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PLAB 1 August 2024 > Psychiatry > Flashcards

Psychiatry Flashcards

1
Q

Psych

Describe what trichotillomania disease is.

A

A disorder characterized by an irresistible urge to pull one’s own hair.

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2
Q

What are the symptoms of trichotillomania?

A
  • Hairl loss;
  • Varied hair lenght;
  • Presence of broken hairs;
  • Absence of scalp scarring;
  • Tension before pulling the hair with relief after pulling it;
  • Anxiety, stress, emotional distress.
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3
Q

What is the management of trichotillomania?

A

Habit reversal training.

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4
Q

What are the risk factors for suicide?

A
  • Previous suicide attempts and self-harm;
  • Divorce;
  • Male gender;
  • Unemployment;
  • Depression / mental illness;
  • Alcohol and drug abuse.
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5
Q

What are the risk factors for COMPLETED suicide?

A
  • Efforts to avoid discovery;
  • Leaving a suicide note;
  • Violent methods.
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6
Q

What are the protective factors for suicide?

A
  • Strong faith;
  • Marriage;
  • Having children.
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7
Q

What are the features of social anxiety behaviour?

A

Avoiding situations such as:
- Meeting / giving presentations;
- Meeting people (strangers);
- Speaking to an authority figure;
- Group events;
- Being observed while eating.

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8
Q

What is the management of social anxiety behaviour?

A
  • Cognitive behavioural therapy;
  • SSRIs.
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9
Q

DDx between:
- Social anxiety behaviour
- Panic disorder

A

Social anxiety behaviour
- Patient feels like being judged or rejected.

Panic disorder
- No specific trigger.

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10
Q

What are the symptoms
of depression?

A

One of the following:
- Constant low moods;
- Loss of interest/pleasure in most activities.

Plus 3 of the following:
- Fatigue;
- Worthlessness;
- Suicidal thoughts;
- Decreased concentration;
- Insomnia;
- Weight loss.

➜ Symptoms should be there > 2 weeks & affect work/daily activities.

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11
Q

What are the management
of depression?

A

1. CBT

2.Antidepressants (SSRI 1st line)
- Fluoxetine;
- Sertaline;
- Citalopram;

3.Electroconvulsive therapy

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12
Q

What is Dysthymia?

A

Chronic mild depression for > 2 years.

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13
Q

After started taking antidepressants, when should improvements be expected?

A
  • Improvements can be expected after 2-4 weeks.
  • Full effects by 6 weeks;
  • If there is improvement, meds should be continued for 6 months.

➜ If no improvement by 4 - 6 weeks on the maximum dose, than switch to another antidepressant.

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14
Q

Describe the symptoms of atypical depression.

A
  • Low mood;
  • ⬆︎ appetite;
  • Weight gain;
  • Hypersomnia, somnolence.
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15
Q

What is the Rx of adolescence depression?

A

First line: Psychotherapy;

Second line:
- Fluoxetine (best med for < 18 YO).

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16
Q

After starting antidepressants, when should a follow up be scheduled for?

A

Adults: 2-4 weeks
Teens: 2 weeks

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17
Q

Which antidepressant is contraindicated on patients with myocardial infarction?

A

Citalopram
- It prolongs the QT interval.

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18
Q

Which antidepressant is reccomended on patients with myocardial infarction?

A
  • Sertaline
  • Mirtazapine (reccomended for coronary patients with risk of GI bleeding due to warfarin)
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19
Q

Which antidepressant can cause weight gain?

A
  • Mirtazapine
  • Amitriptyline

➜ Avoid in high BMI.

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20
Q

What are the indications of electroconvulsive therapy?

A
  • Life threatening depression
  • High suicide rate
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21
Q

Describe gradiose delusions.

A

Belief that one is:
- Famous
- Omnipotent
- Wealthy
- Very powerful

➜ Associated with schizophrenia and bipolar manic state.

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22
Q

Describe what is unilateral neglect delusion.

A

Belief that one limb or side does not exist.

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23
Q

Describe what is delusion of guilt.

A

“I am responsible for the hurricane/flooding and thus need to be punished.”

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24
Q

Describe what is persecutory delusion.

A

“They are spying on me.”
“They are chasing me.”
“They are plotting against me.”

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25
Q

Psych.

Describe what is Ekbom syndrome.

A

“I am infested by parasites.”

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26
Q

Describe what is delusion of control.

A

“The chef is controlling my behaviour and feelings”.

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27
Q

Describe what is delusion of reference.

A

“The TV reporter is talking directly to me and giving me a special message that only I would understand.”

