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3A > Psychiatry > Flashcards

Psychiatry Flashcards

1
Q

What is the strongest RF for schizophrenia

A

family history (monozygotic twins- 50%, parent- 10-15%)

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2
Q

RF for schizophrenia (5)

A

family history
black carribbean
migration
urban environment
cannabis use

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3
Q

two theories of the pathophysiology of schizophrenia

A

neurodevelopmental and neurotransmitter

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4
Q

factors that indicate a poor prognosis in schizophrenia (5)

A

strong Fhx
gradual onset
low IQ
prodromal phase of social withdrawal
lack of obvious precipitant

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5
Q

what are schnieder’s first rank symptoms for schizophrenia (4)

A

auditory hallucinations (3rd person narration)
thought disorder (insertion, withdrawal, broadcasting)
delusional perceptions
somatic passivity

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6
Q

what are the negative symptoms of schizophrenia (4)

A

anhedonia
alogia (poverty of speech)
avolition (poverty of motivation)
affective flattening

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7
Q

what are delusional perceptions

A

where someone experiences a normal perception which triggers a self related delusion
e.g. the traffic light is green so i am god

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8
Q

what are some examples of delusions

A

delusions of grandiosity
erotomatic delusions
cotard syndrome

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9
Q

What is circumstantiality

A

where someone answers a question by going of on a tangent but then returning to the point

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10
Q

what is tangentiality

A

where someone wanders from a topic but does not return to the original poin

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11
Q

What is neoligisms

A

where someone makes up a new word - sometimes from combining two words

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12
Q

what are clang associations

A

where someone speaks in a manner where ideas are related by rhyming

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13
Q

what is word salad

A

incoherent speech

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14
Q

What is knights move thinking

A

where someone makes illogical leaps between topics

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15
Q

what is flight of ideas

A

where someone leaps from one topic to another with discernable links

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16
Q

what is echolalia

A

repition of someone elses speech

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17
Q

what makes up DSM-5’s definition of schizophrenia

A

symptoms must be present for at least 6 months with features of the active phase being present for at least one month

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18
Q

what makes up ICD-10’s definition of schizophrenai

A

at least 2 symptoms present for one month where one of the symptoms is a core symptom:
- persistent delusions
- persistent hallucinations
- disorganised thinking
- experiences of influence, control, passivity
cannot be attributable to another illness or substance

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19
Q

what is the overall treatment of schizophrenia

A

antipsychotics and CBT

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20
Q

what type of antipsychotics are first lien

A

atypical antipsychotics

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21
Q

give some examples of atypical antipsychotics

A

risperidone
olanzapine
quetiapine
aripiprazole

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22
Q

which atypical antispychotic has the least SE

A

aripiprazole

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23
Q

what two types of antipsychotics are there

A

atypical and typical

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24
Q

give 2 examples of typical antipsychotics

A

haloperidol and chlopromazine

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25
Q

what is the criteria for prescribing clozapien

A

at least 2 antipsychotics need to have been tried for 6-8 weeks each

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26
Q

which type of antipsychotic is associated with extrapyramidal side effects

A

typical (e.g. chlorpromazine)

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27
Q

give examples of extrapyramidal SE

A

parkinsonisms
acute dystonia
akasthisia
tardive dyskinesia

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28
Q

how can acute dystonia be treated

A

procyclidine

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29
Q

SE of typical antipsychotics

A

extrapyramidal SE
hyperprolactinoma

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30
Q

SE of atypical antipsychotics

A

metabolic effects
impaired glucose tolerance
weight gain
reduced stroke threshold

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31
Q

which antipsychotic can cause prolonged QT

A

haloperidol

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32
Q

SE of clozapine

A

agranulocytosis
reduced seizure threshold
constipation
myocarditis
hypersalivation

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33
Q

what lifestyle factor can effect clozapine

A

smoking

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34
Q

what is bipolar disorder

A

a psychiatric condition characterised by recurrent episodes of depression and mania/hypomania

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35
Q

what is mania

A

episodes of excessively elevated mood and energy with significant impact on normal functions-
- episodes last at least one week
- epsiodes have severe impacts on social or occupational functioning
- psychotic features (e.g. delusions of grandiosity, flight of ideas, pressured speech)

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36
Q

what is hypomania

A

episodes of elevated mood and energy, milder than manic episodes
- last at least 4 days
- do not have psychotic features or have significant impacts on normal functions

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37
Q

what are some symptoms of mania

A

increased mood
irritability
increased energy
decreased sleep
grandiosity
increased risk taking behaviour
disinhibition and sexually inappropriate behaviour
flight of ideas
pressured speech
psychosis
increased libido

