Psychiatry Flashcards
Psych
Describe what trichotillomania disease is.
A disorder characterized by an irresistible urge to pull one’s own hair.
What are the symptoms of trichotillomania?
- 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.
What is the management of trichotillomania?
Habit reversal training.
What are the risk factors for suicide?
-
Previous suicide attempts and self-harm; -
Divorce; - Male gender;
- Unemployment;
- Depression / mental illness;
- Alcohol and drug abuse.
What are the risk factors for COMPLETED suicide?
Efforts to avoid discovery;- Leaving a suicide note;
- Violent methods.
What are the protective factors for suicide?
- Strong faith;
- Marriage;
- Having children.
What are the features of social anxiety behaviour?
Avoiding situations such as:
- Meeting / giving presentations;
- Meeting people (strangers);
- Speaking to an authority figure;
- Group events;
- Being observed while eating.
What is the management of social anxiety behaviour?
- Cognitive behavioural therapy;
- SSRIs.
DDx between:
- Social anxiety behaviour
- Panic disorder
Social anxiety behaviour
- Patient feels like being judged or rejected.
Panic disorder
- No specific trigger.
What are the symptoms
of depression?
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.
What are the management
of depression?
1. CBT
2.Antidepressants (SSRI 1st line)
- Fluoxetine;
- Sertaline;
- Citalopram;
3.Electroconvulsive therapy
What is Dysthymia?
Chronic mild depression for > 2 years.
After started taking antidepressants, when should improvements be expected?
- 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.
Describe the symptoms of atypical depression.
- Low mood;
- ⬆︎ appetite;
- Weight gain;
- Hypersomnia, somnolence.
What is the Rx of adolescence depression?
First line: Psychotherapy;
Second line:
- Fluoxetine (best med for < 18 YO).
After starting antidepressants, when should a follow up be scheduled for?
Adults: 2-4 weeks
Teens: 2 weeks
Which antidepressant is contraindicated on patients with myocardial infarction?
Citalopram
- It prolongs the QT interval.
Which antidepressant is reccomended on patients with myocardial infarction?
- Sertaline
- Mirtazapine (reccomended for coronary patients with risk of GI bleeding due to
warfarin)
Which antidepressant can cause weight gain?
- Mirtazapine
- Amitriptyline
➜ Avoid in high BMI.
What are the indications of electroconvulsive therapy?
- Life threatening depression
- High suicide rate
Describe gradiose delusions.
Belief that one is:
- Famous
- Omnipotent
- Wealthy
- Very powerful
➜ Associated with schizophrenia and bipolar manic state.
Describe what is unilateral neglect delusion.
Belief that one limb or side does not exist.
Describe what is delusion of guilt.
“I am responsible for the hurricane/flooding and thus need to be punished.”
Describe what is persecutory delusion.
“They are spying on me.”
“They are chasing me.”
“They are plotting against me.”
Psych.
Describe what is Ekbom syndrome.
“I am infested by parasites.”
Describe what is delusion of control.
“The chef is controlling my behaviour and feelings”.
Describe what is delusion of reference.
“The TV reporter is talking directly to me and giving me a special message that only I would understand.”
Describe what is delusional perception.
“I see the man is wearing a blue scarf today, it must mean that aliens are watching me.”
Delusions
Describe what is folie a deux.
➜ Shared psychosis.
- Delusional belief/hallucinations are shared between 2 individuals who are in a relationship.
Delusional of jealousy
Describe what is Othello’s syndrome.
Believing a partner is being unfaithful.
Delusion
Describe what is erotomania.
Belief that a person of higher social status falls in love with him/her.
Delusions
Describe what are:
- Capgras syndrome
- Fregoli syndrome
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.
Describe what is nihilistic delusion.
Belief that the person is:
- Already dead;
- Does not exist;
- The world has ended or it’s not real.
Delusional seen in schizophrenics
Describe what is thought insertion.
Thoughts are being inserted into the patient’s head from outside.
Delusional seen in schizophrenics
Describe what is thought withdrawal.
Thoughts have been stolen from his/her mind.
Delusional seen in schizophrenics
Describe what is thought broascasting.
Thoughts are being acessible directly to others.
Delusional seen in schizophrenics
Describe what is thought blocking.
➜ Sudden break in the chain of thoughts.
“The patient stops talking for a few seconds followed by speech in a different topic.”
What are the features of postpartum blues?
Symptoms
- Anxious
- Tearful
- Irritable
- Low moods
- Benign
Presentation
- Benign;
- 3 to 7 days after birth;
- Resolves within 1 week;
Rx
- Reassurance
What are the features of postpartum depression?
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)
What are the features of postpartum psychosis?
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).
What is the antidepressant reccomended for breastfeeding mothers?
Sertaline.
Describe what is generalised anxiety disorder.
Excessive anxiety and worry for at least 6 months (or several months), about a wide range of events or activities.
What are the symptoms of generalised anxiety disorder?
- Palpitations
- Trembling / shacking
Constant worrying- Sleep disturbances
- Irritability
What is the management of generalised anxiety disorder?
- CBT
- Sertaline
- If innefective offer alternative SSRI or SNRI
DDx between
- Panic attacks
- Panic disorder
- Generalised anxiety disorder
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
DDx between:
- Somatic symptom disorder
- Illness anxiety disorder (hypochondriasis)
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
Describe the features of Munchausen's syndrome?
Facticious disorder imposed on self.
- Intentional falsification of physical or psychological symptoms to obtain medical attention and Rx.
Describe the features of Munchausen's syndrome by proxy?
Parent or carer produce false illness in a child or adult under their care.
