Psychiatry Flashcards

Question

What is cyclothymia?

Answer 1

Cyclothymia - chronic mood fluctuations over 2+ yrs, episodes of depression and hypomania (not mania). Rapid cycling, episodes only lasting few days

Answer 2

Substance abuse (amphetamines, cocaine) Endocrine disease - Cushing's, steroid-induced psychosis Schizophrenia Schizoaffective disorder - Dx when affective and first rank schizophrenic Sx equally prominent Personality disorders - emotionally unstable, histrionic ADHD in younger people

Answer 3

– For depression –> Treat with antipsychotics alone or in combination with SSRI’s – 1st line is **Olanzapine, Lamotrigine or Quetiapine and Fluoxetine** – Do not just prescribe SSRIs by themselves as they can precipitate mania If a patient is taking an antidepressant at the onset of an acute manic episode, the antidepressant should be stopped.

Answer 4

L- Leukocytosis I- Insipidus diabetes (nephrogenic) T- tremors (if coarse think toxicity) H- Hydration ( easily dehydrates, need to drink lots I- increased GI motility U- Underactive thyroid M- metallic taste (warning of toxicity), mums beware- teratogenic lithium and diuretics= dehydration Lithium + NSAIDs= kidney damage

Answer 5

Prior depression Family history Female Abuse Drug and alcohol use Low socioeconomic status Recent bereavement, stress or medical illness, traumatic life event Co-existing medical conditions (chronic disease)

Answer 6

Low mood Loss of energy Anhedonia (loss of enjoyment of formerly pleasurable activities)

Answer 7

Carry out mental state examination - **Appearance may be normal**, or evidence of self beglect. substnace abuse, tearfulllness, anxious, fidegty **Speach may be monotonic and slow** - patient may appear distracted **Psychotic features** - eg auditory hallucinations, loss of insight Baseline tests for FBC and TFT may be useful for ruling out anaemia and hypothyroidism, that can lead to depression

Answer 8

The Patient Health Questionnaire-9 (scored out of 27) is used to grade depression – It asks patients to report over the last 2 weeks how often they have been experiencing symptoms – Made of 9 items which is scored from 0-3

Answer 9

– Mild = 5-9 – Moderate = 10-14 – Moderate/Severe = 15-19 – Severe = >19

Answer 10

Moderate/severe depression * Antidepressants (SSRIs, TCAs) - continued for 6+ mths after Sx stop * Combination therapy e.g. meds + talking therapy SSRI - Selective serotonin reuptake inhibitors eg Sertraline, paroxetine, fluoxetine, citalopram *Fluoxetine 1L in children* TCAs (Tricyclic antidepressants): Imipramine, amitriptyline SNRIs (Serotonin-noradrenaline reuptake inhibitors): Venlafaxine, duloxetine, Mirtazapine

Answer 11

Resistant depression Tx w/ combo of antidepressants + Lithium Atypical antipsychotic Another antidepressant ECT very effective in severe cases (Electroconvulsive Therapy)

Answer 12

Depression and OCD Hyperthyroidism Pheochromocytoma Lung disease- excessive salbutamol use CHF medication Hypoglycaemia Do bloods and BP

Answer 13

Family Hx anxiety Physical/emotional stress Financial, bereavement etc Hx physical/sexual/emotional trauma (in childhood) Excessively pushy parents in childhood Other anxiety disorder - coexisting depression Chronic physical health condition Worries about physical health Female 2:1 Male Environmental triggers/contributors: family relationships, friendships, bullies, school pressures, alcohol and drug use e.g. benzodiazepines

Answer 14

Low levels of GABA, contribute to anxiety. The frontal cortex and amygdala undergo structural remodelling due to maternal separation and isolation * Heightened amygdala activation occurs in response to disorder-relevant stimuli in post-traumatic stress disorder, social phobia and specific phobia Basically overfiring/activation of the amygdala

Answer 15

Mild anxiety can be managed with watchful waiting and advice about self-help strategies (e.g. meditation), diet, exercise and avoiding alcohol, caffeine and drugs. Moderate to severe anxiety can be referred to CAMHS services to initiate: Counselling CBT

Answer 16

SSRI (sertraline is first-line SSRI) – Be careful in young people as the SSRI increases anxiety initially and can lead to suicidal thoughts Pre-gabalin – If acutely anxious –> Benzodiazepine (but not for > 4 weeks) Beta blockers e.g. bisoprolol for physical Sx

Answer 17

Obsessions= unwanted/uncontrolled thoughts and intrusive images Aggressive impulses contamination e.g. – becoming contaminated by shaking hands with another person need for order e.g. – intense distress when objects are disordered or asymmetric religious e.g. – blasphemous thoughts, concerns about unknowingly sinning repeated doubts e.g. – wonder if a door was left unlock

Answer 18

Repetitive actions someone feels like they must do, generates anxiety if this action is not done checking e .g. – repeatedly checking locks, alarms, appliances cleaning e.g. – hand washing hoarding e.g. – saving trash or unnecessary items

Answer 19

Genetic predisposition (twins, especially monozygotic) Developmental factors Emotional/physical/sexual abuse Neglect Social isolation Teasing, bullying Parental over protection Psychological factors Over-inflated sense of responsibility Intolerance of uncertainty Belief in controllability of intrusive Stressors Pregnancy Postnatal period Rarely In adults: neurological conditions e.g. brain tumour, Huntington's chorea, frontotemporal dementia, complication of brain injury to frontal lobe/basal skull

Answer 20

or drug therapy (SSRI, e.g. fluoxetine 20–40mg od) * Severe functional impairment Offer psychological therapy + drug treatment. If inadequate response at 12wk, offer a different SSRI or clomipramine (a TCA that also acts as a serotonin reuptake inhibtior). Refer if symptoms persist

Answer 21

Simple phobias: inappropriate anxiety Social phobias: intense/persistent fear of being scrutinized or negatively evaluated by others leads to fear and avoidance of social situations Agoraphobia: fear of fainting and/or loss of control are experienced in crowds away from home

Answer 22

For simple phobias - Treatment is only needed if symptoms are frequent, intrusive, or prevent necessary activities. Exposure therapy is effective. For social and agoraphobia - drug therapy SSRIs, and TCAs eg **Clomipramine** Psychological therapies CBT (cognitive restructuring) +/- exposure

