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YEAR 4 > Psychiatry > Flashcards

Psychiatry Flashcards

1
Q

Genetics, Age (15-35), FHx and childhood abuse are all risk factors for the development of schizophrenia, name 5 more.

A

Neurochemical imbalances
Neurodevelopmental issues (obstetric complications)
Extremes of parental age (<20 or >35)
Substance misuse
Low socioecocomic background

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2
Q

3rd person auditory hallucinations and passivity phenomenon are two of Schneider’s first rank sx, name 2 others.

A

Delusions (bizarre often paranoid and persecutory)
Thought interference (withdrawal, broadcasting and insertion).

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3
Q

Avolition, alogia and attention deficit are 3 negative symptoms of schizophrenia, name 3 more.

A

Antisocial
Affect blunted
Anhedonia
(Catatonia)

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4
Q

Gradual onset and low IQ are 2 poor prognostic factors for schizophrenia, name 3 more.

A

No obvious precipitant
Strong family history
Premorbid withdrawal

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5
Q

Paranoid, undifferentiated and Hebephrenic are 3 types of schizophrenia, name 4 more.

A

Simple
Catatonic
Post-schizophrenic depression
Residual

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6
Q

Negative symptoms and catatonia are 2 group B symptoms of schizophrenia, name 2 more.

A

Hallucinations of other modalities (not 3rd person auditory)
Thought disorganisation (neologisms, loosening of associations).

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7
Q

How should a person with schizophrenia be managed?

A

Bio-Pscyho-Social Model
Bio:
- Antipsychotic medication, firstline = atypical antipsychotics.
- Clozapine for treatment resistant (previous 2 antipsychotics were not successful).
- Adjuvants: mood stabilisers (lithium) or antidepressants.
- ECT (catatonic)
Psycho:
- CBT
- Family intervention
- Art therapy
- Social skills building
Social:
- Support groups
- Peer support
- Support with employment

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8
Q

Haloperidol and Chlorpromazine are 2 typical antipsychotics, name 3 more.

A

Flupentixol
Sulpiride
Fluphenazine

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9
Q

Olanzapine and Quetiapine are 2 atypical antipsychotics, name 4 more.

A

Risperidone
Amisulpiride
Aripiprazole
Clozapine

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10
Q

Dystonias and Parkinsonism are 2 side effects of typical antipsychotics, name 2 more.

A

Akasthisia
Tardive dyskinesia

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11
Q

Weight gain and hypercholesterolaemia are 2 side effects of atypical antipsychotics, name 4 more.

A

Visual disturbance
Urinary retention
Dry mouth
Constipation

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12
Q

Which typical antipsychotic is associated with QT prolongation?

A

Haloperidol

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13
Q

Which side effects are specific to clozapine and what monitoring is needed?

A

Hypersalivation
Agranulocytosis

Differential WBC monitoring weekly for 18 weeks, then fornightly up to one year and then monthly whilst taking clozpine.

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14
Q

FBC, U+Es, LFTs and blood glucose need monitoring for patients taking antipsychotics, name 6 more things that must be monitored for these patients (and when they should be monitored).

A

ECG - before initiation
Lipids - before intiation, at 3 months and then yearly.
Blood pressure - before intiation and frequently during titration of doses.
Prolactin - before initiation, at 6 months and then yearly.
Weight - before initiation, frequently for 3 months and then yearly.
Creatine Phosphokinase - before initiation and then if NML is suspected.

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15
Q

Genetics, personality type and divorce are 3 risk factors for developing generalised anxiety disorder, name 3 more.

A

Childhood upbringing
Living alone/Single parenting
Low socioeconomic status

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16
Q

What investigations would you do for a patient presenting with GAD?

A

Bedside:
- bloods: FBC (anaemia and infection), TFTs (hyperthyroidism), glucose (hypoglycaemia).
- ECG: sinus tachy or arrhythmias
- Questionnaires: GAD-2, GAD-7 and Beck’s anxiety inventory

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17
Q

What are the psychiatric differenitals for GAD?

A

Other neurotic disorders
Depression
Schizophrenia
Personality disorders

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18
Q

What are the organic differentials for GAD?

A

High caffeine or alcohol intake
Withdrawal from drugs
Anaemia
Hyperthyroidism
Phaeochromocytoma
Hypoglycaemia

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19
Q

What is the medication pathway for GAD?

A

SSRI -> SNRI -> pregablin
Benzodiazepines should not be used unless this is for short-term measures during crises.