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38
Q

what is cyclothymia

A

mild symptoms of low mood and hypomania

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39
Q

how is mania acutely managed (2)

A

stop current antidepressants
start antipsychotics- e.g. olanzapine, haloperidol

can use sodium valproate or lithium

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40
Q

how is depression in bipolar treated

A

olanzapine plus fluoxetine

can do antipsychotics or lamotrigine

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41
Q

what is the first line long term mood stabiliser in bipolar

A

lithium

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42
Q

what are side effects of lithium (10)

A

nausea and vomiting
fine tremor
weight gain
chronic kidney disease (renally excreted)
hypothyroidism
hyperparathyroidism and hypercalcaemia
nephrogenic diabetes insipidus
idiopathic intracranial HTN
T wave flattening on ECG
lithium toxicity

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43
Q

at what level does lithium toxicity often present

A

above 1.5 mmol/l

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44
Q

what can precipitate lithium toxicity

A

dehydration
renal failure
drugs (NSAIDs, thiazides, ACEi)

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45
Q

how does lithium toxicity present?

A

coarse tremor (usually fine tremor at the therapeutic dose)
hyperreflexia
confusion
polyuria
seizure
coma

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46
Q

how is lithium toxicity managed

A

IV isotonic saline
may need haemodialysis
sometimes sodium bicarbonate is used

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47
Q

how soon after a dose change should lithium levels be checked

A

1 weeks

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48
Q

how long after a dose of lithium should levels be checked?

A

12 hours

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49
Q

generally how often should lithium levels be checked

A

every 3 months

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50
Q

what are alternatives to lithium in the long term management of bipoalr

A

sodium valproate and olanzapine

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51
Q

two theories of how lithium works

A

interferes with inositol triphosphate formation
interferes with cAMP formation

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52
Q

what is generalised anxiety disorder

A

excessive worrying and disproportional anxiety about a number of events that negatively impacts the persons everyday life

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53
Q

RF for GAD

A

female
family histord
childhoof adversity
history of sexual or emotional trauma

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54
Q

secondary causes of anxiety that need to be excluded (5)

A

substance use (e.g. caffeine, cortiocsteroids)
substance withdrawal (e.g. alcohol, benzos)
hyperthyroidism
phaeochromocytoma
cushings disease

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55
Q

What can the symptoms of anxiety be split into?

A

emotional and cognitive symptoms
physical symptoms

56
Q

emotional and cognitive symptoms of anxiety

A

excessive worrying
restlessness
difficulty relaxing
difficulty concentrating
unable to control worrying
easily tired

57
Q

physical symptoms of anxiety

A

muscle tension
tremor
palpitations
sweating
insomnia
GI symptoms
headaches

58
Q

how long should symptoms of anxiety occur for for a diagnosis

A

most days for at least 6 months

59
Q

What can be used to quantify the severity of anxiety

A

the generalised anxiety disorder questionnaire (GAD-7)h

60
Q

interpretation of the GAD-7 results

A

5-9 = mild anxiety
10-14= moderate anxiety
15-21= severe anxiety

61
Q

stepwise management of GAD

A

1- education and active monitoring
2- low intensity psychological intervention (e.g. non guided self-help, guided self-help, psychoeducations groups)
3- high intensity psychological interventions (e.g. CBT)
or drug therapy
4- specialisy inputfi

62
Q

first line drug treatment in GAD

A

sertraline

63
Q

stepwise management of drug treatment of anxiety

A

1- sertraline
2- other SSRI or SNRI (venlafaxine or duloxetine)
3- pregabaline

64
Q

what characterises depression

A

a disorder of low mood, low energy and reduced enjoyment of activities

65
Q

pathophysiology of depression

A

thought to be due to neurotransitter disturbance in the CNS - particularly serotonin

66
Q

what might contribuite to causing depression

A

relationship breakdowns
grief
housing situations
occupational stress
financial stress

67
Q

three types of symptoms associated with depression

A

emotional
cognitive
physical

68
Q

emotional symptoms of depression

A

anxiety, low mood, irritability, low self-esteem, guilt, hopelessness

69
Q

cognitive symptoms of depression

A

poor concentration, slow thoughts, poor memory

70
Q

physical symptoms of depression

A

low energy
abnormal sleep (Early awakening)
poor appetite
slow movmements

71
Q

what features of depression need to be risk assessed in assessment

A

self-neglect
self harm
harm to others (including neglect)
suicide

72
Q

what physical conditions can cause depression?

