Psychiatry🤪 Flashcards
1
Q
What is bulimia?
A
An eating disorder marked by recurrent episodes of binge eating followed by compensatory behaviour such as self induced vomiting or laxative abuse
2
Q
What population is bulimia most common in?
A
Women in their 20s and 30s
3
Q
What are the risk factors for bulimia? (3)
A
Female sex Young age Perfectionism History of sexual abuse Personal history of depression or anxiety Family history of depression, anxiety or eating disorders
4
Q
What is the presentation of bulimia? (5)
A
Recurrent episodes of binge eating Purging - self induced vomiting, laxative use Body image distortion Dental erosion Parotid gland swelling Russell’s sign
5
Q
What is Russell’s sign?
A
Scarring on the back of the hands or knuckles, by repeatedly inducing vomiting
6
Q
What blood abnormalities may be seen in bulimia?
A
Alkalosis from vomiting hydrochloric acid
Hypokalaemia
7
Q
What physical signs of bulimia may be seen? (4)
A
Erosion of teeth Russell’s sign Parotid gland swelling GORD Mouth ulcers
8
Q
What are the differentials of bulimia? (3)
A
Binge eating disorder Anorexia nervosa Rumination-regurgitation disorder Other psychiatric disorders
9
Q
What is the management of bulimia? (3)
A
Referral to a specialist CBT Nutrition and meal support SSRIs
10
Q
What is a delusion?
A
Delusions are firmly held beliefs that persist, despite evidence to the contrary
11
Q
What conditions can delusions be a feature of?
A
Bipolar disorder Schizophrenia Psychosis
12
Q
What is a nihilistic delusion?
A
A negative delusion that fits with the patient’s depressed mood - patients may believe that they are dead, or that the world has ended (they believe that everything has come to an end)
13
Q
What is a grandiose delusion?
A
Patients believe that they exhibit extraordinary traits or powers
14
Q
What condition are grandiose delusions common in?
A
Manic phases of bipolar disorder
15
Q
What is a delusion of control?
A
Where a patient experiences the sensation that an external entity is controlling their thoughts or actions
16
Q
What is a persecutory delusion?
A
A delusion where the patient believes they are being persecuted or conspired against
17
Q
What is a somatic delusion?
A
Where the patient believes that they have a medical, physical or biological problem despite no evidence to support the claim
18
Q
What are the differential diagnoses for patients with delusion? (2)
A
Mood disorders with psychotic features
Neurocognitive disorders - dementia, parkinson’s
Substance induced psychosis
19
Q
What is a personality disorder?
A
Maladaptive personality traits that interfere with daily life
20
Q
What are the classes of personality disorders?
A
Class A, B and C
21
Q
What types of personality disorder are there?
A
Anxious/fearful, Odd thinking and eccentric behaviour (Suspicious), Emotional/impulsive
22
Q
What type of personality disorder are class A?
A
Suspicious
23
Q
What type of personality disorder are class B?
A
Emotional/impulsive
24
Q
What type of personality disorder are class C?
A
Anxious/fearful
25
What are the class C personality disorders? (3)
Obsessive compulsive personality disorder Avoidant personality disorder Dependant personality disorder
26
What are the class B personality disorders?
Borderline personality disorder (emotionally unstable personality disorder)Antisocial personality disorderHistrionic personality disorder Narcissistic personality disorder
27
What are the class A personality disorders? (3)
Paranoid personality disorder
Schizoid personality disorder
Schizotypal personality disorder
28
What are the features of obsessive compulsive personality disorder? (3)
Occupied with details, rules, lists Perfectionism Unrealisitic expectations of themselves and others Catastrophising what will happen if expectations are not met Unwilling to pass tasks to othersIncapable of lettings things go
29
What are the features of avoidant personality disorder? (3)
Avoidance of social situations and relationships Fear of rejection and disapproval Self-isolation despite longing for interactionViews self as inferior to othersHypersensitivity to criticism
30
What are the features of dependent personality disorder?
Excessive need to be taken care of
Lack of self confidence and initiative
Relies on others to make decisions
Difficulity in expressing disagreement with others
Extensive efforts to obtain support from others
31
What are the features of EUPD? (3)
Unstable personal relationships which fluctuate between idealisation and devaluation Mood swings Unstable self imageTendency towards self harm and risky behaviours
32
What are the features of antisocial personality disorder? (3)
Disregard for and violation of the rights of others Irritability and aggressivenessDeception Irresponsiblity Lack of remorse
33
What are the features of narcissistic personality disorder? (3)
Grandiose sense of self importance
Taking advantage of others to sustain own needs
Feels that they are special and needs others to recognise this
Pre-occupied with personal fantasies and desires
Lack of empathy
34
What are the features of histrionic personality disorder? (3)
The need to be at the centre of attention Inappropriate sexual behaviours Excessive displays of emotion Perceives relationships as being more intimate than they are
35
What are the features of paranoid personality disorder?
