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PHASE 3A > Psychiatry > Flashcards

Psychiatry Flashcards

1
Q

What drugs are approved by NICE that can be used in the treatment for alcohol dependence to prevent relapses?

A

Acamprosate
Disulfiram
Naltrexone

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2
Q

What personality disorder may display magical thinking?

A

Schizotypal PD

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3
Q

What are the side effects of TCAs?

A

Have anti-muscuranic properties- ‘can’t see, can’t wee, can’t spit, can’t shit’
Dry mouth
Urinary retention
Blurry vision
COnstipation

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4
Q

What is the Rx tx of GAD?

A

1st line- SSRI (sertraline), or SSNRI (Venlafaxine/duloxetine)
Tx of somatic symptoms- Propranolol

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5
Q

List the prominent features of schizoid personality disorder?

A

The absence of close friends
Minimal contact with other people, including family
Insensitivity to social norms
Flattened affect

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6
Q

Demonstrate the key features of Histrionic personality disorder?

A

Excessiev displays of emotion
Attention seeking behaviours
Sexually inappropriate
May consider relationships more intimate than they really are

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7
Q

What is a somatic delusional belief?

A

This type of delusion relates to bodily function or bodily sensations. Often these patients are convinced there is something wrong with them and will focus on symptoms to a level that results in extreme distress and disrupts day to day living

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8
Q

Within how many months of having a baby is Postpartum depression diagnosed?

A

Within 12 months of giving birth

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9
Q

What is the first line pharmacological therpy for alzheimer’s disease?

A

AChE inhibitor- e.g. Donepezil, Galantamine, Rivastigmine

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10
Q

What are the SE of AChE inhibitors?

A

Diarrhoea, Nausea, Vomiting, Bradycardia, Urinary incontinence, Increaved salivary production

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11
Q

What is treatment-resistant schizophrenia (TRS) and what is its management?

A

TRS is a schizophrenia that does not repsond to 2 consecutive trials of antipsychotics

Tx- Clozapine

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12
Q

What is the 1st line pharmacological tx of schizophrenia?

A

Oral atypical antipsychotics e.g. Risperidone

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13
Q

Why are atypical antipsychotics preffered over typical antipsychotics?

A

Because typical antipsychotics e.g. Haloperidol have an increased risk of extr-pyrmaidal side effects

Extrapyramidal side effects:
Akathisia-refers to a feeling of restlessness and an irresistible urge to move

Dystonia- Involves involuntary muscle contractions that cause repetitive or twisting movements

Parkinsonism- Common symptoms include muscle stiffness, tremors or shaking, bradykinesia (slowness of movement), and a shuffling gait.

Tardive dyskinesia-repetitive, involuntary, and abnormal movements, such as lip smacking, tongue protrusion, grimacing, or jerking movements of the limbs.

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14
Q

What is cotard delusion?

A

Patients believes they are dead or have had organs removed

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15
Q

What are the features of delirium tremens?

A

Confusion
Hallucinations (particularly visual and tactile- insects crawling)
Sweating
Hypertnsion
Seizures (rare)

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16
Q

Which type of dementia is described as a ‘stepwise deterioration’?

A

Vascular

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17
Q

What is a section 5(2)?

A

An emergency holding order that can be implemented by hopsital doctor to keep patient in hospital when they are trying to leave.

Can last upto 72hours

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18
Q

REMOVE CARD What is a characteristic feature of the illness which develops after any viral illness or vacicnation?

A

Demyelination

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19
Q

Name a differential diagnosis in young people or adults presenting with an acute onset of new neurological or psychiatric symptoms without a past context of mental health problems?

A

Autoimmune encephalitis

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20
Q

A) What is the first line Rx tretament for OCD?
B) What is the alternative tx?

A

A) Sertraline
B) Clomipramine (TCA)

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21
Q

What are the features of neuroleptic malignant syndrome?