Answer 23

Develop (immediately/delayed) post exposure to stressful event/threatening, catastrophic situation

Answer 24

Serious accident Witness of violence: school, domestic, torture, terrorist attack and rape Combat exposure Natural disaster Sudden death of a loved one

Answer 25

Symptoms: must be present for at least a month - Persistent intrusive thoughts and re-experiencing - Autonomic hyperarousal: overaction to a stimulus such as being startled, hypervigilance or insomnia - Emotional detachment- feeling detached from people and lacking the ability to experience feelings

Answer 26

CBT- education about nature of PTSD and management of symptoms Eye movement desensitisation and reprocessing (EDMR): using voluntary multi-saccadic eye movements to reduce anxiety associated with disturbing thoughts

Answer 27

SSRIs It may be helpful to target specific symptoms such as sleep being improved with mirtazapine For Hyperarousal/anxiety: consider BDZs clonazepam and propranolol * Intrusive thoughts/hostility/impulsiveness: some evidence for use of carbamazepine, valproate, or lithium. * Psychotic symptoms/severe aggression or agitation: may warrant use of an antipsychotic (some evidence for olanzapine, risperidone etc)

Answer 28

Fear/anxiety about falling asleep Change of environment Inadequate sleep hygiene Idiopathic insomnia

Answer 29

Sleep related breathing disorder e.g. sleep apnoea Circadian rhythm disorders Shift work REM behavioural disorder e.g. Lewy body dementia, PD Psychiatric disorders - depression (early morning waking), anxiety (early/middle insomnia) Drugs/alcohol - steroids, antidepressants, stimulants

Answer 30

Encourage good sleep hygiene Sleep restriction

Answer 31

Medication (once good sleep hygiene proved unsuccessful) Z drugs: Zopiclone, Zolpidem, Zaleplon Sedating antidepressants: mirtazapine, amitriptyline Melatonin

Answer 32

Psychotic illness characterised by delusions and hallucinations, without changes in affect It's the most common form of psychosis in old age

Answer 33

*no evidence of dementia w/ later onset cases - no memory problems Delusions, hallucinations - often about neighbours Paranoid - often re. neighbours spying, taking things can also be misidentification, hypochondraical, religious Partition delusion - believe people/objects can go through walls Less -ve Sx (blunting/apathy) and formal thought disorder compared to early onset

Answer 34

Relieve isolation and sensory deficits. Low-dose atypical antipsychotics preferred as elderly are very sensitive to side-effects, but non-compliance secondary to lack of insight is often an issue.

Answer 35

Minor problems with cognition- mental abilities: memory, thinking Not severe enough to interfere with everyday life Mild cognitive impairment= pre-dementia

Answer 36

Depression Sleep apnoea and other sleep disorders Physical illness Vitamin and thyroid deficiencies Medications Drugs and alcohol

Answer 37

- Infection- UTI, pneumonia - Toxicity- substance misuse, intoxication, withdrawal - Vascular - Epileptic - Metabolic - hyper/othyroidism, hyper/oglycaemia, hypoxia, hypercortisolaemia - Medications - anticholinergics, Parkinson's meds, benzodiazepines, drug accumulation, polypharmacy, post surgery, steroids - Nutritional/dehydration - thiamine B1 deficiency, B12 deficiency, folate deficiency

Answer 38

Bipolar disorder – often may present with symptoms of schizophrenia Psychotic Depression Alcohol hallucinations, due to withdrawal Drugs - **especially Cannabis**, Cocaine, LSD, magic Mushrooms (Psilocybin) Dopamine Agonists, like Levo Dopa in Parkinsons Encephalitis Epilepsy's Dementia

Answer 39

A form of psychosis is characterised by distortion to thinking and perception and inappropriate or blunted affect See hallucinations and delusions, thought and speech disorders and negative symptoms

Answer 40

Perceptions in the absence of stimuli. Most commonly auditory but may be visual or affect smell, taste or tactile senses

Answer 41

A fixed or false belief no in keeping with cultural and educational background

Answer 42

Increased size of ventricles and reduced whole brain volume There is an increased activity of **dopamine** in the **mesolimbic region**

Answer 43

- Genetic link - Affected brain development in early ;life - Smoking cannabis in adolescence - Severe childhood bullying/physical abuse - Adverse life events - Social isolation - Typical age onset 20-30s

Answer 44

- Delusions - Hallucinations - Disorganised speech - Disorganised behaviour - Cationic behaviour They are all things that add to someone's character

Answer 45

- Less emotions - Loss of interest - Poverty/decreased speech - Less motivation

Answer 46

- Decline in cognition - Decline in memory - Bad learning

Answer 47

At least ** 1 first rank symptom** or 2 **second rank symptoms** FOR AT LEAST A MONTH

Answer 48

- **Delusional perceptions**- Do you ever see or hear things that you feel are giving a message that is specific to you - **Persecutory of delusions**: do you have any enemies/ do you feel anyone is out to get to you - **Thought insertion/withdrawal/broadcast**- are your thoughts being interfered with or controlled - **Passitivity**: can another person control what you do/feel directly - Third-person auditory hallucinations: do you hear people talking whom others can't hear

Answer 49

**Formal thought disorder** (words come out wrong, thoughts muddled) **Catatonic** behaviour - excitement, posturing or waxy flexibility, negativism, mutism and stupor. **Negative symptoms** - marked apathy, paucity of speech, and blunting or incongruity of emotional responses (it must be clear that these are not due to depression or to neuroleptic medication). **Any other type of hallucination,** not third person auditory

Answer 50

Bloods for organic causes of psychosis FBC LFT TFT Syphilis screen Bloodborne virus screen Autoimmune causes -anti–NMDA receptor antibodies for autoimmune encephalitis,ANA, anti-DS DNA for Lupus Collateral Hx from someone else Blood, hair or urinary screens may be used for illicit drugs and alcohol, particularly in those presenting with acute psychosis of unknown cause. MSE, risk assessment

Answer 51

They work by blocking dopamine and serotonin Quetiapine Olanzapine Risperidone Clozapine Aripiprazole They are first lone other than clozapine

Answer 52

They work by dopamine blockade of D2 receptors: - Haloperidol - Chlorpromazine

Answer 53

If 2 others have not been effective.