Irrational suspicion and mistrust of others Hypersensitivity to insults, unwilling to forgive when insulted Reluctance to confide in others Preoccupied with unfounded beliefs about conspiracies against them
36
What are the features of schizoid personality disorder? (3)
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
37
What are the features of schizotypal personality disorder? (3)
Odd or eccentric beliefs Social anxiety that makes forming relationships difficult More intact grasp on reality than in schizophrenia Inappropriate affect Ideas of reference
38
What is the management of personality disorders? (2)
dialectical behaviour therapy
Medication for underlying psychiatric issues
39
What is bipolar affective disorder?
A psychiatric disorder characterised by periods of mania/hypomania and depression
40
When does bipolar disorder typically develop?
Late teens
41
What are the two types of bipolar disorder?
Type 1 - mania and depression Type 2 - hypomania and depression
42
Which type of bipolar disorder is most common?
Type 1 - mania and depression
43
What are the risk factors for bipolar disorder? (3)
GeneticsPhysical illnessStressful life events Substance misuse
44
What is mania?
Severe functional impairment and psychotic symptoms for 7 or more days, with at least 3 associated symptoms
45
What is hypomania?
Less severe than mania - similar to mania but with no functional impairment, and no psychotic symptoms
46
What are the signs and symptoms of a depressive phase of bipolar? (3)
TearfulnessAnhedonia Suicidal ideation or attempts Withdrawal Low mood Poor sleep
47
What are the signs and symptoms of a manic phase of bipolar? (3)
Elevated moodIrritability Impulsivity Reduced need for sleep Flight of ideas Mood congruent delusions
48
What are the differential diagnoses of bipolar disorder? (3)
Major depressive disorder Schizoaffective disorderGeneralised anxiety disorderSubstance induced mood disorder
49
What is the DSM-5 criteria for diagnosis of bipolar disorder?
Mania - 7 day episode of functional impairment and psychotic symptoms
Hypomania - 4 day episode with features similar to mania but no functional impairment or psychotic symptoms
Depression - one episode of major depression lasting 2 weeks
50
What is the treatment of acute mania with agitation?
IM neuroleptic or benzodiazepine (olanzapine or haloperidol) Admission to secure unit
51
What is the treatment of acute mania without agitation?
Oral antipsychotic monotherapy (+ sedatives)
52
What is the treatment of acute depression in bipolar?
Fluoxetine
Mood stabiliser (lithium, anticonvulsant or antipsychotic), antidepressant or atypical antipsychotic Psychosocial support
53
What is the long term management of bipolar disorder?
Mood stabilisers - lithium or valproateCBT, interpersonal therapy or family therapy
54
What are the side effects of litium? (5)
- hypothyroidism
- hyperparathyroidism and hypercalcaemia
- fine tremor
- weight gain
- leukocytosis
- idiopathic intracranial hypertension
- polyuria (secondary to diabetes insipidus)
55
What are the symptoms of lithium toxicity? (4)
coarse tremor (a fine tremor is seen in therapeutic levels)
hyperreflexia
acute confusion
polyuria
seizure
coma
56
What is the gold standard investigation for lithium toxicity?
Serum lithium levels
57
What other investigations can be performed to help diagnose lithium toxicity? (3)
U&EsTFTsRenal function ECG
58
Which antipsychotics are most typically used in the treatment of mania? (3)
Haloperidol Olanzapine Quetiapine Risperidone
59
What is the first line long term management of bipolar?
Lithium
60
What is the second line long term management of bipolar?
Add valproate/lamotrigine as an adjunct to lithium
61
What other medications can be used as mood stabilisers? (2)
Carbamazepine Olanzapine
62
When should lithium levels be monitored after a change in dose?
1 week after dose change and then every week until levels are stable
63
What is section 2 of the mental health act for?
Admission for assessmentTreatment can be given against a patient's consent
64
How long does section 2 of the MHA last?
28 days (cannot be renewed)
65
What criteria must a patient fit to be treated under the MHA? (3)
They must have a mental disorderThey must be a risk to the safety of themselves or others Their condition must be treatable
66
What are the 5 key principles of the mental capacity act?
A person is assumed to have capacity unless proven otherwise Steps must be taken to help a person have capacity An unwise decision does not mean the patient lacks capacityAny decisions taken under the MCA must be in a patient's best interests Any decisions made should be the least restrictive
67
What is an approved mental health professional AMHP?
A healthcare professional who receive and coordinate mental health assessment referrals
68
What is an S12 approved doctor?
A doctor (usually a consultant psychiatrist) who is approved under section 12 of the mental health act
69
Who is needed for someone to be detained under section 2 of the MHA?
Two healthcare professionals - one S12 approved doctor
70
What evidence is needed to detain someone under section 2 of the MHA?
Patient is suffering from a mental health disorder of a degree that warrants detention for assessment The patient is at risk to themselves or to others
71
What is section 3 of the mental health act for?