A

Confusion
Diaphoreiss
Lead pipe Rigidity **
Hyporeflexia **
hyperthermia
Pyrexia
Tachycardia/Tachypnoea
High blood pressure

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22
Q

What is a complication of claozapine?

A

Agranulocytosis

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23
Q

What is the the most appropriate managemnt steps in patient who presents with GAD?

A

CBT must be trailled in all patients before moving to Rx treatment

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24
Q

What is De Clerambault’s syndrome?

A

Delusional disorder in which patient has a false belief that soemone in a higher position is in love with them

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25
Q

What appropriate parameter should be monitored after starting a patient on a SNRI?

A

Blood pressure (venlafaxine can ause high HR and BP)

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26
Q

What are schneider’s first rank symptoms of schizophrenia?

A

Third person Auditory hallucinations
Thought disorder
Passivity phenomena (bodily sensations being controlled by external influence)
Delusional perceptions

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27
Q

What are the fetatures of avoidant personality disorder?

A

Fearful of criticism,
Being unliked,
Rejection
Ridicule

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28
Q

What factors are asscoaited with a poor prognosis of schizophrenia?

A

Strong family Hx
Gradual Onet
Low IQ
Prodromol phase of social withdrawal
Lack of obivious precipitant

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29
Q

What is facticious disorder?

A

AKA Munchausen’s syndrome
The individual wishes to adopt the sick role in order to receive the care of a patient, for internal emotional gain

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30
Q

What is malingering?

A

Patient seeks advantageous consequences of being diagnosed with a medical condition. For instance, evading criminal prosecution or receiving government

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31
Q

What triad is associated with wernicke’s encephalopathy?

A

Confusion
Ataxia
Opthalmoplegia

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32
Q

What are the features of Korsakoff’s syndrome?

A

Anterograde amnesia
Retrograde amnesia
Confabulation- a patient unconsciously makes up stories to fill a gap in their memory

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33
Q

What is the guidelines regarding the usage of sertraline in pregnancy?

A

Shoudl weigh up the benefits and risk, however usage of sertraline in the 1st trimester gives a small increased risk of congenitak heart defects

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34
Q

What ‘deterrent medication’ used for alcohol detox when taken daily will cause vomiting when consuming alcohol?

A

Disulfiram (Antebuse)

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35
Q

What is the effects of acamprosate usage in alcohol detoxification?

A

Anti craving medication

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36
Q

What is the MOA of benzodiazepines?

A

Enhances the effect of GABA by increasing the frequency of chloride channels.

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37
Q

What is the treatment given to patients who have had a BZD overdose?

A

Flumazenil

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38
Q

What is clang asssociations?

A

A thought disorder characterised by ideas related only by rhyme or being similar sounding

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39
Q

1st line rx tx for PTSD

A

SNRI (venlafaxine), or SSRI (Sertraline)

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40
Q

What class of drugs should be avoided in patients taking a SSRIs?

A

Triptans

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41
Q

Where in the digestive system is the majority of alcohol consumed absorbed

A

The proximal small intestine

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42
Q

Which investigation/s should be performed before starting patient on lithium?

A

Thyroid function

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43
Q

What is Charles-Bonnet syndrome?

A

syndrome characteriesed by persistent or recurrent complex hallucinations (usually visual or auditory), occurring in clear consciousness. This is generally against a background of visual impairment

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44
Q

What is the differece between mania and hypomania?

A

Hypomania is characterised by elevated mood, pressured speech and flight of ideas but without psychotic symptoms

Mania generally lasts for longer than 7 days and is more severe than an episode of hypomania. It can present with all the same symptoms as hypomania but also includes symptoms of psychosis such as hallucinations or delusions

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45
Q

What are the physiological abnormalities in a patient suffering form anorexia nervosa?