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28
Q

Describe what is delusional perception.

A

“I see the man is wearing a blue scarf today, it must mean that aliens are watching me.”

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29
Q

Delusions

Describe what is folie a deux.

A

➜ Shared psychosis.
- Delusional belief/hallucinations are shared between 2 individuals who are in a relationship.

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30
Q

Delusional of jealousy

Describe what is Othello’s syndrome.

A

Believing a partner is being unfaithful.

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31
Q

Delusion

Describe what is erotomania.

A

Belief that a person of higher social status falls in love with him/her.

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32
Q

Delusions

Describe what are:
- Capgras syndrome
- Fregoli syndrome

A

Capgras syndrome
- Belief that someone they know (or recognise) has been replaced by an imposter.

Fregoli syndrome
- Belief that different people (more than one) are in fact a single person that changes appearance.

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33
Q

Describe what is nihilistic delusion.

A

Belief that the person is:
- Already dead;
- Does not exist;
- The world has ended or it’s not real.

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34
Q

Delusional seen in schizophrenics

Describe what is thought insertion.

A

Thoughts are being inserted into the patient’s head from outside.

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35
Q

Delusional seen in schizophrenics

Describe what is thought withdrawal.

A

Thoughts have been stolen from his/her mind.

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36
Q

Delusional seen in schizophrenics

Describe what is thought broascasting.

A

Thoughts are being acessible directly to others.

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37
Q

Delusional seen in schizophrenics

Describe what is thought blocking.

A

➜ Sudden break in the chain of thoughts.

“The patient stops talking for a few seconds followed by speech in a different topic.”

38
Q

What are the features of postpartum blues?

A

Symptoms
- Anxious
- Tearful
- Irritable
- Low moods
- Benign

Presentation
- Benign;
- 3 to 7 days after birth;
- Resolves within 1 week;

Rx
- Reassurance

39
Q

What are the features of postpartum depression?

A

Symptoms
- Low moods
- Loss of pleasure
- Anxiety
- Sleep disturbances
- Suicidal thoughts
- Occasional thoughts of harming baby

Presentation
- 1 month to 1 year after birth;

Rx
- CBT
- SSRI’s (sertaline)

40
Q

What are the features of postpartum psychosis?

A

Symptoms
- Thoughts of harming baby
- Hearing voices saying baby is evil
- Hallucinations
- Delusion
- Suicidal thoughts

Presentation
- 2 - 4 days postpartum;
- Peaks at 2 weeks.

Rx
- EMERGENCY;
- Hospital admission;
- Anti-psychotics;
- Antidepressants;
- ECT (electroconvulsive therapy).

41
Q

What is the antidepressant reccomended for breastfeeding mothers?

A

Sertaline.

42
Q

Describe what is generalised anxiety disorder.

A

Excessive anxiety and worry for at least 6 months (or several months), about a wide range of events or activities.

43
Q

What are the symptoms of generalised anxiety disorder?

A
  • Palpitations
  • Trembling / shacking
  • Constant worrying
  • Sleep disturbances
  • Irritability
44
Q

What is the management of generalised anxiety disorder?

A
  • CBT
  • Sertaline
  • If innefective offer alternative SSRI or SNRI
45
Q

DDx between
- Panic attacks
- Panic disorder
- Generalised anxiety disorder

A

Panic attacks
- Discrete episodes of intense fear with physical symptoms

Panic disorder
- Reccurent panic attacks
- No triggers
- Comes out of the blue

GAD
- Excesive anxiety and worry
- About a wide range of events/activities
- Min of 6 months

46
Q

DDx between:
- Somatic symptom disorder
- Illness anxiety disorder (hypochondriasis)

A

Somatic symptom disorder
- 1 or more physical symptom;
- Chronic course (excessive time focused on symptoms leading to distress);
- Excessive diagnostic testing;
- Rejection of previous doctors;

➜ Rx: psycotherapy with regular visits to the same doctor.

Illness anxiety disorder / hypochondriasis
- Constant thinking of acquiring or having a serious illness (despite medical evaluation and reassurance)
- Minimal to no somatical symptoms
➜ Rx: CBT

47
Q

Describe the features of Munchausen's syndrome?

Facticious disorder imposed on self.

A
  • Intentional falsification of physical or psychological symptoms to obtain medical attention and Rx.
48
Q

Describe the features of Munchausen's syndrome by proxy?

A

Parent or carer produce false illness in a child or adult under their care.

49
Q

Describe the features of conversion disorder?