Detention for treatment
72
How long does section 3 of the MHA last?
6 months (and can be renewed)
73
Who is needed for someone to be detained under section 3 of the MHA?
Two healthcare professionals - one S12 approved doctor
74
What evidence is needed to section someone under section 3 of the MHA?
Patient is suffering from a mental disorder of a degree which makes it appropriate for the patient to receive medical treatment in a hospitalTreatment is in the best interests of the patients and others safetyAppropriate treatment must be available for the patient
75
What is section 4 of the MHA used for?
An emergency 72 hour assessment order, used when a section 2 would cause too much delay
76
How many healthcare professionals are needed for a section 4?
Just one - it is used when waiting for a second doctor would be detrimental
77
What is section 5(2) of the MHA used for?
Section 5(2) is used by doctors for keeping a patient already admitted voluntary to hospital in hopsital
78
How long does section 5(2) of the MHA last for?
72 hours
79
What is section 5(4) of the MHA used for?
Section 5(4) is used by nurses for keeping a patient already admitted voluntarily to hospital, in hospital
80
What is section 135 of the MHA used for?
Section 135 is used by police - a court order is obtained to allow the police to break into a property in order to bring the patient to a place of safety for further assessment
81
What is section 136 of the MHA used for?
Section 136 is used by the police - a person found in a public place that has a suspected mental health disorder can be taken to a place of safety for further assessment
82
What conditions are thought disorders associated with?
Schizophrenia Psychosis
83
What is circumstantiality in thought disorders?
The patient moves onto different topics, in a way that can be followed, and eventually returns back to the original thought
84
What is derailment (or flight of ideas) in thought disorders?
When the conversation moves randomly from topic to topic, that cannot be linked
85
What is poverty of speech?
A lack of spontaneous speech
86
What is perseveration in thought disorders?
The repetition of words or ideas when someone else attempts to change the topic
87
What is thought blocking?
When a patient suddenly halts their thought process and cannot continue
88
What is echolalia?
When a person repeats someone else's speech, including the question that was asked
89
What are clang associations?
When ideas are related to each other only by the fact that they sound similar or rhyme
90
What is tangentiality?
Where a patient jumps from topic to topic, in a way that can be followed, but does not come back around to the original idea
91
What is thought broadcasting?
Where a patient believes that others can hear their thoughts
92
What is Knight's move?
Where there are illogical leaps from one idea to another in conversation
93
What are Cotard delusions?
A delusion that the patient or a part of their body is dead or non-existent
94
What is a Capgras delusion?
A delusion that a person close to the patient has been replaced
95
What is a De Frogoli delusion?
Where a patient identified a familiar person in those around them and thinks that they are under disguise
96
What is a Ekbom delusion?
A delusion that the patient is infested with bugs
97
What is schizophrenia?
A relapsing and remitting form of psychosis characterised by positive features and negative features
98
What is the epidemiology of schizophrenia?
Typically develops in early adulthood (20s and 30s)Slightly more common in men
99
What is the strongest risk factor for schizophrenia?
Genetics
100
What is the risk of developing schizophrenia if a monozygotic twin or both parents have schizophrenia?
50%
101
What is the risk of developing schizophrenia if a parent or sibling has the condition?
10%
102
What are the environmental risk factors for developing schizophrenia? (2)
Heavy cannabis use in childhood Childhood trauma Maternal health issues - rubella and CMV Birth trauma
103
What are Schneider's first rank symptoms of schizophrenia? (4)
Auditory hallucinations
Thought disorders
Passivity phenomena
Delusional perceptions
104
What thought disorders are common in schizophrenia? (3)
Thought withdrawal Thought insertion Thought broadcasting
105
What types of auditory hallucinations are seen in patients with schizophrenia?
Two or more voices discussing the patient in third person
Voices commenting on the patient's behaviour
Thought echo
106
What is thought echo?
A hallucination where the patient hears their own thoughts as if they were being spoken aloud
107
What is passivity phenomena?
The feeling that a patient's actions, thoughts, bodily sensations or feelings are being controlled by an external influence
108
What is a delusional perception?
A true perception, to which the patient attributes a false meaning
109
What are the negative features of schizophrenia? (4)
Affect (blunting of)
Anhedonia (inability to derive pleasure)
Alogia (poverty of speech)
Avolition (poor motivation)
social withdrawal
neologisms: made-up words
catatonia
110
What is blunted affect?
Decreased expression of emotion through facial expressions, tone and movement
111
What are the differentials of schizophrenia? (4)
Substance induced psychosis Schizoaffective disorderDementia with psychosis Depression with psychosis Autoimmune encephalitis Metabolic disorders
112
What investigations are helpful in the diagnosis of schizophrenia? (3)
Mostly a clinical diagnosis CT/MRI to rule out structural abnormalities Infectious screen TFTsU&EsDrug screening
113
What is the first line management of schizophrenia? (2)
Atypical antipsychotics e.g risperidoneCBT
114
What is given as an adjunct for an acute episode of schizophrenia?