A

Hypokalaemia
Long QT syndrome
Low FSH, LH, oestrogen and Testosterone
Raised cortisol and growth hormone
Impaired glucose tolerance
Hypercholaestrameia
Hpercarotinaemia
Low T3

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46
Q

What additional medication should be prescribed to a patient taking an NSAID and SSRI?

A

A PPI e.g omeprazole becuase SSRI+NSAID increase riks of GI bleeds

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47
Q

What is the strongest risk factors for psychotic disorders?

A

Family History

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48
Q

Side effects of TCAs?

A

Dry Mouth
Weight Gain
Mydriasis
Blurred vision
Urinary retention

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49
Q

What is a characteristic side effect of Mirtazapine?

A

Increased appetite and Sedation

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50
Q

What are the different domains you are assessing in an MSE?

A

Appearance and behaviour
Speech
Mood and affect
Thoughts, delusions and hallucinations
Perceptions
Insights and judgement
Risk

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51
Q

What are the 3 characteristics of ADHD?

A

Impulsivity,
Hyperactivity
Inattention

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52
Q

What is the typical characteristics in ASD?

A

Impairment in
- social interactions
- communication
- repetitive/sterotyped behaviour, interests and activities

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53
Q

What are the features of anorexia nervosa?

A

Most things are low (FSH, LH, Potassium etc.)
Gs and Cs high (glucose, growth hormone, salivary glands, cortisol, cholesterol, caotinaemia)

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54
Q

Which instances is ECT recommended in according to NICE

A

Electroconvulsive therapy

E- Euphoria (MANIA)
C- Catatonia
T - Treatment resistnt depression

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55
Q

What parameter must be monitored when patient is on Venfalaxine?

A

BP as SNRIs are associated with HTN

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56
Q

What parameter must be monitored when using SSRIs?

A

Observe U&Es for hyponatraemia- check sodium levels 2-4 weeks prior and 3 months after starting

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57
Q

What parameters must be observed in the use of citalopram (SSRI)?

A

ECG monitoring and QT interval- at risk of long QT syndrome (Torsade de pointes)

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58
Q

What is cotards syndrome?

A

Person believes that they are or part of them are dead/non existent

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59
Q

What is Capgras delusion?

A

Irrational delusion of misidentification where patient believes relative/friend have been replaced by an identical impostor

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60
Q

What is de clerambaults delusion?

A

Patient believes another individual is infatuated with them

AKA erotomania

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61
Q

Name the extrapyramidal Sx that are associated with typical antipsychotic use?

A

Typical antipsychotics- haloperidol, chlorpromazine

Parkinsonism
Acute Daytonia
Akathisisa (severe restlessness)
Tardive dyskinesia

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62
Q

ASD has several associations, what are they?

A

ADHD
Epilepsy
Higher head circumference to brain volume ratio

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63
Q

What age is it appropriate to start Ritalin or any medication in children with ADHD?

A

Children must be older than 5

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64
Q

What is the triad that must be present in order to diagnose someone with a learning disability?

A

Low intellectual performance
Onset at birth or during early childhood
Wide range of functional impairment

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65
Q

What is the depression classification used by NICE 2022?

A

Less severe- PHQ-9 score of <16
More severe- PHQ-9 score of >16

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66
Q

What are the side effects associated with atypical antipsychotics?

A

Weight gain
Hyperprolactinaemia-lless common
impaired gluycaemic control
Dyslipidaemia

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67
Q

What is conversion disorder?

A

Neurological Sx presenting after a period of stress

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68
Q

What is factitious disorder?

A

Aka Munchausens
Feigning Sx in order to receive compassion from healthcare professional

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69
Q

What is malingering?

A

Fraudulent stimulation/exaggeration of Sx with intention of financial or other gain

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70
Q

What is somatisation disorder?

A

Multiple, recurring and frequently changing presenting complaint >2 years

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71
Q

What is echolalia?

A

Repetition of someone else’s speech including questions being asked

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72
Q

What is neologism?