A

➔ Loss of motor or sensory function:
Without organic cause
- Paralysis
- Blindness
- Mutism

➔ Often triggered by stressor
➔ Patients do not intentionally fabricate their symptoms.

50
Q

Describe the symptoms of lithium toxicity.

A
  • Coarse tremor;
  • Nausea and vomiting;
  • Drowsiness;
  • Hyperreflexia
  • Seizure and coma

Diuretics and NSAIDs can cause lithium toxicity by ⬆︎ renal reabsorption.

51
Q

What is the Rx of lithium toxicity?

A

Mild to moderate:
- Stop the drug immediately;
- IV fluids;

Severe toxicity
- Haemodialysis.

52
Q

What is the investigation done in lithium toxicity?

A

Serum lithium concentration.

53
Q

Describe what is Ebstein’s anomaly?

A

A disorder caused by lithium administered during pregnancy.

54
Q

DDx between:
- Mania
- Hypomania
- Bipolar disorder

A

Mania
- High moods
- Psychotic symptoms
- Symptoms impair daily functions

Hypomania
- High moods

Bipolar disorder
- Period of high moods followed by periods of depressive moods.

55
Q

What are the symptoms of mania?

A

➔ Symptoms ≥ 1 week
- Elevated mood
- ⬆︎ physical and mental activity;
- Excessive amounts of energy;
- Rapid speech;
- ⬇︎ need for sleep
- Easily distracted
- Impulsivity
- Delusions of grandeur
- Hallucinations

56
Q

What are the symptoms of hypomania?

A
  • Milder version of mania;
  • No hallucinations or delusions.
57
Q

What are the Rx of mania?

A

1st line
- Lithium

Others:
➔ Anticonvulsants or mood stabilizers
- Sodium valproate
- Carbamazepine

➔ Antipsychotics
- Olanzapine
- Quetiapine
- Aripiprazole

➔ Psychoterapy

58
Q

What are the features of bipolar disorder?

A
  • Mania / Hypomania alternating with depression;
  • High suicide risk.
59
Q

What is the Rx for bipolar disorder?

A
  • If GP surgery (primary care) ⟶ refer to psychiatry;
  • If psychiatry clinic or not mentioned ⟶ mood stabilisers (Lithium);
60
Q

What is cyclothymia?

A
  • Milder form of bipolar disorder;
  • Mild depression and hypomania;
  • ≥ 2 years.
61
Q

Describe what is neuroleptic malignant syndrome.

A

A life-threatening reaction to anti-dopaminergic / antipsychotic meds.

➔ Onset is within a few weeks of starting the meds (but can happen at anytime).

62
Q

What is the treatment of neuroleptic malignant syndrome?

A
  • Stop offending medication;
  • Rapid cooling;
  • Dopaminergic agents: bromocriptine.
63
Q

DDx between:
- Neuroleptic malignant syndrome
- Malignant hyperthermia

A

Neuroleptic malignant syndrome
- High temperature
- Muscle rigidity
- Sweating

◆ Cause: anti-dopaminergic / antipsychotics.
◆ Onset: Hours to days.

Malignant hyperthermia
- Genetic component
- High temperature
- Muscle rigidity
- Sweating

◆ Cause: Suxa / volatile anaesthetics
◆ Onset: Minutes to hours.

64
Q

What is the management of obsessive compulsive behaviour?

A

1st line:
- CBT (exposure and response prevention);

2nd line:
- SSRI’s

65
Q

What are the features of PTSD?

A

Re-experiencing
- Flashbacks of the traumatic event;
- Repetitive nightmares;

Avoidance
- Avoiding situations and people associated with the traumatic event;

Hyperarousal
- Hypervigilance for threat;
- Exaggerated startle response;
- Difficulty sleeping.

66
Q

What is the Rx for PTSD?

A

First line
- Trauma focused CBT
In case of failure
- EMDR: Eye movement desensitisation and reprocessing;

Second line
- SSRIs

67
Q

What are the features of schizophrenia?

A

≥ 2 of the following:
- Delusions;
- Hallucinations (often auditory);
- Disorganised speech;
- Disorganised behaviour;
- Negative symptoms: neglect, social withdrawal, emotional apathy, lack of drive

➜ Symptoms should be present for at least 1 month for diagnosis.

68
Q

What is the Rx of schizophrenia?

A

◆ Atypical antipsychotics:
- Risperidone
- Olanzapine
◆ Depot injections
◆ Electroconvulsive therapy

69
Q

What is the mechanism of action of antipsychotics?

A

Blockage of dopamine D2 receptors.