Oral benzodiazpine e.g lorazepam or haloperidol
115
What drug is considered if schizphrenia is resistant to other antipsychotics?
Clozapine
116
What is the major side effect of clozapine?
Agranulocytosis
117
What monitoring does clozapine require?
FBC before starting FBC weekly for 18 weeks then FBC fortnightly until 1 year then FBC monthly
118
What factors are associated with poor prognosis for schizophrenia? (3)
Strong family history Gradual onset Low IQ Lack of obvious precipitant Prodromal phase of social withdrawal
119
What are the side effects of risperidone?
Weight gain
Poor glycaemic control
Dyslipidaemia
120
What are the side effects of haloperidol?
Dystonia (acute dystonic reaction)
Parkinsonism
Tardive dyskinesia
Akathisia
121
What are the side effects of all antipsychotics? (3)
Sedation Hyperprolactinaemia Sexual dysfunction Cardiac arrhythmias Reduction of seizure threshold
122
What drug can be used to manage the extra pyramidal side effects of antipsychotics?
Procyclidine
123
What are the different types of schizophrenia?
Catatonic Hebephrenic Simple Undifferentiated Paranoid
124
What is tardive dyskinesia?
Involuntary movements most commonly in the face, eyes and mouth
125
What is acute dystonia?
Sustained muscle contraction (commonly affects the head, face and neck, including the eyes)
126
What is generalised anxiety disorder?
GAD is a mental health condition that causes excessive worry that impacts a peron's day to day life
127
What screening tool can be used to diagnose generalised anxiety disorder?
GAD-7 questionnaire
128
What is the NICE recommended step-wise approach of anxiety treatment?
Step 1 - education and monitoring
Step 2 - low intensity psychological interventions (self help or groups)
Step 3 - high intensity psychological interventions (CBT) or drug treatment
Step 4 - specialist input
129
What is the first line drug treatment of GAD?
Sertraline
130
What is the typical SSRI used to treat GAD? Give the dose.
Sertraline 50mg OD (can be increased to 200mg)
131
What is the second line drug treatment of GAD?
An alternative SSRI or an SNRI
132
Give 3 examples of SSRIs
Sertraline Citalopram Fluoxetine
133
Give 2 examples of SNRIs
Duloxetine Venlafaxine
134
What is the third line drug treatment of GAD?
Pregabalin
135
What are the side effects of SSRIs? (3)
Agitation Nausea DizzinessDry mouth Suicidal thoughts G.I symptoms hyponatramia
136
What monitoring is needed for patients on SSRIs?
1 week after starting for 18-25 year olds or if risk of suicide. 2 weeks for everyone else. Subsequent follow up as needed and within 4 weeks of starting medication.
137
What are the key features of generalised anxiety disorder? (3)
Feeling restlessEasily fatigued Poor concentration IrritabilityMuscle tension Sleep disturbance Feeling nervous or on edgeBeing unable to control worry Feeling as though something bad is going to happenGI symptoms
138
What other mental health disorders can cause anxiety? (3)
Depression PTSDPanic disorder Social phobia Somatisation disorder Hypochondriasis
139
What medications can commonly cause anxiety? (3)
Salbutamol Theophylline Herbal medicines CorticosteroidsAntidepressantsAlcohol Illicit drugs
140
What are the risk factors for generalised anxiety disorder? (3)
Family history Physical and emotional stressHistory of physical, emotional or sexual trauma Other anxiety disorder Chronic health condition Female sex
141
How long must a person have had excessive worry to be diagnosed with GAD?
At least 6 months
142
What investigations can be performed to help rule out organic causes for GAD? (3)
TFTsUrine drug screen 24 hour catecholamine urine test Pulmonary function ECG
143
What are the differentials of GAD? (5)
Panic disorder Social anxiety disorder OCD PTSD Depression Substance related anxiety Situational anxiety HyperthyroidismAdjustment disorderWithdrawal from CNS depressantPhaeochromocytoma
144
What is panic disorder?
Unpredictable and recurrent episodes of severe anxiety not confined to any specific situation or circumstances
145
What is the epidemiology of panic disorder?
Bimodal distribution - peak incidence at ages 20 and 50 More common in females Concurrent agoraphobia in 30-50% of cases
146
What are the symptoms of panic disorder? (5)
Difficulty in breathing Chest discomfortPalpitations Hyperventilation Depersonalisation Sweating Shaking
147
What are the differentials of panic disorder? (3)
Generalised anxiety disorder Agoraphobia Depression Alcohol or drug withdrawal Hyperthyroidism Hypoglycaemia
148
What is the first line pharmacological management of panic disorder?
SSRI
149
What is the first line treatment of panic disorder?
CBT
150
What is the second line pharmacological management of panic disorder?
Clomipramine
151
What are the characteristics of a panic attack? (3)
Discrete episode of fear or intense discomfort Starts abruptly
Reaches a crescendo in a few minutes
At least one symptom of autonomic arousal
152
What are the criteria for a diagnosis of panic disorder?