Answer 54

It requires close monitoring as it has a tendency to cause **aplastic anaemia** CPMS – Clozepine monitoring system. A national service in the UK, that gives advice on the drug dosage to use, depeninding on the blood test results you send to them. Compulsory for anyone on clozepine. Only consultant psychiatrists can prescribe clozapine Check for **agranulocytosis**

Answer 55

ECG- as QTC prolongation can occur Glucose and lipids- antipsychotics can lead to diabetes and metabolic syndrome If on CLOZAPINE: regular FBCs to check for AGRANULOCYTOSIS

Answer 56

- Urinary retention - Blurred vision - Dry mouth - Weight gain - Hyperprolactinaemia (due to dopamine blockade and dopamine down regulates prolactin)

Answer 57

Muscle spasm, eyes rolling back Parkinsonism Akathisia- “inner restlessness, pacing and agitated, often intolerable. They literally can’t stop moving e.g. shaking legs, touching table Massive RF for suicide in young males with schizophrenia Tardive dyskinesia (months to years) Grimacing, tounge protrusion, lipsmacking Very difficult/impossible to treat as you’ve upregulated all the D2 receptors These side effects are worse and more common in the older antipsychotics

Answer 58

Procyclidine an anticholinergic drug

Answer 59

Individual CBT: normally consists of at least 16 one-on-one sessions. It helps patients create links between their thoughts, feelings and actions with their experience of schizophrenia. Family intervention: should include the patient suffering from schizophrenia if possible as well as their main carer. Normally consists of 10 sessions over 3 months - 1 year. Art therapies can be particularly helpful for negative symptoms. Self-help groups and forums (e.g. Hearing Voices groups) enable people with psychosis to share experiences and ways to cope with symptoms This should be done alongside antipsychotic medications

Answer 60

Characterised by at least 2 years of physical symptoms with no physical explanation

Answer 61

More common in women Hx of sexual or physical abuse Adverse childhood events Hx trauma related disorders

Answer 62

Speech disturbance Swallowing disturbance Distractible **Often GI/skin complaints** Cognitive complaints - forgetfulness, short term memory problems Refusing to believe no organic cause

Answer 63

Physical signs Would prevent with neurological signs rather than symptoms

Answer 64

Paralysis Loss of speech Sensory loss Seizures Amnesia The examinations and findings will be inconsistent

Answer 65

-Dissociative disorders differ from somatisation in that they more often present with signs rather than only symptoms and are often acute in their presentation.

Answer 66

- Where patients believe they have a serious underlying disease - There are no physical signs or symptoms of the disease

Answer 67

- It's more common in men and people who have more contact with disease

Answer 68

Dysmorphophobia

Answer 69

It is an excessive preoccupation with imagined or barely noticeable defects in physical appearance. For example, patients may become preoccupied by the size of their nose, believing an objectively normal nose to be ugly and deformed

Answer 70

Allow patient time to ventilate their illness anxiet-ies. Clarify that symptoms with no structural basis are real and severe. Explain negative tests and resist the temptation to be drawn into further exploration Uncontrolled trials demonstrate antidepressant benefit, even in the absence of depressive symptoms. Try fluoxetine 20mg, and CBT

Answer 71

This is a group of conditions that involve disruptions or breakdowns in memory, identity or perception - In these disorders, psychiatric symptoms occur in the absence of pathology - More painful memories are cut-off from conscious self and instead converted into more bearable ones. It is seen as a way to cope with previous emotional trauma

Answer 72

- **Dissociative amnesia**- A patient has no recollection of upsetting and personal information - **Dissociative fugue**- A form of dissociative amnesia in which the patient flees away from their home. They will have no idea of actual self - **Dissociative identity disorder**- It is a condition where the patient develops multiple personalities which can take over – It is strongly linked to early childhood trauma e.g. sexual abuse – Patient has amnesia for when the different personalities take over, but maybe aware of their existence

Answer 73

- Involves checking if there is an organic cause - Psychotherapy (e.g. hypnosis) is the main line to explore trauma and recall true identity

Answer 74

Holds the delusional belief that they are dead and do not exist

Answer 75

Complex visual hallucinations with partial or severe blindness Patients understand that the hallucinations are not really and often have insight compared to other disorders For those experiencing CBS, knowing that they have this syndrome and not a mental illness seems to be the most comforting treatment so far, as it improves their ability to cope with the hallucinations.

Answer 76

A condition where patients will produce physical or psychological symptoms to attain a patients role - Patients can feign the symptoms, exaggerate them or deliberately hurt themselves to produce symptoms - Typically, patients take hallucinogens, inject faeces to make abscesses and contaminate urine samples

Answer 77

This is when a patient feigns or exaggerates their symptoms purely for a financial rewards - Unlike Munchhausen syndrome, it is not to play a patient’s role but to **receive compensation, personal damages or get off work** – It is not a medical diagnosis, but can lead to a large economic burden on health care systems

Answer 78

Belief that another person (famous/important) is in love with them

Answer 79

overinflated sense self worth, power, identity, believe have talent/made important discovery

Answer 80

Jealous - spouse/sexual partner unfaithful without any concrete evidence Persecutory - believe someone/something is mistreating/spying on/attempting to harm them, may repeatedly contact legal authorities Somatic - physical issue/medical problem e.g. parasite, bad odour

Answer 81

The characteristics and relatively permanent sets of behaviours, cognitions, and emotional patterns that evolve from biological and environmental factors

Answer 82

Deeply ingrained, repetitive patterns of behaviour abnormal in a particular culture - Increase distress and risk to self and others - Decrease function typically apparent by adolescence, causes long-term difficulties in personal relationships

Answer 83

Split into cluster A,B,C **mad, bad and sad**

Answer 84

**Paranoid**: Characterized by pervasive distrust and suspicion of others, interpreting motives as malevolent, without sufficient basis. **Schizoid Personality Disorder**: Involves detachment from social relationships and a restricted range of emotional expression. **Schizotypal Personality Disorder**: Features odd beliefs, magical thinking, perceptual distortions, and eccentric behaviour, often leading to social isolation.