A

Formation of new words

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73
Q

What is perseveration?

A

Ideas and words repeated several times

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74
Q

What is clang association?

A

Uses words that rhyme with each other/sound similar

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75
Q

What is circumstantiality?

A

Gives excess or unnecessary detail but returns back to topic

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76
Q

What is tangentiality?

A

Wondering off topic WITHOUT returning back to topic

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77
Q

What is word salad?

A

Incoherent speech where real words strung along into nonsense

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78
Q

What is flight of ideas?

A

Feature of mania
Leaps from one topic to another with discernible link

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79
Q

What is knights move?

A

Feature of schizophrenia
Severe type of loosening associations where unexpected and illogical leaps from one idea to another

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80
Q

What are the 3 core symptoms of depression

A

Anhedonia
Anergia
Low mood

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81
Q

What is the choice of SSRI in adolescents and children?

A

Fluoxetine

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82
Q

What is acute dystonia?

A

An extra pyramidal se of typical antipsychotics

Acute dystonia- sustained muscle contraction. Should be managed with PROCYCLIDINE

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83
Q

What is the tetrad associated with neuroleptic malignant syndrome?

A

Hyperthermia
Muscle rigidity
Autonomic instability
Altered mental status

84
Q

List 3 short term se of ECT?

A

Headaches
Nausea
Short term memory impairment
Cardiac arrhythmias

85
Q

List 5 signs of alcohol dependence?

A

Cravings
Narrowed repertoire
Increased tolerance
Loss of control
Primacy
Rapid re-instatement

86
Q

What are the invetsigations that can be done to show alcohol intoxication/dependence?

A

GGT, AST, ALT levels
Carbohydrate deficient transferrin (CDT)

87
Q

Formulation: what are the 5 P’s?

A

Presenting problem.
Predisposing factors.
Precipitating factors.
Perpetuation factors.
Protective factors.

88
Q

Define illusion.

A

A misperception of real external stimuli.

89
Q

What is a hallucination?

A

Perceptions occurring in the absence of an external physical stimulus. Can be auditory, visual or olfactory.

90
Q

Define delusion.

A

A fixed false belief which is firmly held despite evidence to the contrary and goes against individuals normal and cultural belief system

91
Q

Thoughts are a common psychiatric sign. Name 5 types of thoughts patients may report/describe.

A

Thought insertion.
Thought withdrawal.
Thought broadcast.
Thought echo.
Thought block.

92
Q

List 3 positive and 3 negative sx of schizophrenia?

A

Positive:
-Third person auditory hallucinations
-Delusional perceptions
-Thought dsorders
-Passivity phenomenon

Negative:
-Alogia (poverty of speech)
-Anhedonia
-Avolition (poor motivation)
-Neologisms
-Incongruity/Blunting of affect

93
Q

List the 5 factors of schizophrenia that are associated with a poor prognosis

A
  1. Low IQ
  2. Strong FHx
  3. Gradual onset
  4. Prodromal phase of social withdrawal
  5. Lack of obvious percipitant
94
Q

What is the 1st line mx of schizoprenia?

A

Oral atypical antipsychotic e.g. Risperidone, Clozapine(preffered in young people and children)

95
Q

Give 3 signs/symptoms of mania.

A

Pressured speech.
Lots of projects/things going on.
Delusions.
Increased energy/activity.
Overfamiliarity.
Impulsivity.

96
Q

Give 3 symptoms often seen in bipolar disorder.

A

Increased energy.
Pressured speech.
Recklessness.
Impaired judgement.
Inflated self-esteem.
Elevated mood.

97
Q

Give 2 examples of affective disorders.

A

Bipolar disorder
Depression

98
Q

List the cluster A personality disorders.

A

Paranoid
Schizoid
Scizotypal

99
Q

List the cluster B personality disorders.