Recurrent panic attacks
At least one panic attack that is followed by a month of worrying about the attacks
As well as maladaptive changes made because of the panic attack
153
What is agoraphobia?
Fear of public spaces or fear of entering a public space from which there would be difficulty escaping
154
What is the criteria for diagnosis of agoraphobia?
Fear of at least two of the following - crowds, public spaces, travelling alone, travelling away from home Symptoms of anxiety in the feared situations Significant emotional distress due to the anxiety or avoidance Recognised as excessive or unreasonable Symptoms restricted to feared situation
155
What is social phobia?
Fear of social situations which may lead to scrutiny by others, embarassment, humiliation or criticism
156
What is postpartum depression?
A depressive disorder that can develop up to a year after childbirth
157
What are the biological factors in the development of postpartum depression? (2)
Sudden drops in oestrogen, progesterone and thyroid hormoneGenetic predispositions
158
What are the psychological factors in the development of postpartum depression? (3)
History of mood or anxiety disorderPrevious episodes of postpartum depressionUnrealistic expectations of motherhood Psychological stress from becoming a new parent
159
What are the social factors in the development of postpartum depression?
Lack of social support Relationship issues Life stressors Low socioeconomic status
160
What are the symptoms of postpartum depression? (3)
Persistent low mood Anhedonia Low energy levels Reduced appetiteDisturbed sleep patterns Concerns bonding with baby or caring for baby
161
What are the differentials of postpartum depression? (3)
'Baby blues'Postpartum psychosis Adjustment disorderGeneralised anxiety disorder
162
What scale is used to help diagnose postpartum depression?
Edinburgh postnatal depression scale
163
What is the Edinburgh postnatal depression scale?
Evaluates how the mother has felt over the past 10 days - Covers anhedonia, anxiety, overwhelm, sleeping, low mood and thoughts of self harm
164
What score on the Edinburgh postnatal depression scale is indicative of postnatal depression?
A score of 13 (out of a maximum of 30) is indicative of postnatal depression
165
What is the first line management of postnatal depression?
Self help strategies CBT
166
What is the second line management of postnatal depression?
SSRIs - sertraline/paroxetine
167
What is the typical timeline of postnatal depression?
Symptoms typically start within a month of birth, and peak at 3 months
168
What are the clinical features of depression? (6)
Depressed mood or irritabilityAnhedoniaWeight change or change in appetiteSleep alterationsActivity changesFatigueGuilt or feelings of worthlessnessCognitive issuesSuicidality
169
What are the criteria for a diagnosis of depression?
Need to have 5 out of the 9 symptoms for a minimum of 2 weeks, occuring almost every day
170
What are the differentials of depression? (4)
Biopolar disorderAnxiety disordersAdjustment disorderPMDDGrief/bereavementDementia Substance induced mood disorder
171
What are the possible organic causes of depression? (3)
Parkinson's Dementia Multiple sclerosisHypothyroidismHyperadrenalismSubstance misuseMedication side effectsCancersChronic conditions e.g diabetes
172
What investigations are carried out to rule out organic causes of depression? (3)
FBCTFTU&ELFTGlucose B12/folate Cortisol levels Toxicology screenImaging of CNS
173
What clinical questionnaires are used in the diagnosis of depression?
Patient Health Questionnaire 2Patient Health Questionnaire 9
174
What is the first line management of depression?
Low intensity psychological intervention or CBT
175
What is the first line pharmacological management of depression?
SSRI such as sertraline
176
What are the treatment options for refractory depression?
Lithium ECT - electroconvulsive therapy
177
What is the first line management of moderate to severe depression?
CBT + pharmacological therapy
178
What is ECT for depression?
Electroconvulsive therapy
The brain is stimulated with short electric pulses to cause a seizure lasting less than 2 minutes
179
What are the side effects of ECT?
Memory lossHeadache Muscle achesConfusion NauseaCardiac arrhythmia
180
How long should antidepressant therapy be continued after remission of symptoms?
6 months
181
What is serotonin syndrome?
High levels of serotonin
182
What are the symptoms of serotonin syndrome? (5)
neuromuscular excitation
hyperreflexia
myoclonus
rigidity
autonomic nervous system excitation
hyperthermia
sweating
altered mental state
confusion
183
How should antidepressants be changed before starting ECT?
Antidepressant doses should be reduced but not stopped before ECT
184
What are the three core symptoms of depression?
Low moodAnhedonia Anergia
185
What is PTSD?
A condition that may develop following a traumatic event. It can be immediate or delayed
186
What are the four groups of symptoms in PTSD?
- Intrusion
- Avoidance
- Hyperarousal
- Emotional numbing
187
How long must symptoms have been present for in PTSD?
1 month - they must also cause a functional impairment
188
What are examples of intrusion symptoms? (3)
Flashbacks
Nightmares
Repetitive intrusive images
189
What are examples of avoidance symptoms?