Answer 85

**Borderline Personality Disorder/ EUPD (BPD)**: Characterized by instability in mood, self-image, and interpersonal relationships, often accompanied by impulsivity and intense fear of abandonment. **Antisocial Personality Disorder (ASPD)**: Involves a pervasive pattern of disregard for and violation of the rights of others, along with a lack of empathy and remorse. **Narcissistic Personality Disorder (NPD)**: Marked by a grandiose sense of self-importance, a need for admiration, and a lack of empathy for others. **Histrionic Personality Disorder**: Features excessive emotionality and attention-seeking behaviour, often characterized by dramatic expression, shallow relationships, and a desire to be the centre of attention.

Answer 86

**Avoidant Personality Disorder (AVPD)**: People with AVPD tend to be extremely sensitive to rejection and have a pervasive feeling of inadequacy. They avoid social interactions and relationships due to fear of criticism or disapproval. **Dependent Personality Disorder (DPD)**: Individuals with DPD have an excessive need to be taken care of, leading to submissive and clinging behaviour. They have difficulty making decisions without reassurance and support from others and fear being alone. **Obsessive-Compulsive Personality Disorder (OCPD)**: This disorder involves a preoccupation with orderliness, perfectionism, and control. People with OCPD may be overly focused on rules and details, leading to rigid and inflexible behaviour. They often have difficulty delegating tasks and may be seen as stubborn or controlling

Answer 87

- Tendency to interpret the actions of others as demeaning or threatening - Thinks the world is a conspiracy - Thinks people are devious - Reacts severely if they feel like they have been lied to - Holds grudges

Answer 88

- Has an indifference to relationships and a restricted range of emotional experience - Often described as **aloof** - Thinks world is uncaring - Thinks people are pointless and should depend on themselves - Withdrawal and less likely to be emotionally available Schizoi**D** - = **Distant**

Answer 89

- Pervasive pattern of deficits in interpersonal relatedness and peculiarities of ideation, experience, appearance and behaviour - Strong desire to have relationships but unable to maintain them due to poor at gauging other perceptions of them - Overconfidence, self-centred speech and socially inappropriate - Magical thinking Schizo**T**ypical - magical **t**hinking

Answer 90

Similarities - can have paranoia, and will experience the negative symptoms - of flat affect, and blunted emotions *indeed, maybe a genetic link between the two?* ask about FH of one in relatives when taking a history for the other* Differences - Paranoia is more intense in schizophrenia, and in schizophrenia, you have delusions, as well as positive symptoms like hallucinations and racing thoughts

Answer 91

Pervasive pattern of instability of mood, interpersonal relationships and self-image - Emotionally unstable, intense joy to rage very quickly - Self-damaging impulsivity (spending, sex, substance abuse, reckless driving, binge eating) - People are untrustworthy - Shame - Self-harm - Terrified of abandonment - might do extreme things to keep from leaving - Least likely to be – able to show self-compassion - Own self-image is unclear don't really know what you are, poor relationships with others

Answer 92

- Gross irresponsibility - Incapable to maintaining relationships - Irritability - Disregard for moral values - Manipulative - Often charming - Low threshold for frustration and aggression - Incapacity for experiencing guilt - Deceitfulness - Disregard for personal safety **Have to be over 18 to get the diagnosis of this, with a history of conduct disorder** *Overrepresented in the prison population* - Will make friends but won't keep them

Answer 93

Definition = pervasive pattern of excessive emotionality and attention seeking Thinks the world is – their audience Thinks people are – in competition for attention Thinks they are vivacious (attractively lively and animated) Commonest behaviour – exhibitionism Least likely to be – able to listen to others Few meaningful relationships, v superficial

Answer 94

Pervasive pattern of grandiosity, lack of empathy and hypersensitivity to the evaluation of others - Thinks the world is a competition - Thinks people are inferior - Thinks they are special - Commonest behaviour- competitiveness

Answer 95

Pervasive pattern of perfectionism and inflexibility - Excessive doubt, caution, rigidity and stubbornness - Preoccupation with details, rules lists order - Perfectionism interfering with task completion * Excessive conscientiousness * Preoccupation with productivity to the exclusion of pleasure and interpersonal relationships In OCD is ego Dystonic - aka the person wishes they could stop their habits OCPD is Ego syntonic - they are happy w how they are, and they don't feel a need to change

Answer 96

- Pattern of social discomfort, fear of negative evaluation and timidity

Answer 97

- Can't have any other diagnosis - Long lasting and is there in every context - Appears in childhood and adolescent - Ask question about bullying at school

Answer 98

Sertraline Citalopram Fluoxetine

Answer 99

DBT-dialectal behavioural therapy

Answer 100

- Nausea - Sexual dysfunction - Weight gain - Suicidal thoughts in younger people - Serotonin syndrome

Answer 101

NSAIDs Aspirin Heparin Fluoxetine and paroxetine have higher rates of interactions

Answer 102

- Linezolid - Monoamine oxidase inhibitors - Lithium - MDMA - Tramadol - St. John's wort - TCAs - SNRIs

Answer 103

CNS Modulates thermoregulation, behaviour and attention PNS Regulates GI motility, Vasoconstriction, bronchoconstriction and uterine contraction Other Promotes platelet aggregation (combined use with antiplatelet can increase bleeding risk

Answer 104

A group of symptoms that may occur with the use of certain serotonergic drugs A diagnosis is made based off a person's symptoms and medication use

Answer 105

Meningitis

Answer 106

Triad of abnormalities Cognitive affects: Headache, agitation, mental confusion, hallucinations, coma Autonomic effects: Shivering, sweating, hyperthermia, vasoconstriction, tachycardia, diarrhoea Neuromuscular hyperactivity: Muscle twitching, hyperreflexia, tremor

Answer 107

IV fluids, cooling measures Benzodiazepines Consider cyproheptadine (serotonin antagonist if symptoms persist)

Answer 108

Venlafaxine Duloxetine

Answer 109

Lead to the increased concentration of norepinephrine in the synaptic cleft At low doses, they act like an SSRI - noradrenaline changes don’t occur much at low doses

Answer 110

Raise BP Sweating Dose-dependant hypertension

Answer 111

Amitriptyline Imipramine Clomipramine Dosulepin High dose for depression, lower dose used for pain

Answer 112

The inhibit the uptake of monoamines at the presynaptic membrane This increases serotonin and noradrenaline Decreases acetylcholine, histamine, sodium and calcium

Answer 113

Dangerous due to it affecting sodium and calcium very cardiotoxic Check ECG Anticholinergic side effects: - Blurred vision- pupil dilation - Urinary retention - Dry mouth - Constipation - Confusion - Agitation