A

Antisocial
Borderline (EUPD)
Histrionic
Narcissitic

100
Q

List the cluster C personality disorders

A

Avoidant
Obsessive compulsive
Dependent

101
Q

What is the GS mx of EUPD?

A

Dialectical Behavioural Therapy (DBT)

102
Q

Presentation: describe incongruity of affect.

A

A Emotional responses that seem grossly out of tune with the situation or subject being discussed.

103
Q

Presentation: what is blunting of affect?

A

An absence of normal emotional responses.

104
Q

Presentation: what is depersonalisation?

A

Feelings of detachment from one’s own body; the patient feels like a spectator of his own activities.

105
Q

What is confabulation?

A

Giving a false account to fill a gap in memory. This is often seen in dementia patients.

106
Q

What are the essential diagnostic features of a personality disorder?

A
  1. Impairments in self and interpersonal functioning.
  2. Impairments in personality functioning.
  3. Impairments are relatively stable across time and consistent across situations.
107
Q

What is somatisation disorder?

A
  • multiple physical SYMPTOMS present for at least 2 years
  • patient refuses to accept reassurance or negative test results
108
Q

What is illness anxiety disorder?

A

AKA Hypochondriasis
- Persistent belief in the presence of undelrying serious disease.
- Patient refuses to accept reassurance or negative test results

109
Q

What is anorexia nervosa?

A

An eating disorder characterised by restrivction of caloric intake leading to
- low body weight (BMI <17.5)
- an intense fear of gaining weight
- body image disturbance

110
Q

What BMI/percentile is indicative of anorexia?

A

<17.5 in adults
and under 5th percentile in children and adolescents

111
Q

Give 5 signs/symptoms of anorexia?

A

Languno hair
Amenorrhoea
Low body weight
Hypotension
Enalrged salivary glands
Bradycardia

112
Q

List 5 phsyiological abnormlaities present in a patient with anorexia

A

hypokalaemia
low FSH, LH, oestrogens and testosterone
impaired glucose tolerance
low T3

raised cortisol and growth hormone
hypercholesterolaemia
hypercarotinaemia

113
Q

What is Bullimia nervosa?

A

an eating disorder characterised by episodes of binge eating followed by intentional vomiting or other purgative behaviours

114
Q

List 5 signs/sx of bulimia

A

Russell’s sign- scarring on knuckles
Parotid gland swelling
Dental erosison
Purging
Binge eating

115
Q

What is suicide?

A

A fatal act of self harm initiated with the intention of endings one’s own life

116
Q

List 5 risk factors of suicide?

A

Lack of social support
depression
male
occupation
mental health diorder
Alcohol use
Recent life crisis

117
Q

List 4 protective factors of suicide?

A

children
pregnancy
religion
fear of act of sucide

118
Q

What is catatonia

A

Abnormality of tone, posture or movement arising from a disturbed mental state, typically
schizophrenia. Can be excessive or decreased motor activity.

119
Q

What principles underly the Mental Health Act?

A
  1. Respect for patients’ wishes and feelings.
  2. Minimise restrictions on liberty.
  3. Public safety.
  4. Patient well-being and safety,
  5. Involving patients in planning, developing and delivering care.
120
Q

What is the main investigative screening tool used for dementia?

A

ACE-III screening tool
AMT-10.

121
Q

Dementia: what 5 cognitive domains does the ACE-III screening tool assess?

A

Attention.
Memory.
Fluency.
Language.
Visiospatial.

122
Q

What drugs can be used in the treatment of dementia?

A

Acetylcholinesterase inhibitors e.g. Donepezil, Rivastigimine.

NMDA antagonist e.g. Memantine.

RF reduction in vascular dementia is important too.

123
Q

Give one way that you could distinguish between pseudo-dementia and dementia.

A

Patients with pseudo-dementia will use ‘don’t know’ answers whereas those with dementia will make up answers - confabulation.

124
Q

What is pseudo-dementia?

A

Cognitive impairments secondary to a mental illness e.g. depression/anxiety.

