GMAWS, CIWA-Ar

chronic:
non-pharmacological
- specialist alcohol service
- alcohol detoxification programme
- CBT
- support groups e.g. AA
- informing DVLA

pharmacological
- disulfiram: aldehyde dehydrogenase inhibitor
- acamprosate: taurine derivative
- naltrexone: opioid antagonist
- oral thiamine

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33
Q

describe Wernicke-Korsakoff syndrome

A

alcohol excess leads to thiamine (vitamin B1) deficiency

Wernicke’s encephalopathy
- confusion
- oculomotor disturbance e.g. nystagmus
- ataxia
- medical emergency: treat with pabrinex

Korsakoff syndrome
- memory impairment (retrograde/anterograde)
- confabulation
- behavioural changes
- irreversible, requires full-time institutional care

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34
Q

describe alcohol withdrawal

A
  • 6-12h: tremor, sweating, headache, craving, anxiety
  • 12-24h: hallucinations
  • 24-48h: seizures
  • 24-72h: delirium tremens: medical emergency associated with alcohol withdrawal

> features
- acute confusion
- severe agitation
- delusions and hallucinations
- tremor
- tachycardia
- hypertension
- ataxia
- arrhythmias

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35
Q

describe the calculation of alcohol units and recommended alcohol consumption

A

volume of alcohol (L) x ABV %

e.g. 750ml of wine (12%)

0.75 x 12 = 9 units

recommended <14 units per week
binge: women >=6 units, men >=8 units

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36
Q

describe complications of alcohol excess

A
  • alcohol-related liver disease
  • cirrhosis and its complications (oesophageal varices, ascites, hepatocellular carcinoma)
  • Wernicke-Korsakoff syndrome
  • pancreatitis
  • alcoholic cardiomyopathy
  • alcoholic myopathy
  • cardiovascular disease
  • cancer
  • bloods: raised MCV, raised ALT and AST (AST:ALT ratio >1.5 suggestive of alcoholic liver disease), raised GGT
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37
Q

Describe the dosage and monitoring of lithium

A

normal range: 0.4-1.0 mmol/L
concentrations >1.5 mmol/L lead to lithium toxicity

after dose changes re-check dose
- 7 days post-dose change, 12h after last dose
- re-check every week until stable concentration
- then re-check every 3 months

monitoring
- TFTs, U&Es 6 monthly

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38
Q

Describe the causes and features of lithium toxicity as well as its management

A

Toxicity may be precipitated by:
> dehydration
> renal failure
> drugs: diuretics (especially thiazides), ACE inhibitors/angiotensin II receptor blockers, NSAIDs and metronidazole.

Features of toxicity
> coarse tremor (a fine tremor is seen in therapeutic levels)
> hyperreflexia
> acute confusion
> polyuria
> seizure
> coma

Management
> mild-moderate toxicity may respond to volume resuscitation with normal saline
> haemodialysis may be needed in severe toxicity

39
Q

describe adverse effects associated with lithium treatment

A

features
- nausea, vomiting
- diarrhoea
- fine tremor
- nephrotoxicity: polyuria secondary to nephrogenic diabetes insipidus
- hypothyroidism
- ECG: T wave flattening/inversion
- weight gain
- idiopathic intracranial hypertension
- hyperparathyroidism - hypercalcaemia

40
Q

describe benzodiazepine withdrawal

A

features
- anxiety, agitation, irritability
- diaphoresis
- confusion
- nausea
- palpitations
- insomnia
- seizures
- hallucinations
- psychosis

41
Q

describe opioid withdrawal

A

features
- rhinitis
- lacrimation
- yawning
- dilated pupils
- diaphoresis
- insomnia
- nausea, vomiting, diarrhoea
- piloerection
- abdominal cramps
- dysphoria
- tachycardia, hypertension

42
Q

describe extra-pyramidal side effects (EPSEs)

