Psychiatry Flashcards

Question

DSM 5 schiaophrenia criteria

Answer 1

DSM 5: Two or more of the following, present for at least one month, for most days * Hallucinations * Delusions * Disorganised speech * Negative symptoms * Grossly disorganised or catatonic behaviour * At least one of the first three must be present, PLUS * Social or occupational dysfunction * No evidence of other causes for psychosis * Not attributable to medication (illicit or otherwise) * Increased lateral ventricel size * Reduced breain size Negative symptoms - reduced blood flow in the frotnal xortex

Answer 2

Poor prognostic indications: * Pre morbid social withdrawal * Low IQ * Family History * Gradual onset * No obvious precipitant Male

Answer 3

* Schizophrenia * Depression * Bipolar * Drug and alcohol abuse Neurological disorders

Answer 4

* Schizophrenia with a mood component (normally depression)!!!!! * Combination of psychotic and bipolar disorder symptoms * Schizoaffective disorder depressive type - psychotic and depressive symptoms at the same time Schizoaffective disorder mixed type - psychotic, manic and depressive symptoms

Answer 5

* Hard to concentrate * Thoughts feel muddied * Someone is adding or removing thoughts from your head * People can hear your thoughts * Belief you are being controlled * Hallucination Delusions

Answer 6

* Atypical antipsychotics include Olanzapine, Risperidone, Quetiapine and Amisulpride. * SSRIs * CBT * Family therapy Supportive therapy - self-help, art,

Answer 7

The patient has a significant focus on physical symptoms such as pain, weakness, shortness of breath to level that results in major distress and problems functioning. They have excessive thoughts feeling and behaviours relating to the physical symptoms. * One or more physical symptoms that are distressing or cause disruption in daily life * Excessive thoughts, feelings or behaviours related to the physical symptoms or health concerns with at least one of the following: * Ongoing thoughts that are out of proportion with the seriousness of symptoms * Ongoing high level of anxiety about health or symptoms * Excessive time and energy spent on the symptoms or health concerns * At least one symptom is constantly present, although there may be different symptoms and symptoms may come and go * Support and reassurance * Psychotherapy * Antidepressants

Answer 8

* Persistant - presents for more than 2 years * Problamatic - leads to personal distress, difficulties maintiaing relationships Pervasive - various personal and social situations, multiple settings

Answer 9

suspicious Paranoid * Suspicious * Mistrustful * Sensitive to setbacks * Unforgiving to insults * Tenacious personal rights * Hidden meanigns in remarks * Pathological jealousy Schizoid * Introverted * Emotionally cold and detatched * Withdral from affection * Limited capacity to experience pleasure Schizotypical * Magical thinking * Social anxiety * Unusual perceptions

Answer 10

emotional Borderline - * strong fluctuating emotions * Difficulty maintain healthy relationships Histrionic * Need to be centre of attention * Theatrical * Inappropriately seductive Narcissistic * Feelings that they're special * Others need to recognise this or they get upset

Answer 11

anxious Antisocial/avoidant * Severe anxiety about rejection * Avoidance of social situations Dependant * Heavily reliant on others * Unwilling to make demands * Helpless alone * Fear of abandonment Obsessive * Unrealistic expectations of how things should be done * Catastrophising what will happen * Stubborn * Overcautious

Answer 12

- freud based, becoming aware of unconscious past trauma causing present symptoms . - mixed cbt and psychoaylitical aproaches Dialectical behaviour therapy - learnt to understad and regulate emotions, manage distress and realathionshitps - for PDs. family togetehr to manage interactions and behaviours - PTSD, use rapid eye mmovement to recode memories

Answer 13

* Amitryptiline * Amoxapine * Desipramine (Norpramin) * Doxepin * Imipramine (Tofranil) * Nortriptyline (Pamelor) * Protriptyline * Trimipramine nhibiting serotonin and norepinephrine reuptake within the presynaptic terminals also block muscernici receptors leading to anticholinergic affects * Depression resistant to SSRI * Neuropathic pain relif * IBS * Drowsiness * Blurred vision * Constipation * Dry mouth * Postural hypotention * Urine retention * Increased appetite leading to weight gain * Excessive sweating * Tremor * Sexual problems

Answer 14

ECT * Sending electric shocks through the brain to relive symptoms * It is last resort - mania, catatonia, depression to the point of not eating an ddriking, other therapies and medications havent helped

Answer 15

* Sertraline * Fluoxetine * Paroxetine * Ctalopram * Fluvoxamne * Vortoxetne Block seratonins reuptake * Depression * Anxiety * Hyponatirema * Nausea * Headache * GI upset * Insomnia * Sexual dysfunction