Describe the features of conversion disorder?
➔ Loss of motor or sensory function:Without organic cause
- Paralysis
- Blindness
- Mutism
➔ Often triggered by stressor
➔ Patients do not intentionally fabricate their symptoms.
Describe the symptoms of lithium toxicity.
- Coarse tremor;
- Nausea and vomiting;
- Drowsiness;
- Hyperreflexia
- Seizure and coma
Diuretics and NSAIDs can cause lithium toxicity by ⬆︎ renal reabsorption.
What is the Rx of lithium toxicity?
Mild to moderate:
- Stop the drug immediately;
- IV fluids;
Severe toxicity
- Haemodialysis.
What is the investigation done in lithium toxicity?
Serum lithium concentration.
Describe what is Ebstein’s anomaly?
A disorder caused by lithium administered during pregnancy.
DDx between:
- Mania
- Hypomania
- Bipolar disorder
Mania
- High moods
- Psychotic symptoms
- Symptoms impair daily functions
Hypomania
- High moods
Bipolar disorder
- Period of high moods followed by periods of depressive moods.
What are the symptoms of mania?
➔ 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
What are the symptoms of hypomania?
- Milder version of mania;
- No hallucinations or delusions.
What are the Rx of mania?
1st line
- Lithium
Others:➔ Anticonvulsants or mood stabilizers
- Sodium valproate
- Carbamazepine
➔ Antipsychotics
- Olanzapine
- Quetiapine
- Aripiprazole
➔ Psychoterapy
What are the features of bipolar disorder?
-
Mania/Hypomaniaalternating withdepression; - High suicide risk.
What is the Rx for bipolar disorder?
- If GP surgery (primary care) ⟶
refer to psychiatry; - If psychiatry clinic or not mentioned ⟶ mood stabilisers (
Lithium);
What is cyclothymia?
- Milder form of bipolar disorder;
- Mild depression and hypomania;
- ≥ 2 years.
Describe what is neuroleptic malignant syndrome.
A life-threatening reaction to anti-dopaminergic / antipsychotic meds.
➔ Onset is within a few weeks of starting the meds (but can happen at anytime).
What is the treatment of neuroleptic malignant syndrome?
- Stop offending medication;
- Rapid cooling;
- Dopaminergic agents: bromocriptine.
DDx between:
- Neuroleptic malignant syndrome
- Malignant hyperthermia
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.
What is the management of obsessive compulsive behaviour?
1st line:
- CBT (exposure and response prevention);
2nd line:
- SSRI’s
What are the features of PTSD?
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.
What is the Rx for PTSD?
First line
- Trauma focused CBTIn case of failure
- EMDR: Eye movement desensitisation and reprocessing;
Second line
- SSRIs
What are the features of schizophrenia?
≥ 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.
What is the Rx of schizophrenia?
◆ Atypical antipsychotics:
- Risperidone
- Olanzapine
◆ Depot injections
◆ Electroconvulsive therapy
What is the mechanism of action of antipsychotics?
Blockage of dopamine D2 receptors.
What are the side-effects of schizophrenia?
- Weight gain;
- Dystonia;
- Dyskinesia (long term);
- Drug-induced parkisonism;
- Neuroleptic malignant syndrome.
Describe what is:
- Schizoaffective disorder
- Schizophreniform disorder?
Schizoaffective disorder
- Schizofrenia
- Depression or bipolar disorder
Schizophreniform disorder
- Symptoms of schizophrenia lasting 1-6 months.
Psych
What is the Rx for rumination syndrome?
Diaphragmatic breathing.
What are the features of autism?
- Severe difficulties in forming relationships;
- Language difficulties (understanding and expressing it);
- Repetitive and obsessive patterns of behaviour.
What is the management of autism?
- Behavioral and developmental programmes;
- Speech and language therapy.
What are the features of ADHD?
➔ Symptoms present in ≥ 2 settings (home & school);
➔ For > 6 months before 12 years of age;
- Hyperactivity;
- Impulsivity;
- Inattention;
- Excessive talking;
- Easily distracted.
What is the management of ADHD?
Children
- Methylphenidate
- Atimoxetine
- Focused group parents-training programme
Adults
- Methylphenidate
- CBT
What is the management of acute psychosis in a schizophrenic patient?
- IM haloperidol
- IM lorazepam
What is the management of acute psychosis in a patient with:
- Parkison’s disease
- Lewy body dementia?
IM lorazepam.
Haloperidol is contraindicated, it blocks dopamine receptors in parkison worsening the condition.
Describe what is incongruent affect.
A schizophrenic man is seen laughing and smiling about his father’s death whom he loved.
Describe what is clang association.
A schizophrenic man that speaks in rhymes.
What is the management of phobias?
Gradual exposure to reduce fear response.
Antipsychotic side effects
DDx between:
- Tardive dyskinesia
- Akathisia
- Neuroleptic malignant syndrome
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
Which antipsychotics cause galactorrhoea?
- Risperidone
- Olanzapine
Due to ⬆︎ levels of prolactin.
Which antipsychotics cause gestational diabetes and weight gain?
- Olanzapine
- Clozapine
Which antipsychotics cause osteoporosis?
Risperidone.
Due to ⬆︎ levels of prolactin.
DDx between:
- Borderline personality disorder
- Antisocial personality disorder
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
DDx between:
- Acute stress reaction
- PTSD
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.
DDx between:
- Abnormal grief reaction
- Adjustement disorder
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
DDx between:
- Dissociative amnesia
- Dissociative identity disorder
- Depersonalisation / Derealisation disorder
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
What is the management of insomnia?
➔ 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
