Psychiatry Flashcards
During a ward round consultation, the psychiatrist was assessing a patient’s current mental state. The patient’s reply to most of the questions consisted of sentences which did not make any sense such as - ‘painting pizza prince bus brush’. This is a good example of which thought disorder?
Word salad
Name the drug which can be given to prevent alcohol relapse in alcohol detoxification, acting as an anti-craving medication
Acamprosate
Name the drug which can be given to prevent alcohol relapse in alcohol detoxification, by causing unpleasant symptoms following the consumption of alcohol
Disulfiram
Acts as an irreversible inhibitor of acetaldehyde dehydrogenase, which causes the buildup of acetaldehyde → symptoms
What is buprenorphine?
A mixed opioid agonist/antagonist, typically given as a sublingual tablet and provides an alternative opiate replacement therapy to methadone
What is the first line treatment for OCD?
Exposure and response prevention (ERP) therapy
Define hypomania
Hypomania is characterised by elevated mood, pressured speech and flight of ideas but without psychotic symptoms
What is acute dystonia?
Sustained muscle contraction (e.g. torticollis, oculogyric crisis) which can occur as a side effect of first-generation antipsychotics e.g. chlorpromazine, haloperidol
What drug may be used in the management of acute dystonia
Procyclidine
What is the SSRI of choice following an MI?
Sertraline
What is post-concussion syndrome?
The persistence of concussion symptoms beyond the normal course of recovery; can be seen even after minor head trauma
Clinical features include headache, fatigue, anxiety/depression and dizziness
What is the second line medication used for treatment of OCD, following failure of CBD and an SSRI?
Clomipramine
What is the first line management for acute stress disorder?
Trauma-focused cognitive-behavioural therapy
When checking lithium levels, when should the sample be taken?
12 hours post-dose
When should patients under 25 years who have been started on an SSRI be reviewed?
After 1 week due to transient increased risk of suicide
What are the negative symptoms of schizophrenia?
- Incongruity/blunting of affect
- Anhedonia (inability to derive pleasure)
- Alogia (poverty of speech)
- Avolition (poor motivation)
- Social withdrawal
Which drug is the most effective antipsychotic for dealing with the negative symptoms of schizophrenia?
Clozapine
What is the most appropriate treatment for a patient dianosed with borderline personality disorder?
Dialectical behaviour therapy (DBT)
What is the most appropriate course of action if you see a patient in GP with hypomanic symptoms?
Routine referral to CMHT
What investigation is indicated in a first episode of sudden onset psychosis in an elderly person?
CT head (rule out organic causes)
The risk of developing schizophrenia if one monozygotic twin is affected is approximately what percentage?
50% - concordance rate for schizophrenia in monozygotic twins, who share 100% of their genetic material, is around 50%
Name a common side effect of benzodiazepines
Anterograde amnesia
If a patient misses clozapine for 2 consecutive days, what is the best course of action?
Re-titrate the clozapine doses again slowly
What drug is most suitable to treat moderate/severe tardive dyskinesia?
Tetrabenazine
Name that personality disorder: rigid with respect to morals, ethics and values and often are reluctant to surrender work to others
Obsessive-compulsive personality
What are the somatic symptoms of depression?
Early morning waking and changes in appetite and weight
How would you treat severe OCD, or if unresponsive to CBT/exposure and response prevention?
SSRI e.g. fluoxetine and CBT
Name a drug class that can cause overflow incontinence
Tricyclic antidepressants e.g. amitriptyline (anti-cholinergic effect)
What is the typical onset of symptoms of alcohol withdrawal?
6-12 hours
What is the typical onset of seizures following alcohol withdrawal?
36 hours
What is the typical onset of delirium tremens following alcohol withdrawal?
72 hours
What are the risk factors for generalised anxiety disorder?
- Aged 35- 54
- Being divorced or separated
- Living alone
- Being a lone parent
What are the clinical feature of sleep paralysis?
- Sleep paralysis is a condition characterized by the inability to move or speak when transitioning between sleep and wakefulness, either when falling asleep or upon awakening
- It can be accompanied by vivid hallucinations, which may explain the patient’s description of seeing another person in the room
Why might a patient with bulimia have short, rounded teeth?
Repeated vomiting can lead to erosion of the teeth
What is Knight’s move thinking?
Knight’s move thinking is a severe type of loosening of associations, where there are unexpected and illogical leaps from one idea to another
It is a feature of schizophrenia
What is flight of ideas?
Flight of ideas, a feature of mania, is a thought disorder where there are leaps from one topic to another but with discernible links between them
Why should SSRIs and MAOIs (e.g. selegilin) not be combined?