Answer 16

* Duloxetine * Venlafaxine Blc setatonin and neuroepinephrine reuprtek in the brain * Depresson * Anxety * Nerve pan * feeling agitated, shaky or anxious. * feeling and being sick. * indigestion and stomach aches. * diarrhoea or constipation. * loss of appetite. * dizziness. *

Answer 17

* chlorpromazine (Largactil) * flupentixol (Depixol) * haloperidol (Haldol) * levomepromazine (Nozinan) * pericyazine. * perphenazine (Fentazin) * pimozide (Orap) * Inhibit dopamine neutrotransmission Pscyhcosis * dry mouth. * dizziness. * weight gain that can lead to diabetes. * blurred vision. * movement effects (for example, tremor, stiffness, agitation) * sedation (for example causing sleepiness or low energy) * loss of menstrual periods in women. * fluid retention

Answer 18

* Aripiprazole * Olanzapine * Quetiapine * Risperidone * Ziprasidone * Clozapine * Cariprazine * Paliperidone * Lurasidone nhibit dopamine neutrotransmission and modulate serotonin (5-HT), norepinephrine, and/or histamine neurotransmissio Pscyhcosis f weight gain, hyperlipidemia, diabetes mellitus, QTc prolongation, extrapyramidal side effects, myocarditis, agranulocytosis, cataracts, and sexual side effects

Answer 19

Barbituates amobarbital (Amytal), pentobarbital (Nembutal), and secobarbital (Seconal) ncreaes GABA levels * Insomnia * Seizures * rouble breathing (dyspnea). * Confusion or trouble thinking. * Passing out or fainting. * Slow pulse (bradycardia); however, barbiturate overdose can also cause a fast, weak pulse. * Dizziness and vertigo. * Nausea and vomiting. * Low body temperature (hypothermia). * Muscle weakness.

Answer 20

* Valium (diazapam) * Xanax * Halcion * Ativan * Klonopin * Librium (chlordiazepoxide) * Lorazapam facilitating the binding of the inhibitory neurotransmitter GABA at various GABA receptors throughout the CNS. * Anxity * Insomnia * Alchol withdraw * rowsiness. * light-headedness. * confusion. * unsteadiness (especially in older people, who may fall and experience injuries) * dizziness. * slurred speech. * muscle weakness. * memory problems.

Answer 21

Lithium salts Lithium - ncreases adenylate cyclase activity, and inositol monophosphatase. This affects the PI signalling pathway (PI = phosphoinositide). The result of this is a stablising effect on aminergic and cholinergic activity. This results in stabilised intracellular signalling pathways – the pathways have increased basal activity – but respond less strongly to stimuli. * Bipolar disorde, prophylaxis of mania * Severe depression * Lithium * Affcte bone and thryroid * Can be reabsobed in the kidneys and casues toxicity * Very narrow theraputic index * Diabeties insipidus * Renal damage * Drug interactions

Answer 22

valproate, gabapentin, carbamazepin Carbamazapine and valproic acid - Modulate GAGergic neurons

Answer 23

* Eqasym * Retanil act as a norepinephrine and dopamine reuptake inhibitor (NDRI), * ADHD * Narcolepsy * Headache * Irritability * Dizziness * Fast heartbeat * Less appetite * Diarrhea * Hives * Tics * Tremors

Answer 24

* Too much lithium * Dehydration and fluid shits * Issues with excretion * Acute: ingest too much lithium at once or have too little salt I your body * Acute on chronic - you normally take lithium but this time you take too much ri have too little water in your body * Chronic - take lithium every day but long term it builds up to be too much, * Arly symptoms are GI related * N&V, diarrhoea * Abdo pain ad bloating Neurologica: * Confusion or delerium * Tremors * Muscle twitches * Atxia * Dysarthria * Hypereflexi * Nystagmus * Hyperthermia * Seizures * Coma Chrnic toxixity (kidney damage): * Dehydration * Diabeties insipius * #polyusria * Muscle cramps * Mental state changes * Fatigue * Foamy pee * Oedema * Hyperlipidemia * Loss of appetien * Hypothyroidism * Hyperthyroidism * Hyperparathyroidism * Mild toxicity: 1.5 to 2.5 mmol/L (millimoles per liter). * Moderate toxicity: 2.5 to 3.5 mmol/L. * Severe toxicity: Higher than 3.5 mmol/L. * U&Es * TSH * Urinanalysis * Kidney function tests * Stomach pumping * Activated charcole * Bowel irrigation * Heamodialysis * IV fluids It can induce serotonin syndrome!!!!!