Answer 114

MAOIs are seldom used, then only in treatment of: - Resistant depression or atypical depression - Depression with increased sleep, increased appetite and phobic anxiety

Answer 115

MAOIs inactivate monoamine oxidase enzymes that oxidase the monoamine neurotransmitters, such as **dopamine, noradrenaline, serotonin and tyramine** This creates more of them in the CNS

Answer 116

Can cause v. v. high BP if taken with tyramine (aged cheese, cured meats, broad beans). **Tyramine reaction crisis** can lead to SAH anticholinergic side - effects, weight gain, insomnia, postural hypotension, tremor, paraesthesia of the limbs, and peripheral oedema

Answer 117

Selegiline, phenelzine

Answer 118

Mirtazapine

Answer 119

Drowsiness Weight gain

Answer 120

Acute manic episode and long-term prophylaxis of bipolar affective disorder It should only be prescribed if there is a clear intention to carry on treatment for at least 3 years otherwise can cause rebound mania

Answer 121

Side effects between 0.4-1: - Nausea - Fine tremor - Weight gain - Oedema - Polydipsia - Hypothyroidism

Answer 122

Above 1.0 mmol/L Vomiting Diarrhoea Coarse tremor Slurred speech Ataxia Drowsiness and confusion Lithium is also teratogenic

Answer 123

Bipolar, prophylactically They are **Teratogenic!!**

Answer 124

Lamotrigine Skin reactions (including Stevens– Johnson syndrome) aseptic meningitis drowsiness diplopia leukopenia insomnia Sodium valproate Nausea Gastric irritation diarrhoea Weight gain They are **Teratogenic!!**

Answer 125

1. Supportive 2. Cognitive behaviour 3. Psychodynamic

Answer 126

Explanation and reassurance Establishing rapport, and facilitating emotional expression * Non-directive problem-solving, e.g. for adjustment disorders, stress, bereavement * Mild depression or anxiety Counselling is similar to supportive therapy in that it involves explanation, reassurance, and support.

Answer 127

his is a therapy with works on the interplay between thoughts, emotions and behaviours. Its aim it to tackle both negative the cognitive thinking and behaviour in mental illness. a) Cognitive –> Aim is to help people identify and challenge automatic negative thoughts and abnormal beliefs b) Behaviour –> This is based on learning theory of operant condition (positive and negative reinforcement) – If people have habitual wrong behaviours (e.g. avoidance in anxiety) it teaches people relaxation techniques and gradual exposure with positive reinforcement to change their behaviour.

Answer 128

psychoanalysis stems from the work of Sigmund Freud. - views human behaviour as determined by unconscious forces derived from primitive emotional needs. Therapy aims to resolve longstanding underlying conflicts and unconscious defence mechanisms (e.g. denial, repression). Helping the person to become more aware of the unconscious processes which are giving rise to symptoms or to difficult repeating patterns Helping the person construct a narrative of their life and give meaning to symptoms

Answer 129

– Patients then recall the disturbing events and the emotion they felt at the time (e.g. sexual abuse and feeling powerless – They then work together to create a positive belief about the event (“I am stronger now and so not powerless”) – The therapist then activates both sides of your brain using Dual Activation Stimulation (DAS) by making they do eye movements usually involves the therapist directing the patients’ lateral eye movements by asking them to look first one way then the other (saccadic eye movements) – This allows the brain to reprocess the upsetting memories by removing the old emotion and replacing it with the more positive, empowering emotion – This means the memory is no longer experienced as a traumatic

Answer 130

It uses electrodes to induce a modified cerebral seizure Severe depression Prolonged episode of mania that hasn't responded to treatment Catatonia ECT should be used to induce fast and short-term improvement of severe symptoms after all other treatment options have failed, or when the situation is thought to be life-threatening (because of high risk of suicide or not eating and drinking).

Answer 131

It uses electrodes in the brain to induce a modified cerebral seizure in the brain - This leads to neurotransmitter release, hormone secretion and an increase in the permeability of the blood brain barrier - It is used if all other treatment options have failed

Answer 132

Patient gives informed consent (before every treatment) The patient lacks capacity, and it does not conflict with advance decision AND It’s an emergency, and the independent consultant has not yet assessed (Section 62 of Mental Health Act) OR An Independent Consultant (appointed by Mental Health Act Commission) agrees to it **IF A PATIENT HAS CAPACITY AND REFUSES, IT CANNOT BE GIVEN**

Answer 133

- Raised intracranial pressure - Previous stroke or MI

Answer 134

Can cause cognitive impairment and function should be assessed prior to, during and after a course of treatment

Answer 135

It is a psychiatric emergency that is caused by an excess of neuroleptic medications e.g. antipsychotics which reduce dopamine Can also be caused by withdrawal from dopamine agonists like Parkinson's medications Also caused by cocaine and ecstasy

Answer 136

Occurs over hrs to days - Hyporeflexia - Hyperpyrexia - Sweating - Palpitations - Reduced consciousness - Diffuse rigidity - Raised CK can cause rhabdomyolysis

Answer 137

- Stopping the drug and supportive measures such as oxygen, fluids and cooling blankets - Can also use lorazepam for muscle rigidity

Answer 138

- Drowsiness - Respiratory depression - Hypotension - Tachycardia - Pinpoint pupils - Constipation

Answer 139

ABCDE approach Give naloxone

Answer 140

Withdrawal is mediated by noradrenaline overactivity: - Dilated pupil - Tachycardia and hypertension - Insomnia - Abdo pain - Diarrhoea and vomiting - Watering eyes - Muscle aches

Answer 141

Lofexidine

Answer 142

* Methadone (opioid agonist) or buprenorphine (opioid partial agonist) are first line; they are less euphoriant and have a relatively long half-life than opioids of abuse. * Lofexidine is sometimes used for short detoxification treatments or where abuse is mild or uncertain Naltrexone (opioid antagonist) blocks the euphoric effects and is occasionally used to help prevent relapse.