70
Q

What are the side-effects of schizophrenia?

A
  • Weight gain;
  • Dystonia;
  • Dyskinesia (long term);
  • Drug-induced parkisonism;
  • Neuroleptic malignant syndrome.
71
Q

Describe what is:
- Schizoaffective disorder
- Schizophreniform disorder?

A

Schizoaffective disorder
- Schizofrenia
- Depression or bipolar disorder

Schizophreniform disorder
- Symptoms of schizophrenia lasting 1-6 months.

72
Q

Psych

What is the Rx for rumination syndrome?

A

Diaphragmatic breathing.

73
Q

What are the features of autism?

A
  • Severe difficulties in forming relationships;
  • Language difficulties (understanding and expressing it);
  • Repetitive and obsessive patterns of behaviour.
74
Q

What is the management of autism?

A
  • Behavioral and developmental programmes;
  • Speech and language therapy.
75
Q

What are the features of ADHD?

A

➔ Symptoms present in ≥ 2 settings (home & school);
➔ For > 6 months before 12 years of age;
- Hyperactivity;
- Impulsivity;
- Inattention;
- Excessive talking;
- Easily distracted.

76
Q

What is the management of ADHD?

A

Children
- Methylphenidate
- Atimoxetine
- Focused group parents-training programme

Adults
- Methylphenidate
- CBT

77
Q

What is the management of acute psychosis in a schizophrenic patient?

A
  • IM haloperidol
  • IM lorazepam
78
Q

What is the management of acute psychosis in a patient with:
- Parkison’s disease
- Lewy body dementia?

A

IM lorazepam.

Haloperidol is contraindicated, it blocks dopamine receptors in parkison worsening the condition.

79
Q

Describe what is incongruent affect.

A

A schizophrenic man is seen laughing and smiling about his father’s death whom he loved.

80
Q

Describe what is clang association.

A

A schizophrenic man that speaks in rhymes.

81
Q

What is the management of phobias?

A

Gradual exposure to reduce fear response.

82
Q

Antipsychotic side effects

DDx between:
- Tardive dyskinesia
- Akathisia
- Neuroleptic malignant syndrome

A

Tardive dyskinesia
- Repetitive ticking the tongue out;
- Repetitive lip smacking;
- Repetitive chewing

Akathisia
- Pacing around the room
- Feeling restless
- Needs to move legs

Neuroleptic malignant syndrome
- Hyperthermia
- Muscle rigidity

83
Q

Which antipsychotics cause galactorrhoea?

A
  • Risperidone
  • Olanzapine

Due to ⬆︎ levels of prolactin.

84
Q

Which antipsychotics cause gestational diabetes and weight gain?

A
  • Olanzapine
  • Clozapine
85
Q

Which antipsychotics cause osteoporosis?

A

Risperidone.

Due to ⬆︎ levels of prolactin.

86
Q

DDx between:
- Borderline personality disorder
- Antisocial personality disorder

A

Borderline personality disorder
- Unstable personal relationships
- Mood swings
- Marked impulsivity
- Self-harm
- Dramatic and attention seeking

Antisocial personality disorder
- Criminal acts
- Impulsiveness
- Aggresiveness
- Reckeless and consistent irresposability
- Lack of remorse

87
Q

DDx between:
- Acute stress reaction
- PTSD

A

Acute stress reaction
- Symptoms start minutes to hours after the initial event and lasts up to 4 weeks;

PTSD
- Lasts for more than 4 weeks.

88
Q

DDx between:
- Abnormal grief reaction
- Adjustement disorder

A

Abnormal grief reaction
- Recent loss of someone close
- Symptoms > 6 months

Adjustement disorder
- Recent loss of someone close
- Occurs within 1 month
- Cannot last more than 6 months

89
Q

DDx between:
- Dissociative amnesia
- Dissociative identity disorder
- Depersonalisation / Derealisation disorder

A

Dissociative amnesia
- After a traumatic event
- Memory loss / forgetfulness

Dissociative identity disorder
- Multiple personality disorder

Depersonalisation / Derealisation disorder
- Out of body experiences
- Watching oneself from outside of their own body
- Feeling of surrounding’s not being real

90
Q

What is the management of insomnia?

A

➔ Sleep hygiene

➔ Sleep hygiene failure + insomnia due to short term stressor
- Zoplicone
- Zolpidem

➔ Sleep hygiene failure + insomnia unlikely to resolve soon
- CBT

➔ Insomnia + Learning disability (ADHD)
- Sleep hygiene
- Melatonin

PLAB 1 August 2024 (32 decks)

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