125
Q

What is delirium?

A

Delirium is an acute fluctuating change in mental status, with inattention, disorganised thinking and altered levels of conciousness

126
Q

Give 3 causes of delirium.

A

Infection e.g. UTI.
Dehydration.
Iatrogenic e.g. medication changes or surgery.
Constipation.
Urinary retention.

127
Q

Lithium is an effective treatment for many psychiatric conditions including mania, bipolar disorder, depression etc. Why should it be used with care?

A

Lithium has a narrow therapeutic range which can lead to renal failure.

128
Q

What is the therapeutic index for Lithium?

A

0.4-1 mmol/L

129
Q

List 5 adverse effects of lithium

A

Fine tremor *
Hypothyroidism *
Leucocytosis *
Hypercalcaemia *
Hyperparathyroidism
Weight gain
N/V/D

130
Q

What are the sx of lithium toxicity

A

Coarse tremor
Hyperreflexia
Confuison
coma
Polyuria
Ataxia

131
Q

What is bipolar I and Bilpolar II?

A

Bipolar I- Mania and depression
Bipolar II- Hypomania and depression

132
Q

What is the mx of mania

A

w/o agitation- Oral monotherphy with antipsychotic

w/ agitation- IM Haloperidol or Benzos

133
Q

What is the harmful metabolite that is produced in Paracetamol overodose?

A

NAPQI

134
Q

What rx can be given to treat moderate/severe tardive dyskinesia?

A

Tetraebnazine

135
Q

What rx can be given to treat akathiasis

A

Propanolol/Procyclidine

136
Q

What rx can be given to treat acute dystonia

A

Procyclidine

137
Q

What is the most appropriate antipsychotic that has the least se and can combat sx of hyperprolactinameia

A

Aripiprazole

138
Q

Describe Section 2 of the MHA - purpose, duration, professionals involved.

A

Purpose: assessment, treatment can be given without consent.

Duration: 28 days.

Professionals involved: 2 doctors, AMHP.

139
Q

Describe Section 3 of the MHA - purpose, duration, professionals involved.

A

Purpose: treatment.

Duration: 6 months.

Professionals involved: 2 doctors, AMHP.

140
Q

Describe Section 4 of the MHA - purpose, duration, professionals involved.

A

Purpose: emergency order.

Duration: 72 hours.

Professionals involved: 1 Dr and 1 AMHP.

141
Q

Describe Section 5(2) of the MHA-purpose, duration, professionals involved.

A

Purpose: Holding

Duration- 72 hours

Profesisonals- Doctor

142
Q

Describe Section 5(4) of the MHA-purpose, duration, professionals involved.

A

Purpose: Holding

Duration- 6 hours

Profesisonals- Nurse

143
Q

Describe Section 135 of the MHA-purpose, duration, professionals involved.

A

Purpose- Police to break into property to remove person to plce of safety

Duartion- 72 hours

Professionals- Magistrate/Police officer

144
Q

Describe Section 136 of the MHA-purpose, duration, professionals involved.

A

Purpose- Someone found in public place appering to ahve a mental disorder can be taken by police to place of safety

Duartion- 72 hours

Professionals- Police officer

145
Q

What type of delusional disorder is most common in episodes of mania?

A

Grandeaur delusions

146
Q

How long should sx of depression be present for before a diagnosis?

A

2 weeks

147
Q

List 5 sx of opioid withdrawal

A

Diarrhoea
Dilated pupils
runny nose
yawning
muscle aches
insomnia
Agitation and anxiety

148
Q

What test should be regulary done if a person is on SSRIs?

A

U&Es beuase SSRIS can cause hyponatraemia

149
Q

Which of the lowering alcohol dependency drugs cause a patient to be violently sick if they drink alcohol

A

Disulfiram (Antebuse)

150
Q

How does acaprosate work in order to stop alcohol dependence

A

anti craving

151
Q

SE of clozapine

A

Constipation
Agranulocytosis
Reduces seizure threshold

152
Q

What is a se of citalopram

A

Long QT –> Trosade de pointes

153
Q

What is the mx of lithium toxicity?