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20
Q

Family history and low socioecomic status are 2 risk factors for personality disorders, name 2 more.

A

Dysfunctional family - poor parenting or parental deprivation.
Abuse during childhood - physical, sexual (particularly eupd) and emotional.

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21
Q

What are the cluster A personality disorders?

A

Paranoid
Schizoid

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22
Q

What are the cluster B personality disorders?

A

Emotionally unstable
Dissocial
Histrionic

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23
Q

What are the cluster C personality disorders?

A

Avoidant
Dependent
Anankastic (obsessional)

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24
Q

What is the biological management for personality disorders?

A

Atypical antipsychotics
Mood stabilisers (eupd)
Small role for SSRIs

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25
Q

Which form of therapy is most appropriate for a patient with eupd?

A

Dialectical behavioural therapy

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26
Q

Amitriptyline, clomipramine and nortriptyline are 3 tricylic antidepressants, name 4 more.

A

Dosulepin
Doxepin
Imipramine
Lofepramine

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27
Q

TCAs are indicated in depressive disorders, name 3 other indications.

A

Nocturnal enuresis in children, neuropathic pain and migraine prophylaxis.

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28
Q

Dry mouth, constipation, urinary retention and blurred vision are 4 side effects of TCAs, name 5 more.

A

Arrhythmias
Postural hypotension
Urticaria
Hypomania
Increased appetite and weight gain.

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29
Q

Cardiac disease, pregnancy, breast-feeding and hepatic impairment are 4 reasons for caution with TCAs, name 4 more.

A

History of epilepsy
Thyroid disease
Phaeochromocytoma
History of mania

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30
Q

Recent MI and arrhythmias are 2 contraindications for TCAs, name 2 more.

A

Agranulocytosis
Severe liver disease

31
Q

What features must obsessions and compulsions have for a diagnosis of OCD?

A

Failure to resist
Originate from the patient’s mind
Repetitve and distressing
Carrying out the obsessive thought is not pleasurable but reduces anxiety levels.

32
Q

What are the potential differentials for OCD?

A

Obsessions and Compulsions:
- Eating disorders
- Anankastic PD
- Body dysmorphia
Primarily Obsessions:
- Anxiety
- Depression
- Schizophrenia
- Hypochondrial
Primarily Complusions:
- Tourette’s syndrome
- Kleptomania
Organic:
- Head injury
- Dementia
- Epilepsy

33
Q

What is the bio-pyscho-social management for OCD?
Then the order of the treatments.

A

Bio: SSRIs, TCAs. Addition of antipyschotic in some cases. Treatment of co-morbid depression.
Psycho: CBT (ERP), psychoeducation.
Social: Self-help books.

Mild: CBT
Moderate: CBT or SSRI
Severe: CBT + SSRI

34
Q

Citalopram, Fluoextine and sertraline are 3 SSRIs, name 3 more.

A

Paroxetine
Escitalopram
Fluvoxamine

35
Q

Depression, Panic disorder, GAD and OCD are 3 indications for the use of SSRIs, name 3 more.

A

Bulimia nervosa
Social phobia
PTSD

36
Q

Nausea, dyspepsia, diarrhoea and constipation are 4 side effects of SSRIs, name 4 more.

A

Sweating
Tremor
Rashes
Sexual dysfunction

37
Q

For what condition are SSRIs contraindicated?

A

Mania

38
Q

How long should SSRIs be gradually reduced before stopping?

A

4 weeks

39
Q

How long should patients be advised to continue taking SSRIs for after they begin to feel the benefits?

A

6 months

40
Q

Early twenties, anxiety disorders and strong family history are 3 risk factors for Bipolar disorder, name 3 more.

A

Substance misuse
Stressful life events
Depression

41
Q

What is bipolar 1 vs bipolar 2?

A
  1. Mania + depression
  2. Hypomania + severe depression
42
Q

What is the treatment for an acute manic episode?

A

Antipsychotic (faster acting)
Mood stabiliser (lithium)
Benzodiazepines (sleep and reduce agitation)
Rapid tranquilisation with haloperidol or lorazepam (violent)

43
Q

What is the treatment of a bipolar depressive episode?

A

STOP antidepressants
Atypical antipsychotic - olanzapine or quetiapine
Mood stabiliser (lamotrigene)

44
Q

What is the longterm management of bipolar?

A

Lithium firstline 4 weeks after acute episode.
If lithium ineffective consider addition of valproate, olanzapine or quetiapine.