A
  • parkinsonism
  • tardive dyskinesia: late onset of choreoathetoid symptoms, abnormal and involuntary, most commonly chewing and pouting of jaw
    > treat with tetrabenazine
  • akathisia: severe restlessness
    > treat with propranolol
  • acute dystonia: sustained muscle contraction (torticollis, oculogyric crisis, opisthotonus)
    > more common in first generation antipsychotics
    > treat with procyclidine
43
Q

describe the mechanism of action of antipsychotics and their associated side-effects

A

typical antipsychotics: haloperidol, chlorpromazine
> dopamine D2 receptor antagonists
> more EPSEs and hyperprolactinaemia

atypical antipsychotics: olanzapine, clozapine, risperidone
> act on many receptors (D2, D3, D4, 5-HT)
> fewer EPSEs and hyperprolactinaemia
> metabolic side-effects

other side-effects
> weight gain (most common)
> sedation
> antimuscarinic effects: dry mouth, blurred vision, urinary retention, constipation
> impaired glucose tolerance
> neuroleptic malignant syndrome
> reduced seizure threshold (greater with atypicals)
> prolonged QT interval
> increased risk of stroke and VTE

44
Q

describe depot antipsychotics

A

long-acting antipsychotic IM injections e.g. olanzapine

helpful in patients who struggle with compliance, reduces reliance on patient adherence

clozapine not available in depot injection

45
Q

differentiate between hypomania and mania

A

common symptoms
- predominantly elevated mood, can be irritable
- pressured speech and thought
- flight of ideas: rapid speech with frequent changes in topic
- poor attention
- behaviour: insomnia, sexual promiscuity, risk-taking, excessive spending, increased appetite

hypomania
- lasts less than 7 days, usually 3-4 days
- can be high functioning and does not impair social/work function
- no psychotic symptoms

mania
- at least a week or longer
- severe functional impairment in social and work setting
- risk of harm to self or others
- may require hospitalisation
- may have psychotic symptoms

46
Q

describe psychotic depression

A

depression with added symptoms of psychosis

  • hallucinations
  • delusions
  • thought disorder: abnormal communication and behaviour

treatment involves combination of antipsychotics, antidepressants, ECT

47
Q

describe bipolar affective disorder

A

features
- recurrent episodes of depression and mania/hypomania

  • bipolar I: at least one episode of mania
  • bipolar II: at least one episode of major depression and at least one episode of hypomania
  • cyclothymia refers to milder symptoms of low mood and hypomania

management
- acute manic episode: admission
> stop antidepressant if they’re taking it
> start anti-psychotics first-line
> can also use lithium or sodium valproate

  • acute depressive episode
    > olanzapine plus fluoxetine
    > antipsychotics
    > lamotrigine
  • long-term management
    > lithium most commonly
48
Q

describe generalised anxiety disorder

A

excessive and disproportional anxiety lasting at least 6 months

symptoms are persistent and occur most days

not caused by substance use or another condition

features
- excessive worrying
- difficulty relaxing
- muscle tension
- palpitations
- sweating
- tremor
- GI symptoms

scoring system: GAD-7

49
Q

describe panic disorder

A

recurrent panic attacks which are unexpected and appear randomly, often without a trigger

50
Q

describe post-traumatic stress disorder (PTSD)

A

can result from any traumatic event e.g. violence, natural disasters, major health events

symptoms should be present for at least 4 weeks, otherwise called acute stress reaction

features
- intrusive thoughts
- re-experiencing (flashbacks, nightmares)
- hyperarousal (easily startled, on edge)
- avoidance of triggers
- negative emotions and beliefs
- difficulty with sleep
- depersonalisation
- derealisation
- emotional numbing

trauma screening questionnaire: screening

management
- trauma-focused CBT

  • eye movement desensitisation and reprocessing (EMDR)
  • medication
    > first-line: SSRIs or venlafaxine
    > antipsychotics
51
Q

describe dissociative disorders

A

depersonalisation-derealisation disorder
> feeling of being separated or outside of the body and of the world not being real

dissociative amnesia
> forgetting autobiographical information typically following a traumatic experience and leading to gaps in memory

dissociative identity disorder
> lack of clear individual identity
> multiple separate identities with unique names, personalities and memories
> associated with severe stress and trauma in childhood