Answer 143

ICD - 10 F10 Alcohol F11 Opioids F12 Cannabinoids F13 Sedatives or hypnotics F14 Cocaine F15 Other stimulants, including caffeine F16 Hallucinogens F17 Tobacco F18 Volatile solvents F19 Multiple drug use and other

Answer 144

ICD - 10 .0 Acute intoxication .1 Harmful use .2 Dependence syndrome .3 Withdrawal state .4 Withdrawal state with delirium .5 Psychotic disorder .6 Amnesic syndrome .7 Residual and late-onset psychotic disorder .8 Other mental and behavioural disorders

Answer 145

Addiction liability - depends on: How substance taken: orally, injection, inhaling Rate substance crosses blood brain barrier and triggers reward pathway in brain Time takes to feel effect of substance Substance ability to induce tolerance ± withdrawal symptoms Male Aged ~ 18-25 Mental health conditions: ADHD, bipolar, depression, GAD, panic disorder, PTSD Adverse childhood experiences: childhood abuse/neglect, witnessing domestic violence, family members with SUD

Answer 146

10ml or 8g of pure alcohol

Answer 147

- Alcohol increases the GABA function - GABA is the main inhibitory neurotransmitter in the brain - Glutamate is inhibited, it is the main excitatory neurotransmitter in the brain

Answer 148

CANT STOP C- Compulsion to drink A- Aware of harms but persists N- Neglect of other activities T- tolerance to alcohol S- Stopping causes withdrawal T- time preoccupied with alcohol O- Out of control use P- Persistent, futile wish to cut down

Answer 149

Tremors Anxiety Nausea Headache Tachycardia Irritability Delirium

Answer 150

CAGE questionnaire screening C - do you ever think about cutting down A - do you get annoyed when others comment on drinking habit G - ever feel guilty about drinking E - ever drink in morning (eye-opener) AUDIT questionnaire Developed by WHO Multiple choice for harmful alcohol use screen

Answer 151

Bloods: - Raised MCV - Raised ALT and AST ( AST:ALT ratio above 1.5 suggests ALD Raised GGT Raised bilirubin Low albumin Deranged U+Es in hepatorenal syndrome

Answer 152

- Disulfiram- this inhibits acetaldehyde dehydrogenase, so people feel hungover as soon as they drink alcohol - Acamprosate- this is a weak NMDA antagonist which is used to reduce alcohol craving

Answer 153

Alcohol boosts GABA, which inhibits the brain and dampens excitatory glutamate receptors. Over time the brain adapts, becoming more sensitive to excitatory signals When alcohol stops, the brain becomes overactive, causing symptoms like confusion and agitation

Answer 154

0-12 hours: increased anxiety, with sweating and agitation After 24 hours: seizures with visual hallucinations From 48-72 hours: coarse tremors, agitation, delusions and severe visual hallucinations

Answer 155

Management – 1st line is benzodiazepine chlordiazepoxide

Answer 156

The CIWA-Ar is used to guide the pharmacological management of alcohol withdrawal Clinicians add up scores for all ten criteria. The total CIWA score can be used to assess the presence and severity of alcohol; Absent or minimal withdrawal: score 0-9 Moderate withdrawal: score 10-19 Severe withdrawal: score > 20 The total CIWA score influences the frequency at which further observations are made: Initial score >8: repeat hourly for 8 hours Then if stable 2-hourly for 8 hours then if stable 4-hourly Initial score <8: assess 4 hourly for 72 hours and if score <8 for 72 hours, discontinue assessment. The total CIWA score guides clinicians with regards to the need for pharmacological management of alcohol withdrawal: Symptom-triggered regimen (not prescribed regular withdrawal medication): give PRN medication when CIWA score is ≥ 8 Fixed-dose reducing regime with PRN medication (prescribed regular withdrawal medication): give additional PRN medication if CIWA score is ≥ 15

Answer 157

It is a neurological emergency resulting from thiamine deficiency with varied neurocognitive manifestations

Answer 158

Hypothalamic damage& cerebral atrophy due to thiamine (vitamin B1 deficiency) Wernicke's encephalopathy is the acute, reversible stage of the syndrome, and if left untreated it can later lead to Korsakoff syndrome, which is chronic and irreversible

Answer 159

It **block the phosphorylation of thiamine** stopping it from being converted into its active form Ethanol **reduces gene expression of thiamine transporter**, so can stop it getting absorbed in the duodenum Alcoholic tend to have a poor diet, relying on alcohol for calories so will not get enough thiamine (b1) anyway

Answer 160

- Thiamine deficiency impairs glucose metabolism and this leads to a decrease in cellular energy - The brain is particularly vulnerable to impaired glucose metabolism since it utilises so much energy

Answer 161

1. Confusion 2. Ataxia 3. **Ophthalmoplegia** (nystagmus, lateral rectus or conjugate gaze palsies)

Answer 162

- Mainly targets the limbic system, causing severe memory impairment: - **Anterograde amnesia** inability to create new memories - **Retrograde amnesia** inability to recall previous memories - **Confabulation** creating stories to fill in the gaps in their memory which they believe to be true - **Behavioural changes**

Answer 163

- Diagnosis is typically made **based in clinical presentation** - **Bloods including LFTs**: measure thiamine levels, measure blood alcohol levels, liver function may be deranged in alcoholism - **MRI/CT:** can confirm diagnosis by showing degeneration of the mammillary bodies Lumbar puncture to rule out other causes of the symptoms of wernickes

Answer 164

Urgent replacement to prevent irreversible Korsakoff's syndrome. Give thiamine Oral supplementation Correct magnesium deficiency as well if there is coexisting deficiency as well

Answer 165

It's important to normalise the thiamine levels first, because without thiamine pyrophosphate **most of the glucose will become lactic acid and that can lead to metabolic acidosis** Make sure thiamine is given before glucose as Wernicke's can be caused by glucose administration to thiamine-deficient patient

Answer 166

These drugs block the reuptake of dopamine and noradrenaline (and 5-HT) increasing transmission at synapses

Answer 167

Main effect- Increased energy and concentration and hyperactivity Side effects: - Cardiovascular -> increased pulse, blood pressure, hyperthermia, can lead to aortic dissection - Heart -> QRS widening and QT prolongation - GI -> reduced appetite and ischaemic colitis – Psychological –> Insomnia, agitation and hallucinations e.g. formication (sensation of ants under the skin) – If you take a prolonged large dose, the euphoria can turn to depression and anxiety – Can get psychosis –> delusions, visual and auditory hallucinations

Answer 168

- IV benzodiazepines+ treat complications

Answer 169

1) A person is assumed to have capacity until it is established the person does not have it 2) A person should not be treated as unable to decide **unless all practicable steps to help them have failed** 3) A person should **not** be treated as unable to decide **just because it is unwise** 4) Decisions made on **behalf if an incapable person must be in their best interests** 5) Regard should be taken to **find the solution which is least restrictive of the person's rights and freedom of action**

Answer 170

- If a valid advanced decision to refuse treatment exists - If a valid lasting power of attorney for health and welfare exists - If neither exists, then person providing treatment should act in the patient's best interests

Answer 171

1. Does the person have an impairment of their mind or brain, whether as a result of an illness, or external factors such as alcohol or drug use? 2. Does the impairment mean the person is unable to make a specific decision when they need to? People can lack capacity to make some decisions but capacity to make others.