Avoiding people, situation or circumstances resembling or associated with the event
190
What are examples of hyper arousal symptoms? (3)
Hyper-vigilance for threat Sleep problems Irritability Exaggerated startle responseDifficulty concentrating
191
What are the risk factors for PTSD? (3)
Exposure to extreme traumatic stressors - Acts of violence - Physical or sexual abuse - Military action - Accidents - DisasterPeople who have experienced a threat to their own life in medical careLow social support History of mental health problems History or drug or alcohol abuse
192
What conditions are frequently comorbid with PTSD?
AnxietyDepression Drug and alcohol misuse
193
What scales are used in the diagnosis of PTSD? (3)
PTSD checklist (DSM-5)
Trauma screening questionnaire
Posttraumatic diagnostic scale
International trauma questionnaire
194
What are the differentials of PTSD? (5)
Depression Anxiety Specific phobias Panic disorder Adjustment disorderDissociative disordersOCD Psychosis
195
What is the first line management of PTSD?
For cases under 4 weeks - watchful waiting For cases over 4 weeks - Trauma focused CBT
196
What other form of therapy may be used first line in PTSD?
Eye movement desensitisation and reprocessing
197
What is eye movement desensitisation and reprocessing?
A therapy that uses eye movements to change the way that the memory is stored in the brain, reducing problematic symptoms
198
What is the first line pharmacological management of PTSD?
Venlafaxine or an SSRI such as sertraline
199
What are the risk factors for suicide? (5)
Male sexPrevious deliberate self-harmPrevious suicide attemptsAlcohol or drug misuseHistory of mental illnessHistory of chronic diseaseAdvancing ageUnemployment Being unmarried, divorced or widowed
200
What are protective factors from suicide? (3)
Social support
Having children at home
Religious beliefs
201
In someone who has previously attempted, what factors put them at increased risk of a future completed suicide?
Efforts to avoid discoveryPlanning Leaving a written note Final acts e.g sorting out financesViolent method of attempt
202
What is psychosis?
Psychosis is when you perceive or interpret reality in a very different way from people around you. You might be said to 'lose touch' with reality.
203
What are the features of psychosis? (3)
Hallucinations Delusions Thought disorganisation Agitation/aggression Neurocognitive impairment Depression Thoughts of self harm
204
What is brief psychotic disorder?
An episode of psychosis lasting less than a month with a return to baseline functioning
205
What disorders might psychosis be seen in? (3)
Schizophrenia Depression Bipolar disorderPuerperal psychosisNeurological conditions - Parkinson's, Huntington's
206
What is OCD?
A mental disorder characterised by persistent obsessions and compulsions
207
What are obsessions?
Uncontrolled thoughts and intrusive images that the patient finds it difficult to ignore
208
What are compulsions?
Repetitive actions that the patient feels they must doIt generates anxiety if they are not done
209
What other mental health disorders is OCD associated with?
Depression Anxiety ASDPhobias Eating disorders
210
What are the risk factors for OCD? (3)
History of abuse, bullying or neglect
Age (teens)
Family history of OCD
Postnatal period/pregnancy
211
When does OCD typically develop?
Peak incidence of OCD is between 10 and 20 years
212
What scale is used to determine the severity of OCD?
Y-BOCS (yale brown obsessive compulsive scale)
213
What are the differentials of OCD? (3)
Obsessive compulsive personality disorder Hypochondriasis Body dysmorphic disorderSomatic symptom disorderSevere social phobia Panic disorder Delusional disorder
214
What is the first line management of mild OCD?
CBTExposure and response therapy
215
What is exposure and response therapy?
It aims to prevent responses to obsessive thoughts by exposing patients to anxiety inducing situations and prolonging compulsions as long as possible
216
What is the first line pharmacological management of OCD? What should be given if for body dysmorphic disorder?
SSRI (any SSRI is suitable in OCD)Fluoxetine should be given for body dysmorphic disorder
217
What is the alternative drug to SSRI in OCD?
Clomipramine
218
What should be done in cases of severe OCD?
Refer to secondary care mental health team for assessment Offer SSRI and CBT
219
When does postpartum psychosis typically occur?
Within 2-3 weeks postpartum
220
What are the features of postpartum psychosis?
ParanoiaDelusionsHallucinations Manic episodesDepressive episodesConfusion
221
What is the pharmacological management of postpartum psychosis?
Antipsychotic medications Mood stabilisers
222
What management option may be necessary for women with postpartum psychosis?
Admission to mother and baby unit/ referral to perinatal mental health team
223
Why does alcohol withdrawal occur?
Decreased inhibitory GABA and increased NMDA glutamate transmission
224
When do symptoms of alcohol withdrawal start?
6-12 hours after last drink
225
What are the first symptoms of alcohol withdrawal? (3)
Tremor Anxiety Sweating Tachycardia
226
When is the peak incidence of seizures after alcohol withdrawal?