52
Q

describe catatonia

A

abnormal movement, communication and behaviour

features
- unusual postures
- odd actions
- repeat sounds or words
- remain blank and unresponsive

common causes - severe depression and bipolar disorder

management
- benzodiazepines
- ECT

53
Q

describe reactive attachment disorder

A

severe neglect and trauma in early childhood

features
- emotional withdrawal and inhibition
- sadness, irritability
- impaired cognition
- struggle to form close relationships
- do not respond well to affection or discipline

54
Q

describe factitious disorder

A

aka Munchausen syndrome

features
- conscious effort to fake illness and seek medical attention for personal gain
- symptoms are invented, exaggerated or induced

repeated presentations with inconsistent and dramatic symptoms that do not fit with examination and investigation findings

55
Q

describe hoarding disorder

A

features
- excessive accumulation of possessions and emotional difficulty getting rid of items
- may have enormous amounts of clutter in home
- may or may not have insight
- can be associated with depression or anxiety

56
Q

describe alien hand syndrome

A

patient loses control of one of their hands

may move independently without conscious control

often due to underlying brain tumour, injuries, aneurysms

57
Q

describe Cotard delusion

A

false belief that the patient is dead or actively dying

aka walking corpse syndrome

most often caused by depression or schizophrenia

can be caused by brain tumours, migraines

58
Q

describe Capgras syndrome

A

delusion that someone close to them has been replaced by an identical duplicate

may involve suspicion or aggression towards imposter

can be caused by schizophrenia, dementia

59
Q

describe de Clerambault’s syndrome

A

delusion that somebody famous or high status is in love with the patient

can lead to inappropriate harassment of the individual by the patient

often without other psychiatric condition

60
Q

describe Alice in wonderland syndrome

A

aka Todd syndrome

incorrectly perceiving the sizes of body parts or objects e.g. hands perceived as being excessively large or small

associated with changes to the perception of time (e.g., time passing fast or slow) and symptoms of migraines (e.g., aura and headache).

symptoms intermittent

causes - migraine, epilepsy, and brain tumours

61
Q

describe Koro syndrome

A

delusion) that the sex organs are retracting or shrinking and will ultimately disappear

causes anxiety and panic attacks

Cases primarily reported in Asia, particularly China and India

62
Q

describe body integrity dysphoria

A

strong feeling that part of the body, for example, one or both of the legs, does not belong to them

healthy body part causes = distress, and they want it removed

not associated with psychiatric or neurological conditions

63
Q

describe foreign accent syndrome

A

sudden change in a person’s voice

they are aware that their voice has changed

new speech pattern or accent is not connected with someone’s previous experience

most common cause is stroke in the left hemisphere.

64
Q

describe functional neurological disorder (FND)

A

aka conversion disorder

sensory and motor symptoms that are not explained by any neurological disease and may be caused by underlying psychosocial factors (significant trauma/stress)

Symptoms
- weakness / paralysis
> Hoover’s test positive to differentiate non-organic paresis
- gait disturbance
- seizures
- sensory loss e.g. blindness
- vision disturbances

symptoms are not under the patient’s control and can cause considerable distress and functional impairment

65
Q

Describe schizoaffective disorder and schizophreniform disorder

A

schizoaffective disorder
- symptoms of psychosis as well as bipolar disorder (depression, mania)

schizophreniform disorder
- symptoms of schizophrenia lasting less than 6 months

66
Q

describe adverse effects associated with clozapine

A

usually reserved for when two antipsychotics have not worked in treatment resistant cases

no depot form available

adverse effects
- agranulocytosis
- myocarditis
- constipation
- seizures (reduces seizure threshold)
- excessive salivation

67
Q

describe autistic spectrum disorder

A

features
- deficits in social interaction: lack of eye contact, avoiding physical contact, unable to read non-verbal cues