Answer 172

- Understand the information relevant to the decision - Retain the information relevant to the decision - Use or weigh up that information as part of the process of the making the decision - Communicate their decision in any way

Answer 173

Under section 2 of the mental health act Need 2 Drs: One section 12 approved, one ideally previous contact with the patient and then approval from approved mental health professional to confirm the section Patient suffering from mental disorder to degree that warrants detention in hospital for assessment Pt should be detained for own health/safety or the protection of others **Lasts 28 days, cannot be Cannot be renewed**

Answer 174

Under section 3 of the mental health act Again, Need 2 Drs: one section 12 approved, one ideally previous contact w/ pt, and then approval from approved mental health professional (AMHP) to confirm the section. Patient suffering from mental disorder to degree that warrants detention in hospital for treatment. Pt should be detained for own health/safety or the protection of others The treatment needed cannot be effectively provided unless the patient is detained. Appropriate medical treatment is available to them. lasts 6 months, can be renewed

Answer 175

Patient suffering from mental disorder to degree that warrants the detention in hospital for assessment Pt detained for own safety/safety of others. Not enough time for 2nd Dr to attend 1 Dr (does not need to be section 12 approved) Lasts for 72 hours

Answer 176

For pt already admitted (to psychiatric/general hospital) but wanting to leave Section 5(4) says nurses can detain patients in hospital (this is their holding power until a Dr can attend) for 6 hours Section 5(2) says doctors (this is their holding power until section 2/3 can be put place) NB- has to be DR on a specific ward, cannot be done in A&E lasts for 72 hours

Answer 177

135- allows police to enter a house and move a patient to a place of safety 136 allows police to take someone to a place of safety for an assessment Both can be done by police, but t

Answer 178

onsent to Treatment As a general rule, once a patient is detained under S2, 3, 35, 36 or 37 of the MHA, consent is not required for the administration of psychiatric treatment. – The justification for treatment is provided by S63 which states that: “The consent of a patient shall not be required for any medical treatment given to him for the mental disorder from which he is suffering” Treatments are Covered by S63 All medical treatment for the mental disorder, including: Treatments for the disorder itself (e.g. antipsychotics for schizophrenia) Treatment for conditions causing the disorder (e.g. hypothyroidism causing depression) Treatments for the physical consequences of the disorder (e.g. NG in anorexia) Safe holds and physical control and restraint (when necessary)

Answer 179

Intentional non-fatal sel-ifnflicted harm a desire to interrupt a sequence of events seen as inevitable and undesirable * a need for attention * an attempt to communicate/express themselves * a true wish to die

Answer 180

- It is more frequent in women - More common in under 35s - Associated with psychiatric illness, particularly depression and personality disorder

Answer 181

- Cuts on arms and legs - Picking at skin - Burns - Bruising - Weight loss/gain - Hair loss (pulling at hair)

Answer 182

Before During After

Answer 183

Precipitants - specific event/build up? Planned/impulsive? Precautions taken against discovery? (left the house, turned off phone etc) Alcohol/recreational drugs at time of event? - suggests more impulsive

Answer 184

Method (if drugs - what did they take, how much) Was pt alone Where was it - more remote = higher risk What went through mind at the time Did they think their self-harm would end their life? What did they do straight after the self-harm?

Answer 185

Did pt call anyone? Go to A&E? Who were they found by How they felt when help arrived Current mood Still feel suicidal? - would they attempt again

Answer 186

A good first step is to agree with patients what their problems are and what immediate interventions are both feasible and acceptable to them. * Ensure that they know who they can turn to if suicidal intent returns (e.g. A & E). * Crisis Resolution Team referral may be necessary if suicidal ideation is present. * Think about reducing access to means of suicide if possible – for example, by encouraging patients to dispose of unneeded tablets from the home, and by prescribing antidepressants of lower lethality (e.g. SSRIs rather than tricyclics) and in small batches. * Consider psychological therapy and encouraging engagement in self-help and community social and support organisations.

Answer 187

SAD PERSONS Sex (male) Age <19 or >45 Depression Previous suicide attempt Excess alcohol or substance use Rational thinking loss Separated or single Organised plan No social support Sickness

Answer 188

Warning signs: * Obsessive thinking about death * Feelings of hopelessness, worthlessness, helplessness * Behaviours suggestive of absolute death wish: ○ Put financial affairs in order ○ Visiting people to say goodbye in community, awareness of pts who: Frequently, repeatedly attend Disengaged w/ services Prescribed several antidepressants Heightened concern from family members

Answer 189

* Detect and treat psychiatric disorders. * Be alert to risk and respond appropriately to it. * Prescribe safely * Give urgent care at appropriate level of patients with suicide intent – refer to Crisis Resolution and Home Treatment Teams. - Can also admit for hospitalization (consider detention under the Mental Health Act) if patients considered unsafe outside hospital even with intensive support. *Provide careful management of deliberate self-harm (DSH) * Act at the population level, tackling unemployment and reducing access to methods of self-harm.

Answer 190

- Do you ever throw up after eating food - Do you eat food to have a sense of control - Have you lost more than 1 stone in 3 months - Do you feel like you're fat when other people tell you you're not - Does food dominate your life SCOFF

Answer 191

- Hypokalaemia - Low white cell count neutropenia - Anaemia (either of chronic disease or iron deficient)

Answer 192

- Will often show long Qt syndrome as as result of hypokalaemia

Answer 193

Sick squat test: Should be able to deep squat, if they can’t do this without using hands, proximal muscles must be weak therefore so must the heart.

