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PSYCHIATRY Flashcards

1
Q

Features of PTSD?

A

1 month of…
Re-experiencing - flashbacks, nightmares, repetitive/distressing intrusive images
Avoidance - avoiding people, situations or circumstances associated with the event
Hyperarousal - hypervigilance for threat, exaggerated startle response, sleep problems, irritability, difficulty concentrating
Emotional numbing - lack of ability to experience feelings, feeling detached

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2
Q

When does acute stress disorder occur?

A

Within the first 4 weeks after a person has been espoused to a traumatic event

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3
Q

Which foods should be avoided when on MAOI? why?

A

Tyramine containing foods e.g. cheese, marmite, broad beans, oxo, bovril, pickled herring
Can cause hypertensive reactions!

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4
Q

Factors suggesting pseudodementia?

A

Short history & rapid onset
Biological symptoms e.g. weight loss, sleep disturbance
Pt worrying about their bad memory
Reluctant to take tests and disappointed with the results
Global memory loss rather than recent memory loss

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5
Q

Features of borderline personality disorder?

A

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 and self-harm
Affective instability
Chronic feelings of emptiness
Difficulty controlling temper
Quasi psychotic thoughts - non-bizarre short-lived hallucinations/delusions

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6
Q

Features of antisocial personality disorder?

A

Failure to conform to social norms e.g. laws
Deception: repeated lying, using aliases, conning others
Impulsiveness
Irritability and aggressiveness -> repeated physical fights
Reckless disregard for safety of self or others
Consistent irresponsibility -> failure to sustain work/finance obligations
Lack of remorse

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7
Q

Features of paranoid personality disorder?

A

Hypersensitivity and an unforgiving attitude when insulted
Unwarranted tendency to questions 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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8
Q

Features of schizoid personality disorder?

A

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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9
Q

Features of schizotypal personality disorder?

A

Ideas of reference (differ from delusions in that some insight is retained)
Odd beliefs and magical thinking
Unusual perceptual disturbances
Paranoid ideation and suspiciousness
Odd, eccentric behaviour
Lack of close friends other than family members
Inappropriate affect
Odd speech without being incoherent

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10
Q

Features of histrionic personality disorder?

A

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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11
Q

Features of narcissistic personality disorder?

A

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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12
Q

Features of obsessive-compulsive personality disorder?

A

Is occupied with details, rules, lists, order, organization, or agenda to the point that the key part of the activity is gone
Demonstrates perfectionism that hampers with completing tasks
Is extremely dedicated to work and efficiency to the elimination of spare time activities
Is meticulous, scrupulous, and rigid about etiquettes of morality, ethics, or values
Is not capable of disposing worn out or insignificant things even when they have no sentimental meaning
Is unwilling to pass on tasks or work with others except if they surrender to exactly their way of doing things
Takes on a stingy spending style towards self and others; and shows stiffness and stubbornness

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13
Q

Features of avoidant personality disorder?

A

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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14
Q

Features of dependant personality disorder

A

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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15
Q

The age group for highest rates of suicide in the UK?

A

Highest among people aged 45-54

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16
Q

What severity rating scale can be used for OCD?

A

Yale-Brown Obsessive-Compulsive Scale (Y-BOCS)

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17
Q

Symptoms of serotonin syndrome?

A

Neuromuscular excitation - hyperreflexia, myoclonus, rigidity
ANS excitation - hyperthermia, sweating
Altered mental state - confusion

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18
Q

What is Hoover’s sign?

A

A test to differentiate between the organic and functional weakness of pyramidal origin - for functional neurological disorder

It is based on the principle of crossed extensor reflex - when one hip is flexed, the contralateral hip is extended eg. if a person in supine is asked to lift the right leg with knee extended, the left heel will be observed to dig into the bed/onto your hand if its underneath their foot

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19
Q

Schneider’s first rank symptoms

A

Auditory hallucinations - voices discussing the pt in third person, thought echo or voices commenting on pt behavior
Thought disorders - insertion, withdrawal, broadcasting
Passivity phenomena - being controlled by an external source
Delusional perceptions

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20
Q

Negative symptoms of schizophrenia?

A

5As:
Affected blunted
Anhedonia
Alogia (Poverty of speech)
Avolition (Poor motivation)
Avoiding society (Social withdrawal)

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21
Q

What is catatonia

A

Abnormal movements - waxy flexibility, posturing, stereotypy etc
Immobility & mutism
Abnormal behaviours
Withdrawal

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22
Q

What is conversion disorder also known as?

A

Functional neurological disorder

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23
Q

What questionnaire can be used to assess the nature and severity of alcohol misuse

A

AUDIT
Alcohol Use Disorders Identification Test\

(AUDIT-C is a shorter version!)