A

mild-moderate toxicity- IV fluid resuscitation

haemodialysis may be needed in severe toxicity

sodium bicarbonate is sometimes used but there is limited evidence to support this. By increasing the alkalinity of the urine it promotes lithium excretion

154
Q

List the metabolic side effects of antiphyschotics

A

Dysglycaemia
Dyslipidaemia
diabetes mellitus

155
Q

What combination of electrolyte abnormalities is most likely to be seen in refeeding syndrome?

A

Hypomagnesaemia, hypokalaemia, hypophosphataemia

156
Q

What is the mx of Neuroleptic malignant syndrome?

A

Stop antipsychotic
Iv fluids
Dantrolene
Bromocriptine

157
Q

What is the mx of serotonin syndrome?

A

Stop seratonergic drug
Iv fluids and cooling
Benzodiazepines
Cryoheptadine

158
Q

What iS the difference in pupils in NMS and serotonin syndrome?

A

NMS- Pupils normal
SS- Pupils dilated

159
Q

What area of the brain is affected in ADHD?

A

Frontal lobe- decreased activity

160
Q

What is the management of ADHD?

A

Behavioural and educational support
1st line- Methylphenidate
2nd line- Atomoxetine/Lisdexamfetamine
3rd- Dexamfetamine

161
Q

List 3 features of ASD?

A

Prefer to play alone- avoids eye contact
Speech and language delay
narrowed interets/ritualistic behaviours, sterotypical movemnts
Learning disability

162
Q

What tool can be used to assess patients with acute alcohol withdrawal?

A

CIWA-Ar questionnaire

163
Q

List 5 sx of alcohol withdrawal 6-12 hours post drink

A

Insomnia
agiitation
tremor
anxiety
N+V
Sweating
Palpitations

164
Q

Which area of the brain is affected in wernickes encephalopathy?

A

Mammilsry bodies

165
Q

List the 2 specific signs of dependence related to alcohol?

A

Rapid re-instatement- person gets back to previous drinking levels quite rapidly

Narrowing of repetoire-

166
Q

What is the MOA of N-acetylcysteine?

A

Replenishes gluthathione stores

167
Q

What blood gas would be seen in a paracetamol overdose?

A

Metabolic acidoisis

168
Q

list 2 short term and long term SE of ECT?

A

LT- Perisistent memory loss, damage to mouth and teeth, riks of death, cardiac arrhythmia

ST- Headaches, N+V, memory loss

169
Q

List the causes of anterograde and retrograde amnesia?

A

anterograde- Benzos, WE, KS

retrograde- ECT

170
Q

List the ICD-10 criteria for delirium?

A

Impairmnet of conciousness
Global disturbance in cognition
Pschomotor disturbance
Disturbance in sleep/wake cycle
Emotional distress

171
Q

What factors may prompt refferal to a mother and babay inpatient mental health unit in someone with PPD?

A

high risk of harm to baby or mother (thoughts of harming baby)
High level suicidality
inability to care for baby
Lack of support around mother
Psychotic symptoms present

172
Q

What are the key environmental RF for schizophrenia?

A

Traumatic events in childhood
Heavy cannabis use in childhood
Maternal poor health
Birt trauma
Living in the city

173
Q

What are the examples of negative sx in schizophrenia

A

Alogia (poverty of speech)
Anhedonia
Incongruity/blunting of affect
Avoliton (Poor motivation)

174
Q

What is the risk of schizo in a patient whose parent or sibling has the disorder

A

0.1

175
Q

Whta ix are indicated in a patient with a fist episode of psychosis?