Answer 25

* SSRI * SNRI * Tricyclic antidepressants * Tramadil * St johns wart * Stimulants - MSD, LSD, Amphetaamine, cocain Normally occurs when a new medication is added to a patients regeime, within 2 weeks. * Agitation * Confusion * Hypomania * Seizures * Increased muscle tone * Tremor * Shaking * Hyperreflexia * Clonus * Hyper/otension * Tachycardia * Fever * Diarrhoea Clinicla diagnosis Increaed WCC Increaed CK * Stop all serotonergic drugs * Send to tertiary care * May need ICU admission * Cyproheptadine (seratonin antagonist) * Hyperthermia is the main complication * Use ice packs and cooling sprays to keep cool, ocassionaly may reqire intubation * ARDS * Rhabdomyalysis * Renal faliure

Answer 26

Antipsychotics * D2 blockedge in the nigrostriatal pathways * Less likely ith atypical antipsychotics * Don’t havppen with clozapine * Dystonia - Incolutanry ,ovements * Tremors * Muscle contractions * Akathesia - restlessness * Parkinsonism - rigidity, bradykinesua, tremor, mask face * Stop the drug and it normally stops yt can be permanent change * Sart with low doses and titrare up

Answer 27

Antipsychotics * Happens in 3% * Typical antipsychotics * Occurs in the first 2 weeks after starting the antipsychotics * Idiosyncratic reaction - unpredictable and not doose dependant * Confusion, catatonia , altered mental state * Fever * Rigidity * Dysautomia - autonmic instability - tachcaydia, weird blod pressure, profuse swating and arrhythmias * Electrolyte * Kidney tests * LFTs * CK * CT/MRI head * Lumbar puncture to rule out cereberal infection * Stop medication * Cardiac monutering # * Intubation, heamofiltration and ICU * Maintain a euvolemic state * Dantrolene: ryanodine receptor antagonist (causes skeletal muscle relaxation). Helps treat hyperthermia and rigidity. * Bromocriptine: dopamine agonist. Prescribed to restore ‘dopaminergic tone’. Cardiac arrest Cardiac arrhythmias Acute kidney injury Rhabdomyolysis Disseminated intravascular coagulation Seizures Respiratory failure Venous thromboembolism Mortality of 5-20%.

Answer 28

* Myocarditis generally occurs one to two months after commencing clozapine; cardiomyopathy usually presents later, at around nine months. Common presenting symptoms of myocarditis include chest pain, tachycardia, and flu-like symptoms. These warrant immediate investigation and withholding of clozapine * 80% of clozapine patients had gastrointestinal hypomotility Approximately 25% to 50% of the population is affected by this condition. A proposed hypothesis of clozapine induced agranulocytosis is that the toxic effects from the formation of a nitrenium ion on the leukocytes causes acceleration of the physiologic cell death cycle

Answer 29

* Sitting very still and staring into space. * Holding unusual postures which would normally be uncomfortable. * Keeping their arms or legs in whatever position someone else moves them into. * Repeating the same movements for a long time. * Repeating the same movements as another person (known as ‘echopraxia’). * Repeating phrases or words that they hear (known as ‘echolalia’). * Holding strange faces. * Not speaking, eating or drinking. * Doing as they are told or directed without question. * Not doing something, or resisting doing something (known as ‘negativism’). * Becoming suddenly very agitated or restless. This is called ‘excited catatonia’. * EEG * Bloods * Brain scan * Treat underlying condition * Lorzazpam - benzodiazapine, * ECT - if lorazapm doesn’t work * Moniter nutrition 8/10 improve with lorazapam, once it has improved the medication shold be stopped as soon as possible.

Answer 30

* Ethanol is a CNS depressant and enchaces GABA. * INTERACTS WITH METRONIDAZOLE and CHLORPORPAMIDE * Alcohol downregulater GABA recpetors * Benzodiazapines increased GABA by increased chloride ions Few hours: * Tremor * Nausea * Agitation * Tachycadia * Raised BP 24-28 hours * Delusions * Confusion * Diarhoea * Convulsions * Auditory halucinations * Dya and a bit (36 hours) have a fit * Delerium temens (duex trois) day 2,3 * AUDIT C questionare * CAGE questionaire * FBC * LFT * Heamanitics- B12 ad folate * TFT * If they drink over 30 units a day they need hospitl admission * Detox, slowly using specalsit alcohol services * Chlordiazepoxide - help in detox phase, benzodiazepine, stops withdrawl symptoms. * Naltrexone - opiate blocker that makes alcohol less enjoyable. * Acamprotase - increases GABA and reduced cravings * Disulfiram - inhibit acetaldehyde dehydrogenase leading to accumulations and unpleasant sympotoms upon drinking - flushing, sweating, N&V, arrhythmias. It can make people ver unwell, they even need to avoid perfumes with it n! * Give thiamine as well!