36 hours
227
When does delirium tremens occur after alcohol withdrawal?
48-72 hours after last drink
228
What is delriuim tremens?
The rapid onset of confusion precipitated by alcohol withdrawal
229
What are the symptoms of delirium tremens? (4)
Confusion, coarse tremor, delusions, hallucinations, tachycardia, fever
230
What is the first line management of delirium tremens?
Oral lorazepam
231
What is the second line management of delirium tremens?
Pareneteral lorazepam or haloperidol
232
What questionnaires can be used to assess alcoholism?
AUDIT questionnaire SADQ questionnaire
233
What are the indications for inpatient withdrawal from alcohol? (5)
Drinking > 30 units per day Scoring over 30 on the SADQ questionnaire High risk of alcohol withdrawal seizuresConcurrent withdrawal from benzodiazepines Significant medical or psychiatric comorbidity Patients under 18 Vulnerable patients
234
What is the medical management of alcoholism?
Assisted withdrawal with chlordiazepoxide
235
What other medical options are available for alcoholism?
Acamprosate (decreases craving/desire)
236
What is acamprosate used for?
Acamprosate is used to help maintain abstinence from alcohol
237
What is the first line psychological management for alcoholism and withdrawal?
CBT
238
What are the features of opiate intoxication? (3)
Drowsiness Confusion Decreased respiratory rateBradycardia Constricted pupils Track marks
239
What are the features of opiate withdrawal? (5)
Agitation and anxiety Chills Runny eyes and nose Sweating Tachycardia High blood pressureDilated pupils Muscle cramps Insomnia Vomiting
240
When does withdrawal from heroin begin?
6 hours after last dose
241
When do symptoms of heroin withdrawal peak?
36-72 hours
242
What is the first line management of opiate dependence?
Methadone or buprenorphine
243
What drug can be used to prevent relapse of opiate addiction?
Naltrexone (by reducing cravings and euphoria associated with substance misuse)
244
What is the treatment of opiate overdose?
Naloxone
245
What are the features of cannabis intoxication? (5)
Drowsiness Impaired memory Slowed reflexes and motor skillsConjuntival injection Increased appetite Paranoia Tachycardia
246
What are the features of LSD intoxication? (5)
Hypertension
Tachycardia
Increased temperature
Labile mood
Hallucinations
Sweating
Insomnia
Euphoria
Palpitations
Tremors
247
What are the features of stimulant intoxication? (3)
Euphoria Hypertensive crisisSeizures Agitation Psychosis Excessive thirst Ischaemic events
248
What is the action of MDMA?
Induces rapid serotonin and dopamine release by binding to the 5HT2 receptor
249
What is the action of cocaine?
Increases free levels of serotonin and dopamine by decreasing uptake of dopamine, serotonin and noradrenaline
250
What is the action of methamphetamines?
Acts at the sigma receptors which increase release of dopamine
251
What is the action of LSD?
Acts at the dopamine receptors to increase release of dopamine
252
What are the complications of opioid misuse? (3)
HIVHepatitis B and CInfective endocarditis Sepsis VTE Respiratory depression Social problems - homelessness, crime
253
How long does opioid detox last for?
4 weeks in an inpatient setting 12 weeks in the community
254
How is opioid dependence treatment compliance monitored?
Urinalysis
255
Which drugs are stimulants? (3)
Cocaine Methamphetamine Khat Nicotine MDMA
256
Which drugs are hallucinogens?
Ketamine LSD
257
What type of drug is cannabis and what type of effects can it have?
Cannabinoid - can have hallucinogenic, depressive and stimulant effects
258
What is neonatal abstinence syndrome?
A condition caused by withdrawal from substances that a mother has taken during pregnancy
259
What is the treatment for neonatal withdrawal of opiates?
Morphine
260
What is the treatment for neonatal withdrawal of cocaine?
Phenobarbital
261
What is Wernicke's encephalopathy?
A syndrome of low vitamin B1 that is associated with chronic alcohol consumption
262
What are the features of Wernicke's encephalopathy?
Confustion Ataxia Ophthalmoplegia Nystagmus
‘Can Of Aperol’
263
What is Korsakoff's syndrome?
An irreversible manifestion of untreated Wernicke's encephalopathy
264
What are the features of Korsakoff's syndrome?
Retrograde amnesia Anterograde amnesia Confabulation (pt creates a false memory without the intention of deceit)
265
What is the treatment of Wernicke's encephalopathy?
IV pabrinex
266
What foods should be avoided in patients on MAO inhibitors? (3)
Aged cheese Smoked fish and meats Red wines, ales and beers Other fermented foodsAvocado
267
Why should these foods be avoided in patients on MAO inhibitors?
Tyramine can build up leading to hypertension
268
What is neuroleptic malignant syndrome?