  • deficits in communication: delay in language development, repetitive use of words or phrases
  • deficits in behaviour: greater interest in objects than people, stereotypical repetitive movements e.g. rocking (stimming), anxiety with experiences outside regular routine

management: MDT
> CAMHS, clinical psychologists, speech and language therapists…

68
Q

describe Alzheimer’s dementia

A

features
- gradual onset, gradual decline
- short-term memory loss
- word-finding difficulty
- emotion (apathy)
- language impairment
- impaired olfaction
- behavioural change (wandering, aggression)
- poor insight

causes
> early onset
- genetic risks: presenilin 1/2
- amyloid precursor protein (trisomy 21)

> late onset
- sporadic
- age, family history, apolipoprotein E

investigations: SPECT-CT
> medial temporal lobe / hippocampal atrophy

pathology: beta amyloid plaques, neurofibrillary tangles (intracellular hyperphosphorylation of tau)

69
Q

describe vascular dementia

A

features
- stepwise decline in cognition
- risk factors for cardiovascular disease e.g.hypertension, hypercholesterolaemia
- Emotional lability and focal neurological deficits

investigations
- CT head: established infarcts, small vessel disease

70
Q

describe Lewy Body Dementia

A

features
- fluctuating alertness / deficits
- dementia before motor symptoms (parkinsonism)
- silent visual hallucinations, fluctuating cognition

pathology: lewy bodies in cerebral cortex, aggregates of alpha synuclein

investigations: DaT scan

management
- donepezil, rivastigmine
- memantine for visual hallucinations

71
Q

describe the management of Alzheimer’s dementia

A

management
- mild-moderate: 3-acetylcholinesterase inhibitors
> donepezil, galantamine, rivastigmine

  • severe: NMDA antagonist
    > memantine
  • group cognitive stimulation therapy: mild and moderate dementia
    -group reminiscence therapy and cognitive rehabilitation
72
Q

describe frontotemporal dementia

A

features
> impulsive and socially inappropriate behaviour + personality changes
> expressive dysphasia / language difficulties
> onset typically earlier, usually 45-65 and rapid progression

CT head: frontal and temporal lobe atrophy

treatment: avoid cognitive enhancers

73
Q

describe progressive supranuclear palsy (PSP)

A

features
- axial imbalance
- oculomotor disturbance (vertical gaze palsy)
- early bulbar involvement (speech and swallowing difficulty)

74
Q

describe multiple system atrophy

A

features
> parkinsonism
> cerebellar and autonomic dysfunction e.g. orthostatic hypotension, urinary or faecal incontinence or retention

75
Q

describe Parkinson’s disease dementia

A

motor symptoms ongoing at least a year before the emergence of dementia

76
Q

describe a brief psychotic disorder

A

episode of psychosis lasting less than a month with return to baseline functioning

77
Q

describe the monitoring of SSRIs

A

patients <=25 who have been started on an SSRI - review after 1 week

patients >25 who have been started on an SSRI - review after 2 weeks (unless deemed at high risk of suicide)

78
Q

differentiate between somatisation disorder and hypochondriasis

A

somatisation disorder
> multiple physical symptoms present for at least 2 years
> patient refuses to accept reassurance or negative test results

illness anxiety disorder (hypochondriasis)
> persistent belief in the presence of an underlying serious disease e.g. cancer
> patient refuses to accept reassurance or negative test results

79
Q

describe electroconvulsive therapy

A

indications
- severe refractory depression (life-threatening
- catatonia
- prolonged or severe manic episode

prep: reduce the SSRI dose

side-effects
- short-term memory loss (rarely long-term)
- headache
- nausea
- cardiac arrhythmia

contraindication: raised ICP

80
Q

describe Charles Bonnet syndrome

A

features
- persistent or recurrent complex hallucinations (usually visual or auditory)
- occur in clear consciousness
- background of visual impairment
- preserved insight

associated ophthalmological conditions: cataracts, ARMD, glaucoma

81
Q

describe clozapine dosing

A

if missed for >48h must retitrate clozapine doses again slowly
> can make side effects worse e.g. dizziness, BP changes, drowsiness