Answer 31

Happens 48 hours after alcohol withdrawl * Middle age men with many years drinking history * Only in 5% od withdrawals * 3-4 days after withdrawal * Restlessness * Fear] paranoia * Confusion * Terror stricke face * Ataxia * Tremor * Sweaty * Tachycardia * Visual hallucinations - terriying ones * Auditory hallucinations

Answer 32

* Medical emergancy!!! * Benzodiazapines - contiune for 10 nigths after symptoms have stopped * B vitamisnto reduce chance of encephalopathy * Fluid replacemnt * Dextrose * Infection and head injust checks * Symptmso should stop aafter 4 dyas but the anxety may remain for a few montsh * Death occurs in around 10-15% of cases (up to 35% if untreated).It results from epileptic seizure, heart failure, self-injury and infection.

Answer 33

* Male * <35 YO * Old adolescent * Phx mental health * Childood truama * Low self esteem * Poor physical health * Life stress * Drug and alcohol abuse * Past suicide attempts * Sexual assult * Insomonia * Parental mental illness Lack of support system

Answer 34

* HEADSS - home, educatoin, activities, srugs, sexualiy, suicide/self harm * Pathos score - adolescents in overdose - P – Problems – have you had problems for more than 1 month? A – Alone – were you alone at the time? T – Time – have you planned it for more than 3 hours? Ho – Hopeless – are you feeling hopeless about the future S – Sad – were you feeling sad for most of the time before the overdose? If they answer yes to any of these it is an indicator of future harm!

Answer 35

* Assessment order - must be signed by 2 doctors who agree the patient is unwell and require a fulfil psychiatric assessment * patient must have been examined by both doctors within 5 days of each other * Doctors are from different organisations * one of the doctors has to have previously known the patient * Patient can be treated against their well * Cannot be renewed * Approved social worker put in place * Appeal must be made in 14 days 2 doctors (normally GP and psychiatrist) 28 days

Answer 36

Police officer can enter somebodys home and remove a person to safety. Can use force. Can only be used if a social worker has obtained a warrant. Cant treat agais the persosn will. Police officer 72 hours

Answer 37

Police offics may remove paient to a place of safety from a public place Police officer 72 hours

Answer 38

5.2 * Compulsory detention of patient who has come to hospital voluntarily and is on the ward untll they can be properly assesed. * They cannot be treated aganst ther wll under ths * HOWEVER you can treat them under the menatal capacity act if they lack the ability to weigh up and understand Doctors over F2 72 hours starting from the initial nurses section being put in. 5.4 Compulsory detention of patient who has come to hospital voluntarily and is on the ward until they can be properly assessed Nurses 6 hours

Answer 39

* Treatment orders - * Social worker must see consent of nearest relative and the patient cannot be detained if this relative objects * Doctor must state the category of mental illness the patient is suffering from * Treatment can be given but after 3 months they either have to consent or a third doctor has to review patient and consent for them * Discharged by registered medical officer, hospital manager * Patient can appela to mental health tribunal - must be done in 6 months 6 months

Answer 40

* Emergancy order * Must be signed by doctro and ASW * Cannot treat agaisnt persons will * Can be converted to a section 2 when in hospital and approved by another doctor Doctor and social worker Up to 72 hours

Answer 41

37 A hospital order given by eh crown court after conviction. Very similar to S3. 37/41 Similar to 37 but with added restrictions the patient must meet when they return to the community.

Answer 42

Gender dysphora: A marked incongruence between one’s experienced/expressed gender and assigned gender, of at least 6 months’ duration, as manifested by at least two of the following: * A marked incongruence between one’s experienced/expressed gender and primary and/or secondary sex characteristics (or in * young adolescents, the anticipated secondary sex characteristics). * A strong desire to be rid of one’s primary and/or secondary sex characteristics because of a marked incongruence with one’s * experienced/expressed gender (or in young adolescents, a desire to prevent the development of the anticipated secondary sex * characteristics) * A strong desire for the primary and/or secondary sex characteristics of the other gender. * A strong desire to be of the other gender (or some alternative gender different from one’s assigned gender). * A strong desire to be treated as the other gender (or some alternative gender different from one’s assigned gender). * Hormone therapy for trans men - blocker and testosterone * Hormone therapy for trans women - estradiol * Psychological support * Hair removal * Fertility preservation * Surgery * * Top surgery too!