Risk of serotonin syndrome
Guess the personality disorder: lack close friends other than family and can have odd or eccentric behaviour, speech and beliefs
Schizotypal personality disorder
What is an oculogyric crisis?
A type of acute dystonia which involves prolonged upward involuntary deviation of the eyes
What is torticollis?
Type of acute dystonia which involves unilateral pain and deviation of the neck with pain on palpation and restricted range of motion
What is the definition of an obsession in OCD?
An obsession is an intrusive, unpleasant and unwanted thought
What is the definition of a compulsion in OCD?
Senseless action taken to reduce the anxiety caused by the obsession
What is the first line treatment for schizophrenia?
Atypical antipsychotic e.g. olanzapine, clozapine and quetiapine
What is the most common side effect of atypical antipsychotics?
Weight gain
What are the metabolic side effects of anti-psychotics?
Include dysglycaemia, dyslipidaemia, and diabetes mellitus
A patient with a history of bipolar presents to the GP after having routine bloods which revealed a leucocytosis. He feels well in himself. What would you advise the patient?
Safety net to return if symptoms develop, arrange repeat bloods under normal schedule
Lithium can precipitate a benign leucocytosis
How long must symptoms of depression be present in order to be classified as a depressive episode?
2 weeks
Which class of drug have the Medicines and Healthcare products Regulatory Agency warned may be associated with an increased risk of venous thromboembolism in elderly patients?
Atypical antipsychotics e.g. clozapine, risperidone, olanzapine, and quetiapine
How can you differentiate between dementia and memory loss in depression (pseudodementia)?
Severe depression gives a pattern of global memory loss, dementia is more commonly a short-term memory loss
What is the mechanism of venlafaxine?
SNRI - serotonin and noradrenaline reuptake inhibitor
What is the first line treatment for severe depression recommended by NICE?
Combination of individual cognitive behavioural therapy (CBT) and an antidepressant
What PHQ-9 score would indicate ‘more severe’ depression?
Over 15
What are the biochemical features of anorexia?
Most things low
G’s and C’s raised: growth hormone, glucose, salivary glands, cortisol, cholesterol, carotinaemia
What is the mechanism of action of mirtazapine?
Noradrenergic and specific serotonergic antidepressant which increases release of neurotramsitters by blocking alpha2 adrenoreceptors
What are the adverse effects of clozapine?
- Agranulocytosis, neutropaenia
- Reduced seizure threshold
- Constipation
- Myocarditis - baseline ECG should be taken before starting treatment
- Hypersalivation
A 45-year-old female with a history of bipolar disorder complains of lower back pain, constipation, headaches, low mood, and difficulty concentrating.
Her presentation is likely due to which of the following medications?
Lithuim - long-term litium use can result in hyperparathyroidism and resultant hypercalcaemia
What is the first line drug for generalised anxiety disorder?
Sertraline
What is the difference between pseudohallucinations and true hallucinations?
Patients with pseudohallucinations understand that what they are seeing isn’t real
True or false: pseudohallucinations can form a part of the normal greiving process
True
Which form of non-pharmacological therapy is most likely to be beneficial in a patient with schizophrenia?
CBT
What is somatisation disorder?
Condition is characterised by the recurrent presentation of physical symptoms such as nausea, headaches, and palpitations in the absence of a detectable organic cause
What is conversion disorder (FND)?
- Typically presents with neurological symptoms such as paralysis, blindness, or seizures that cannot be explained by medical evaluation
- The presented case does not describe any such neurological symptom
Which drug has the most tolerable side effect profile of the atypical antipsychotics, particularly for prolactin elevation?
Aripiprazole
What is catatonia?
Stopping of voluntary movement or staying still in an unusual position
What is the definition of chronic insomnia?
Chronic insomnia may be diagnosed after three months, if a person has trouble falling asleep or staying asleep at least three nights per week
Which gender is most often affected by anti-social personality disorder?
Men
What is tangentiality?
Tangentiality refers to wandering from a topic without returning to it
What is circumstantiality?
Patients give unnecessary and excessive detail before finally answering a question
If a first line SSRI such as sertraline is ineffective or not tolerated for generalised anxiety disorder, what should be tried?
Try another SSRI or an SNRI
What is a potential risk of SSRIs when used in the third trimester of pregnancy?
Persistent pulmonary hypertension of the newborn
What should be monitored at initiation and dose titration of SNRIs e.g. venlafaxine?
Blood pressure - association with hypertension
What should be monitored prior to starting citalopram or escitalopram?
ECG - association with QT prolongation/ventricular arrhytmias including TdP
A patient taking a SSRI has had their dose recently increased. They present to A&E with new onset confusion. What is the likely diagnosis?
Hyponatraemia - check U&Es