82
Q

define the following terms
- echolalia
- copropraxia
- echopraxia
- palilalia

A

echolalia: repetition of someone else’s speech including questions being asked

copropraxia: involuntary performing of obscene or forbidden gestures or inappropriate touching

echopraxia: meaningless repetition or imitation of movement of others

palilalia: automatic repetition of one’s own words, phrases or sentences

83
Q

list medications to avoid while taking SSRI

A

precipitate serotonin syndrome
- triptans
- tramadol

increased risk of GI bleeding
- NSAIDs (if necessary co-prescribe PPI)

84
Q

describe REM sleep disturbance disorder and chronic insomnia

A

REM sleep disturbance disorder
- abnormal behaviours during REM sleep e.g. acting out dreams

chronic insomnia
- difficulty falling/staying asleep/early morning wakening
- for at least 3 nights a week for at least 3 months
- management:
> good sleep hygiene and hypnotics if daytime impairment is severe e.g. zopiclone, zolpidem

85
Q

describe the management of anorexia nervosa

A

management

adults
- individual eating disorder focused cognitive behavioural therapy (CBT-ED)
- Maudsley Anorexia Nervosa Treatment for Adults (MANTRA)
- Specialist supportive clinical management (SSCM)
- admission for controlled refeeding

children and adolescents
- first-line: anorexia-focused family therapy
- adolescent-focused psychotherapy
- CBT-ED

86
Q

list interactions with MAOIs

A

MAOIs e.g. phenelzine, rasegiline

tyramine containing foods e.g. cheese, pickled herring, bovril, marmite, broad beans - can precipitate hypertensive crisis

avoid co-prescribing SSRIs due to risk of serotonin syndrome

87
Q

which antipsychotic has the most tolerable side-effect profile

A

aripiprazole

88
Q

describe obsessive compulsive disorder

A

intrusive thoughts (obsessions) which can be distressing /sexual

compel the individual to engage in repetitive behaviours (compulsions)
e.g. excessive hand washing/repeating phrases internally

classification: Yale-Brown Obsessive Compulsive Scale
> degree of distress / disruption to patient’s life and their level of control over symptoms

management
- mild: exposure and response prevention therapy (ERP), variant of CBT
> if insufficient offer SSRI
- moderate: SSRI or more intensive CBT; clomipramine if SSRI contraindicated
- severe: refer to secondary care

89
Q

list side effects of tricyclic antidepressants

A

TCAs: imipramine, clomipramine, amitriptyline, dosulepin

side-effects
- histamine antagonism: drowsiness, weight gain

  • muscarinic antagonism: can’t see can’t pee can’t shit can’t spit
    > blurred vision, urinary retention, dry mouth, constipation
  • adrenergic receptor antagonism: postural hypotension
  • QTc prolongation
90
Q

describe post-concussion syndrome

A

features
- headache
- fatigue
- anxiety/depression
- dizziness

91
Q

differentiate between sleep paralysis and night terrors

A

sleep paralysis:
- inability to move or speak when transitioning between sleep and wakefulness
- can be accompanied by vivid hallucinations
- management: if troublesome, clonazepam

night terrors:
- episodes of intense fear and agitation during deep non-REM sleep
- more common in children
- individual may scream, thrash around, or exhibit other signs of distress

92
Q

describe fibromyalgia and its treatments

A

features
- chronic pain at multiple sites
- lethargy
- cognitive impairment: fibro fog
- sleep disturbance, headaches, dizziness

management
- aerobic exercise
- cognitive behavioural therapy
- medication: pregabalin, duloxetine, amitriptyline

93
Q

describe multisystem atrophy

A

features
- parkinsonism

  • autonomic disturbance
    > atonic bladder
    > postural hypotension
94
Q

describe Tourette’s syndrome and tics

A

Tourette’s: development of tics that are persistent for over a year

tics - involuntary movements/sounds that the child performs repetitively throughout the day, more pronounced under pressure/excitement

examples
- simple tics: clearing throat, blinking, head jerking, sniffing, eye rolling
- complex tics: copropraxia (obscene gestures), coprolalia (obscene words), echolalia (repeating words)

management
- reassurance and monitoring; reduce stress and triggers
- if severe:
> habit reversal training
> exposure with response prevention
> medications in very severe cases: antipsychotic medications

Phase 4 (14 decks)

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