Answer 43

* Overestimation fo actual weight and body size * Phobia or normla weight and size * Over excercies, vomiting, diuretics, reduced calorie intake. * Very low body weight * Contorll of weivht may give a sense fo power * Obsession with food and cooking * Low metabloic rate * Cold peripheris * Bradycardia * Alopecia * Osteopenia * Vitmain definancys and elctrolyte disturbances * Amenohrohea * Lanugo hair * Skin changes * Low T3 falesly * Low plasma protie - ankele oedema * Acid damage to teeth * Anaemia - Koilynchia, angular stomatitis, palpitations Lenugo hair - baby hair russles rign - callouses on knuckeles from makig self sick

Answer 44

SCOFF questionnaire: * S – Do you make yourself SICK because you feel uncomfortably full? * C – Do you worry you have lost CONTROL over how much you eat * O – Have you recently lost more than ONE STONE (6kgs) in a three month period * F – Do you believe yourself to be FAT when other say you are thin? * F – Would you say FOOD dominates your life? Yes to tow of the above has a high sensitivity for bulimeia

Answer 45

* History and exam * Weight and BMI check for reflexs * Exmain thyroid * FBC, U%E, ESRm CRP< LTF, TFT * CXR * Urinanalyss * Cancer * Diabeties * Parentl councelling * Weight gain * Psychatic help * Enourage weight ain of 500g a week, if this is nto met, admit to hosptial Nervosa - * 1/3 of patients make a complete recovery * 1/3 make only partial recovery and have many relapses * Anorexia nervosa has a mortality rate of 10-25%. This can be from suicide, pneumonia or hypokaleamia (leading to arrhythmias) *

Answer 46

* When to admit: * They're fully stopped eating * % median BMI <70 * Postural tachycarda >35 or drop ni BP >20 * Hypothermia * Severe abdo pain * Parets are worried Imagine an animal going to hubernation - conserving energy. Slow the heart rate, reduce the blood pressire, reduced body temperature,

Answer 47

* Refeeding syndrome * 3-4 days after feeding begins * Change of metablosim * Protien especially can cause it * Electroltre imbalances due to massive cellular uptake of electrolytes causng all of them to deop n the extra cellular compartment * Ths s because th ntroducton of glucose causes nslun to be released whoch draws the electrolytes nto the cells * Confusion * Coma * Convulsions * Death * Thiamine and vit b supplements Bicochemistry should be closely monitored

Answer 48

* Psysiological, emotional and physicla symtoms tha occusr during the luteal phase of the menstural cycle. * Caused by fluctation of sex homones and the interaction on seratonin and GABA * Low mood * Anxiety * Mood swings * Irratibilty * Bloating * Fatigue * Headache * Breast paon * Cognitive impartment * Clumsiness * Reduced libido * * Keep a symtom diary between menstura cycles * Cyclical structreu ti the symtoms * They an use GnHR analouge to stoop eh mensturaltion and see if the symptoms stop * General healthier living - alcohol, smoking, diet, exercise, stree, sleep * COPC * SSRI * CBT * Transdermal oestrogen patches (with preogesterone for protection) * Histerectomy with bilateral orichectomy * Spironolactone to manage water retention * Danazole and tamoxifen - options for cyclical breast pain

Answer 49

* Tremor * Functional dystonia - uncontrollable spasms * Functional myoclonus - uncontrollable movements and tics * Gait difficulties - * Functional tics * Limb and muscle weakness * Paralysis * Functional and dissociative seizures * Hypersensitivity to sense * Cognitive issues 0- memory loss, poor concentration, speech disturbance * Fleeting sensations – electric shock , twitching, skin crawling * It is not a diagnosis of exclusion and needs to be done by a neurologist * Medical examination * B12, and other blood tests * CT * MRI * EMG * EEG Hoovers test - hold teh bottom of teh ankles and get them to lidt teh affected leg up. if they dnt push down with teh other legat teh sam etme it is functional.

Answer 50

* Psychotherapy about emotions causing the symptoms * Neurophysiono therpay * MDT appreoach * Occupational therapy * Grounding tecnuiques for seizures Prognosis is worse if they cant admit its functional

Answer 51

Repression Threataning throughts are kept unconsious Projection Seeing your own unnaceptable trains and desires in others Displacement Redirectino of impule onto a powerless substitute target Regression Become more childlike or primative Sublimation Displace unacceptable emotions onto constructive and acceptabe ones such as art Rationalisation Distrotion of the facts to make them less threatening Reaction formation Behaves in the oposite way to what you feel, exaggeraed behaviout Interjection Taking on personality traits of others that are good for conform - child becoming mum to dolls Identification with aggressor Adopts behaviour of the aggressor to avoid abuse