45
Q

Bipolar disorder is an indication for the use of lithium, name 2 more indications.

A

Acute manic episode (if antipsychotic ineffective)
Depression (prevent antidepressant-induced hypomania)

46
Q

Gi disturbances, fine tremor, polydypsia and polyuria are 4 of the side effects of lithium, name 7 more.

A

Leucocytosis
Impaired renal function
Teratogenic
Hypothyroidism
Hair loss
Increased weight
Fluid retention
Metallic taste

47
Q

A coarse tremor and decreased consciousness are two of the symptoms of lithium toxicity, name 7 more.

A

Oligouria
Ataxia
Increased reflexes
Coma
Convulsions
Nystagmus
Hypotension

48
Q

What is the therapeutic range for lithium?

A

0.4-1mmol/L

49
Q

When does lithium begin to become toxic?

A

> 1.5mmol/L
2mmol/L (severely toxic)

50
Q

What should be checked before initiating a patient on lithium?

A

U+Es and EGFR (renallly excreted and can cause renal impairment).
Pregnancy test (teratogenic) - advise contraception.
Baseline ECG (QT prolongation)

51
Q

How often should lithium levels be checked once a patient is on a stable therapeutic dose?

A

Every 3 months.

52
Q

How often should U+Es and TFTs be monitored for a patient on lithium?

A

U+Es every 6 months
TFTs every 12 months

53
Q

How long must a patient be on lithium to see a clear benefit?

A

At least 18 months.

54
Q

When is lithium normally taken?

A

At night - makes testing the levels 12 hours after the dose change more convinient for the patient.

55
Q

What is the minimum length of time that sx need to be present in order for a diagnosis of PTSD to be made?

A

4 weeks

56
Q

Which drugs should not be prescribed with SSRIs as they can precipitate serotonnin syndrome when taken together?

A

Triptans
Monoamine Oxidase Inhibitors

57
Q

What are the four cardinal features of PTSD?

A

Avoidance
Reliving
Emotional numbing
Hyperarousal

58
Q

How long must sx persist for it to be classed as PTSD? What timeframe must these sx occur?

A

4 weeks
Within 6 months

59
Q

What is the mx of PTSD for sx present within 3 months of trauma?

A

Watchful waiting sx lasting <4 weeks
Trauma focused CBT once a week 8-12 weeks
Short term drug treatment for sleep disturbance
Risk assessment

60
Q

What is the mx of PTSD for sx present for more than 3 months following trauma?

A

Trauma focused psychological intervention
- CBT
- Eye movement desensitisation and reprocessing
Drug treatment considered when little benefit from psychological therapies, patient preference or co-morbid depression/severe hyperarousal.

61
Q

What medications are licensed for treatment of PTSD?

A

Paroxetine
Mirtazapine
Amitriptyline
Phenelzine

62
Q

SSRIs are one of the causes of serotonin syndrome, name 3 other drugs that can cause serotonin syndrome.

A

Monoamine oxidase inhibitors
Amphetamines
Ectasy

63
Q

Hyperreflexia, confusion and sweating can be features of serotonin syndrome, name 3 more.

A

Hypoclonus
Rigidity
Hypothermia

64
Q

What is the mx of serotonin syndrome?

A

IV fluids
Benzodiazepines
Serotonin antagonists - cyproheptadine and chlorpromazine

65
Q

How long after his first drink does delirium tremens start?

A

48-72 hours

66
Q

What medication can be used to treat moderate-severe tardive dyskinesia?

A

Tetrabenazine

67
Q

What is the difference between circumstantiality and tangentiality?

A

circumstantiality - return to the question
tangentiality - do not return to the question

68
Q

When do the seizures typically begin after acute alcohol withdrawal?

A

36 hours.

69
Q

Is Paraoxetine safe in pregnancy?

A

No, increases the risk of congenital malformations.

70
Q

What are the features associated with Korsakoff’s syndrome?

A

Anterograde amnesia, retrograde amnesia, and confabulation

71
Q

What is the risk of using SSRIs in the first trimester?

A

Small risk of congenital heart defects

72
Q

What needs to be monitored before starting SNRIs?

A

Blood pressure

73
Q

GI upset and mood change are two of the sx of discontinuation syndrome associated with SSRIs, name 5 more.

A

Dizziness
Electric shock sensations
Restlessness
Difficulty sleeping
Sweating

YEAR 4 (11 decks)

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