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24
Q

What questionnaire can be used to screen for excessive alcohol drinking and alcoholism

A

CAGE

Cut down
Annoyed when people critique
Guilty about drinking
Eye-opener

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25
What questionnaire can be used to assess risk of alcohol harm quickly?
FAST - Fast Alcohol use Screening Test
26
Outline features of alcohol withdrawal and their timings?
6-12 hrs - tremor, sweats, tachycardia, anxiety 36 hrs - seizures 48-72 hrs - coarse tremor, confusion, delusions, auditory and visual hallucinations, fever, tachycardia (this is DT)
27
Interpret PHQ9
<15 = less severe >15 = more severe
28
Peak times for symptoms, seizures and DT after alcohol withdrawal?
6-18 hours - Sx 36 hours - seizures 72 hours - DT (Half hours: 72 -> 36 -> 18 (6+12))
29
Causes of pseudohallucinations
Normal grieving process Trauma BPD
30
What type of hallucinations are pseudohallucinations typically?
Auditory or visual
31
Features of mania?
Psychotic symptoms - delusions of grandeur, auditory hallucinations Elevated mood Irritable Pressure speech, flight of ideas and poor attention Insomnia Loss of inhibitions: risk-taking, sexual promiscuity, overspending Increased appetite
32
Mania vs hypomania?
Mania lasts at least 7 days, causes severe functional impairment, and may present with psychotic symptoms Hypomania lasts for <7 days, can be high functioning and does not exhibit any psychotic symptoms
33
Physiological abnormalities of anorexia nervosa?
Hypokalaemia Low FSH, LH, oestrogen and testosterone Raised cortisol and GH Impaired glucose tolerance Hypercholesterolaemia Hypercarotinaemia Low T3
34
Diagnostic criteria for anorexia nervosa?
Restriction of energy intake relative to requirements leading to significantly low body weight Intense fear of gaining weight or becoming fat, even though underweight Disturbance in the way in which ones body weight or shape is experienced, denial of seriousness of current low body weight
35
Features of PTSD?
Re-experiencing e.g. nightmares and flashbacks Avoidance of things associated with the event Hyperarousal e.g. hypervigilance, exaggerated startle response, sleep problems, irritability, diffiuclty concentrating Emotional numbing e.g. feeling detached, lack of ability to experience feelings
36
Examples of non-selective MAOIs?
Tranylcypromine Phenelzine Isocarboxazid
37
Examples of selective MAOIs?
Selegiline Rasagiline
38
Moa of non-selective vs selective MAOIs?
Non-selective - inhibit MAO-A and B = increase serotonin, norepinephrine and dopamine Selective - only inhibit MAO-B = increase dopamine so used to Tx parkinsons
39
Features of acute stress disorder?
Within 4 weeks of the event… Intrusive thoights Dissociation Negative mood Avoidance Arousal e.g. hypervigilance and sleep disturbance
40
What is catatonia?
A neuropsychiatric syndrome characterised by abnormal movements, immobility, abnormal behaviours and withdrawal E.g. Sitting or standing in the same position for hours Usually caused by schizophrenia
41
What is an oculogyric crisis?
An acute dystonia reaction to certain drugs or medical conditions Causes restlessness, agitation and involuntary upward deviation of the eyes
42
What can cause oculogyric crises?
Antipsychotics Metoclopramide Postencephalitic parkinsons disease
43
Features of paranoid personality disorders?
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
44
Moa of chlordiazepoxide?
It’s a long acting benzodiazepine It works by enhancing the effects of the inhibitory neurotransmitter GABA by increasing the frequency of chloride channels
45
Adverse effects of clozapine?
Agranulocytosis and neutropenia Reduced seizure threshold Constipation and risk of intestinal obstruction & perforation Myocarditis Hypersalivation
46
Monitoring before starting clozapine?
Baseline ECG FBC, LFT, U&E, CRP Troponin Random BG Lipids and weight
47
Monitoring whilst on clozapine?
FBC for leukocytes every week for 18 weeks and then fortnightly for up to 1 year and then monthly Blood lipids and weight every 3 months for the first year and then yearly Fasting BG after 1 month and then every 4-6 months
48
Why is it important to know if a pt has stopped or started smoking whilst on clozapine?
As dose adjustment may be required Smoking is a potent inducer of CYP1A2 which reduces serum clozapine concentrations
49
How long does a pt have to be experiencing trouble falling asleep for a diagnosis of chronic insomnia?