A

CT/MRI Head
HIV and SYphyllis screen
Drug tetsing
FBC/U&Es and TFTs

176
Q

WHta conditons can mimic schizophrenia?

A

Substance induced pyscotic disorders
Organic psychosis caused by infection, brian injury and CNs disease e.g wilsons disesase
Hyperthyroidism/Hyperparathyroidism
Dementia and Depression

177
Q

List the auditory hallucinations in schizo

A

3rd person auditory hallucinations
Thought echo
Voices commenting on patients behaviour

178
Q

Management of lithium toxicity?

A

Stop lithium
Iv fluids
Maintain electorlytes
Haemodialysis if severe

179
Q

What are thr triggers for a manic episode in bipolar disorder?

A

Stress
lack of sleep
stopping meds
Relationship breakdown

180
Q

What are the features of PTSD?

A

Rexperiencing
Avoidance
Hyperarousal
Emotinal numbning

181
Q

WHat is the definition of a staggered overdose?

A

First and last paracetamol more than 1 hour apart

182
Q

When on Ritalin what needs to be monitored and how often?

A

Pulse/BP/Symptoms/Appetite/Weight and Height

At the start
Every 6 months atleast
+following dosage changes

183
Q

Tx for acute dystonia

A

Procyclidine or Benzatropine

184
Q

What is the MOA of Disulfiram?

A

Causes ACh buildup upon alcohol drinking –> unpleasant side effects anxiety, flushing, headaches

185
Q

What is the MOA of Acamprosate?

A

Enhances GABA transmission- reduces cravings

186
Q

What is the MOA of Naltrexone?

A

Blocks opiod receptors- reduces pleasurable effects

187
Q

What is the reversal agent for TCA overdose?

A

Sodium Bicarbonate

188
Q

What does SSRI discontinuation syndrome present with?

A

Restlessness, Sweating, Diarrhoea, Vomiting and Abdominal Pain,

189
Q

When checking lithium levels, when should a sample be taken?

A

12 hours post-dose

190
Q

What is the initial management of delirium tremens?

A

Benzodiazepines such as Lorazepam.

Chlordiazepoxide can be used for simple withdrawals

191
Q

Which specific ECG change is associated with Haloperidol use?

A

Prolongation of QT interval

192
Q

What is the most likely sign of acute methodone overdose?

A

Decreased respiratory rate

193
Q

Common symptoms of serotonin syndrome?

A

Hyperreflexia
Tremors
Hyperthermia
Agitation
Autonomic instability
Altered mental status

194
Q

How long after starting Sertraline should a under 25 and over 25 be reviewed?

A

Under 25 - 1 week

Over 25 - 2 week

195
Q

What are the features of Anorexia?

A

G’s and C’s raised

Growth hormone
Glucose
Salivary glands
Cortisol
Cholesterol
Carotinaemia

196
Q

What are the symptoms of SSRI discontinuation syndrome?

A

Dizziness
Electric shock sensations
Anxiety

197
Q

How is OCD differentiated from psychosis?

A

Level of insight into their actions

198
Q

Define a panic attack?

A

Sudden episodes of intense fear or discomfort that peak within minutes and have physical symptoms such as palpitations, sweating, trembling and SOB

199
Q

Risk factors of panic disorder?

A

Female
White ethnicity
Family history
Major life stressors
Asthma
Recent trauma

200
Q

What is the Mx of Panic disorder?

A

SSRI

If no response try Clomipramine or Imipramine

201
Q

What is the non-pharmacological Mx of OCD?

A

CBT including Exposure and Response Prevention

202
Q

What is the risk of giving Zopiclone to elderly?

A

Increased risk of falls

203
Q

What is the Mx of Alcoholic ketoacidosis?

A

IV thiamine and IV saline

204
Q

What is signs of opioid overuse?

A
205
Q

What is signs of benzodiazepine overuse?

A
206
Q

What is signs of cocaine overuse?

A

PHASE 3A (11 decks)

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