A life-threatening reaction to antipsychotic drugs (dopamine antagonists)
269
What are the symptoms of neuroleptic malignant syndrome? (3)
pyrexia
muscle rigidity
autonomic lability: typical features include hypertension, tachycardia and tachypnoea
agitated delirium with confusion
270
What blood test results would be seen in neuroleptic malignant syndrome?
Raised creatinine kinaseRaised white blood cells Deranged LFTsMetabolic acidosis Renal failure
271
What is the treatment of neuroleptic malignant syndrome?
Stop dopamine antagonist + supportive therapy - Rehydration - Cooling
272
What is the action of benzodiazepines?
Target the GABAA receptor to increase the inhibitory effect of GABA on the nervous system
273
What are the side effects of lithium? (5)
Hypothyroidism Hyperparathyroidism and hypercalcaemia Fine tremor Nausea/vomiting Weight gain Idiopathic intracranial hypertension Leukocytosis
274
What monitoring is needed for patients on lithium?
Serum lithium TFTs Renal functionU&Es
275
When should patients be followed up after starting an SSRI?
1 week for patients aged 18-25 (or risk of suicide) 2-4 weeks for patients over 25
276
What medication might be helpful in patients with acute dystonia?
Procyclidine
277
What medication might be useful for patients with tardive dyskinesia?
Tetrabenazine
278
What medication might be helpful for patients with akathisia?
Atenolol
279
What is schizoaffective disorder?
A condition that combines both 'psychotic' symptoms and 'bipolar' type symptoms
280
What are the types of schizoaffective disorder?
Schizoaffective manic type Schizoaffective depression type Schizoaffective mixed type
281
What psychotic symptoms are experienced by people with schizoaffective disorder? (3)
Hallucinations Delusions Thought disorder
282
What manic symptoms are experienced by people with schizoaffective disorder? (4)
Elevated mood Lack of sleep IrritabilityFlight of ideas Incomprehensible speech Excessive energyRisky behvaiours
283
What depressive symptoms are experienced by people with schizoaffective disorder?
Low mood Anhedonia Low energy Lack of concentration Suicidal thoughts Sleep disturbance
284
What is the treatment of an acute episode of schizoaffective disorder?
Antipsychotics - Risperidone - Olanzapine - Quetiapine
285
What is the treatment of depressive symptoms in schizoaffective disorder?
Antidepressants - SSRI - sertraline, citalopram
286
What is the treatment of manic symptoms in schizoaffective disorder?
Lithium
287
What is neuroleptic malignant syndrome?
A life-threatening emergency associated with the use of antipsychotics
288
What type of drugs can neuroleptic malignant syndrome occur with? (3)
Typical antipsychotics Atypical antipsychotics Withdrawal of dopaminergic drugs (levodopa)
289
What are the symptoms of neuroleptic malignant syndrome? (5)
Pyrexia Muscle rigidityHypertension TachycardiaTachypnoea Altered mental state Tremor
290
What results might be seen on blood tests in neuroleptic malignant syndrome? (3)
Raised creatinine kinase AKI LeukocytosisDeranged LFTsMetabolic acidosis
291
What is the management of neuroleptic malignant syndrome? (3)
Stop antipsychotic IV fluids AntipyreticsMuscle relaxant - dantrolene, bromocriptine
292
What are the risk factors for neuroleptic malignant syndrome? (3)
Use of antipsychotics
Withdrawal of parkinsons medication
Depot medication
High dose antipsychotics
Previous episode of NMS
293
What are the symptoms of a paracetamol overdose? (4)
NauseaVomiting Loin pain Haematuria Proteinuria Jaundice Coma Severe metabolic acidosis
294
What investigations should be performed in a paracetamol overdose? (5)
FBC U&E Clotting screenLFTs VBG Serum paracetamol level
295
What is the definition of a staggered paracetamol overdose?
If all the paracetamol tablets are not taken within 1 hour
296
What can be given if a patient presents within hour of a paracetamol overdose?
Activated charcoal
297
What is the main treatment of paracetamol overdose?
N-acetylcysteine
298
Give the criteria for liver transplantation in a paracetamol overdose
Arterial pH < 7.3, 24 hours after ingestion
or all of the following:
prothrombin time > 100 seconds
creatinine > 300 µmol/l
grade III or IV encephalopathy
299
What are the features of tricyclic overdose? (4)
antagonism of histamine receptors
drowsiness
antagonism of muscarinic receptors
dry mouth
blurred vision
constipation
urinary retention
antagonism of adrenergic receptors
postural hypotension
lengthening of QT interval
300
What ECG changes are common in tricylic overdose?
Sinus tachycardiaWidening of QRS QT prolongation
301
What investigations are performed in tricyclic overdose? (5)
FBC U&ECRPLFTsVBG ECG (prolonged QT, wide QRS, sinus tachycardia)
302
What is the management of tricylic overdose? (3)
IV sodium bicarbonate Activated charcoal within 2-4 hours of overdoseIV fluids Invasive ventilation
303
Fill in the following table (antipsychotic medication)