3 nights a week at least for 3 months or longer
50
Adverse effects of lithium?
N&V Diarrhoea Fine tremor Nephrogenic diabetes insipidus Hypothyroidism Weight gain Idiopathic intracranial hypertension Leucocytosis Hyperparathyroidism -> hypercalcaemia
51
Monitoring requirements when on lithium?
After starting or changing dose, check lithium levels weekly at 12 hours post-dose. Once stable then check every 3 months Asses renal, cardiac, thyroid function before starting treatment. ECG if CVD or RF for CVD, BMI, serum electrolytes and FBC before treatment starts Monitor BMI, serum electrolytes, eGFR, TFT every 6 months during treatment.
52
What are the features of brief psychotic disorder?
At least 1 positive psychotic symptoms Symptoms are short term i.e. <1 month Pt returns to normal baseline functioning afterwards
53
When do acute dystonia reactions typically occur after starting drug/changing dose?
Within the first 4 days
54
Wernickes vs korsakoffs?
Wobbly wernickes - ophthalmoplegia, confusion, ataxia Konfabulatory korsakoffs - confabulations, anterograde and retrograde amnesia
55
SE of benzodiazepines?
Drowsiness Confusion Ataxia Dizziness Slurred speech Muscle weakness Anterograde amnesia Constipation Nausea Dry mouth Blurred vision Respiratory depression with high doses Sleep disorders Tremor Vision disorders
56
Benzos vs barbiturates MOA?
Ben likes it often and Barb likes it long Benzos - increase frequency pf Cl- channels to enhance effects of GABA Barbiturates - increase the duration of Cl- channels opening to enhance the efefcts of GABA
57
Features of avoidant personality disrder?
Avoidance of occupation 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 fear of being ridiculed Reluctance to take personal risks due to fears of embarrassment Views self as inept and inferior to others Social isolation but a craving for social contact
58
Lifetime risk of bipolar disorder in the UK population?
2%
59
Lifetime risk of schizophrenia if a sibling has schizophrenia?
10%
60
What % of all deaths globally are caused by suicide?
1.3%
61
What % of completed suicides are pts with a psychiatric Hx?
>90%
62
Types of schizophrenia?
Paranoid - most common Hebephrenic/disorganised Catatonic Undifferentiated Residual Simple Cenesthopathic Unspecified
63
Features of Phaeochromocytoma?
Hypertension Headaches Palpitations Sweating Anxiety
64
Diagnostic test for Phaeochromocytoma?
24 hour urinary collection of metanephrines
65
Features of serotonin syndrome?
Neuromuscular excitation - hyperreflexia, myoclonus, rigidity Autonomic nervous system excitation - hyperthermia and sweating Alternated mental state
66
What can precipitate lithium toxicity?
Dehydration Renal failure Drugs - Diuretics, ACEi/ARBs, NSAIDs and metronidazole
67
What is somnambulism?
Sleep walking
68
What is Asperger’s?
What doctors sometimes refer to as high functioning autism
69
Features of opioid misuse?
Rhinorrhoea Needle track marks Pinpoint pupils Drowsiness Watering eyes Yawning
70
Features of Ecstacy use?
Agitation, anxiety confusion, ataxia Tachycardia and hypertension Hyponatraemia Hyperthermia Rhabdomyolysis
71
What causes hyponatraemia in Ecstacy poisoning?
SIADH Excessive water consumption whilst taking Ecstacy
72
Features of LSD toxicity?
Impaired judgements which can lead to injury Amplification of current mood Agitation Drug-induced psychosis Nausea Headaches Palpitations Dry mouth Drowsy Tremors Pyrexia Tachycardia, hypertension, Mydriasis, paraesthesia, hyperreflexia
73
Complication sof massive LSD overdose?
Respiratory arrest Coma Hyperthermia Autonomic dysfunction Bleeding disorders
74
Adverse effects of cocaine?
Cardiovascular -> coronary artery spasm causing MI, tachycardia, bradycardia, hypertension, QRS widening and QT prolongation, aortic dissection Neurological -> seizures, Mydriasis, hypertonia, hyperreflexia Psychiatric effects -> agitation, psychosis, hallucinations Ischaemic colitis Hyperthermia Metabolic acidosis Rhabdomyolysis
75
MOA of cocaine?
Blocks the uptake of dopamine, noradrenaline and serotonin
76
Benzodiazepine withdrawal sundrome?
Up to 3 weeks after stopping… Insomnia Irritability Anxiety Tremor Loss of appetite Tinnitus Perspiraopn Perceptual disturbances Seizures
77
What is pathological intoxication to alcohol?
A temporary psychotic reaction which is triggered by consumption of alcohol by a person with pre-disposing mental/physical condition Often manifested by violence

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