Answer 194

Magnesium and phosphate. Can both go low when refeeding. Known as **refeeding syndrome**

Answer 195

MEED risk assessment for eating disorders: Red flags: Recent weight loss more than a 1kg over 2 weeks, under 13 BMI, Postural drop, MUAC <18cm, other clinical state, ECG abnormalities, duration.

Answer 196

1) Binge eating disorder is the most common form of eating disorder. 2) Anorexia 3) Bulimia

Answer 197

Anorexia: CBT, SSCM Bulimia: Fluoxetine 60mg once a day, CBT

Answer 198

Hormonal problems, loss of periods and erections, bone scans and calcium levels

Answer 199

Haloperidol

Answer 200

Concrete thinking refers to a cognitive process characterized by a focus on literal, tangible, and specific details rather than abstract or hypothetical concepts. This type of thinking is grounded in the here-and-now, dealing with concrete objects and straightforward facts rather than ideas or possibilities that require imaginative or theoretical consideration.

Answer 201

Loosening of associations (LOA), also known as derailment, is a cognitive disturbance where there is a significant disconnection or fragmentation in the logical flow of thoughts and ideas. This phenomenon is often observed in certain psychiatric conditions, most notably schizophrenia, and is characterized by speech that is disorganized and difficult to follow.

Answer 202

a communication disorder characterized by an overabundance of unnecessary and irrelevant details in conversation or writing

Answer 203

Perseveration is a cognitive and behavioural phenomenon where an individual repeatedly performs the same action, says the same words, or persists in the same thought despite the absence or cessation of the original stimulus.

Answer 204

Confabulation is a memory disturbance where a person creates false memories without intending to deceive. These fabricated or distorted memories can include incorrect details about real events or entirely invented scenarios. Confabulation often occurs in individuals with certain brain injuries or neurological conditions and is typically not recognized by the person as false.

Answer 205

Somatic passivity is a symptom often associated with certain psychiatric conditions, particularly schizophrenia. It refers to a sensation where an individual feels that their bodily experiences, movements, or sensations are being controlled or influenced by an external force or entity. This can include feelings of physical sensations, movements, or even thoughts that seem imposed upon the person, rather than originating from their own will.

Answer 206

Belle indifference is a term used in psychiatry to describe a paradoxical lack of concern or apparent indifference to significant physical symptoms. This phenomenon is often observed in individuals with certain psychological disorders, particularly conversion disorder (also known as functional neurological symptom disorder).

Answer 207

is a distressing neurological condition characterized by an intense feeling of inner restlessness and an irresistible urge to move. It is a common side effect of certain medications, particularly antipsychotic drugs, although it can also occur spontaneously or as a result of other medications. Akathisia can significantly impair a person's quality of life and may lead to agitation, anxiety, and difficulty sitting still or relaxing.

Answer 208

Catatonia is a neuropsychiatric syndrome characterized by a range of motor disturbances that can include immobility, excessive motor activity, negativism, mutism, and peculiarities of voluntary movement. It is associated with various psychiatric and medical conditions, including schizophrenia, bipolar disorder, major depressive disorder, and neurological disorders.

Answer 209

Stupor is a serious mental state where people don’t respond to normal conversation, but only to physical stimulation.

Answer 210

Global impairment, below 18, IQ below 70

Answer 211

Wechsler scale for adults and children Mean IQ: 100 Genius: 145 LD: below 70

Answer 212

66 for men 67 for women

Answer 213

Infective, Infections, toxic, trauma, genetic, metabolic

Answer 214

Anorexia features most things low: hypokalaemia low FSH, LH, oestrogens and testosterone G's and C's raised: growth hormone, glucose, salivary glands, cortisol, Cholesterol, carotinaemia

Answer 215

- Parkinsonism - Akathisia - Tardive dyskinesia - Dystonic reactions - Neuroleptic malignant syndrome

Answer 216

- Bradykinesia - Ridgity - Resting tremor Although less pronounced and symptoms are always bilateral Caused by D2 receptor blockade by the medications

Answer 217

- Dose reduction Switching to a different medication - Use procyclidine

Answer 218

- It means to not be able to sit still - A subjecitve component of feeling like they need to move - Manifests with symptoms such as pacing, inability to stand, sit or lie still

Answer 219

- Acute which occurs within hours to weeks of starting medication - Acute persistant - Tardive akathisia: usually develops after 3 months of treatment

Answer 220

- Try choloropromazine/quitiapine - Try beta-blocker - Mitrzapine

Answer 221

- Involuntary, repetitive purposeless movements, occuring with long-term antipsychotic treatment

Answer 222

- Tongue, lips and jaw movements - Trunk twisiting - Torticollis - Pelvic thrusting

Answer 223

- Tertrabenazine - Dopamine agonists - Clonazepam if dystonia also present

Answer 224

- Usually occurs within 1wk of commencing or rapidly increasing the dose of the antipsychotic medication

Answer 225

- Muscles of head and neck are most commonly affected - Forceful protrusion of tongue - Occurs in the mouth most commonly

Answer 226

- IM Procyclidine

Answer 227

- A rare life-threatning reaction to anti-psychotic medication

Answer 228

- Fever - Muscle ridigity - Alterned mental status - Autonomic dysfunction

Answer 229

- Hyperthermia - Muscle ridigity - Confusion - Hyporeflexia - tremor - Raised CK (can cause rhabdomyolsis)

Answer 230

- Stop drug - Give fluids and oxygen - Cool body temperature - **Lorzepam**/Dantrolene - Can also give bromocriptine - Give bicarbonate to prevent alkalisation of urine

Answer 231

De Clerambault's: This is the presence of a delusion that a famous person is in love with them, with the absence of other psychotic symptoms as is the case, here.

Answer 232

Capgras syndrome: This is the delusion that a person closely related to the patient has been replaced by an impostor.

Answer 233

De Fregoli syndrome: This is the delusion of identifying a familiar person in various people they encounter.

Answer 234

Othello syndrome: This is a delusion of sexual infidelity on the part of a sexual partner.

Answer 235

Ekbom syndrome is: This is delusional parasitosis and describes the delusion of infestation.

Answer 236

most things low G's and C's raised: growth hormone, glucose, salivary glands, cortisol, cholesterol, carotinaemia