A

stroke
MI
MS
parkinsons

73
Q

What questionnaire can assess the severity of depression and how does it work?

A

the PHQ-9 questionnaire
enquires about how often someone has experienced certain symptoms over the past 2 weeks

74
Q

interpretation of the scores of the PHQ-9

A

5-9 mild
9-14 moderate
15-19 moderate- severe
20-27 severe

NICE recommends that >16 is more severe depression and <16 is less severe

75
Q

features of the ICD-10 definition of depression

A

at least one core symptom (low mood, anhedonia, low energy) on most days for the past 2 weeks

76
Q

management of less severe depression

A
  • guided self help and active monitoring
  • therapy- group CBT, group behavioural activation, individual CBT, individual BA, group exercise, group meditation and mindfulness
  • antidepressants (not 1st line)
77
Q

first line treatment of more severe depression

A

CBT and SSRI (sertraline)

78
Q

examples of SSRI’s

A

sertraline
citalopram
fluoxetine
paroxetine
escitalopram

79
Q

how do SSRI’s work?

A

they block the reuptake of serotonin from the neuromuscular junction

80
Q

which two groups of patients would likely have sertraline first line

A

those with anxiety symptoms
those who have had MI’s or cardiac disease

81
Q

specific SE of citalopram

A

prolonged QT interval - can cause Torsades de pointes

82
Q

why is fluoxetine preferred in children

A

it has a longer half life so is less likely to cause discontinuation syndrome (stays in body for longer)

83
Q

SE of SSRIs

A

GI upset (diarrhoea- particularly sertraline) , headaches, sexual dysfunction (ED, low libido), hyponatraemia (SIADH), anxiety, increases suicide risk in first few weeks, increased bleeding (particularly if on NSAIDs, anticoagulants)

84
Q

what is a complication that can occur with SSRIs (increased)

A

serotonin syndrome

85
Q

what can trigger serotonin syndrome

A

St Johns wart, triptans, MAO-B’s

86
Q

pathophysiology of serotonin syndrome

A

too much serotonin stimulation

87
Q

how does serotonin syndrome present

A

altered mental state- confusion
autonomic system hyperactivity- hyperthermia, sweating
neuromuscular hyperactivity- rigidity, hyperreflexia, myoclonus

88
Q

how is serotonin syndrome managed?

A

IV fluids
benzodiazepiens
serotonin antagonists- chlorpromazine

89
Q

What is discontinuation syndrome and why does it occur

A

occurs when antidepressants aren’t slowly tappered down

90
Q

how does discontinuation syndrome present?

A

increased mood changes
restlessness
difficulty sleeping
parasthesia
GI upset
sweating
unsteadiness

91
Q

which antidepressants are at an increased likelihood of discontinuation syndrome

A

paroxetine and venlafaxine

92
Q

which antidepressant does not cause discontinuation syndrome

A

fluoxetine

93
Q

which patients would not be prescribed SNRI’s

A

those with uncontrolled HTN as can cause increased BP

94
Q

2 examples of SNRIs

A

venlafaxine and duloxetine

95
Q

action of TCA’s

A

blocks the reuptake of serotonin and noradrenaline

96
Q

SE of TCAs

A

anticholinergic effects- dry mouth, blurred vision, constipation , urinary retention
drowsiness
postural HTN
arrhythmias - tachycardia, prolonged QT

97
Q

Who might be prescribed mitrazapine (2)

A

those with low appetite
those with insomnia

98
Q

what is OCD

A

a mental disorder characterised by recurrent obsessions, compulsions or both which causes significant functional impairment and or distress

99
Q

what is an obsession

A

an unwanted intrusive thought, image or urge that repeatedly enters the persons mind

100
Q

what is a compulsion

A

a repetitive behaviour or ritual including mental acts that the person may be driven to perform by their obsession

101
Q

RF for OCD

A

female
family history
pregnancy and postpartum
history of abuse

102
Q

common obsessions

A

contamination with dirt
fear of harm
forbidden thoughs

103
Q

common compulsions

A

repetitive hand washig
checking
ordering and arranging

104
Q

how can the severity of OCD be determined?

A

Y-BOCS scale

105
Q

what would classify severe OCD

A

> 3 hours a day are taken up by compulsions or obsessions
there is significant distress
there is little self control

106
Q

features of the ICD-10 definition of OCD

A

present on most days for 2 weeks
- thoughts or impulses are recognised as individuals own
- must be at least one thought that is resisted unsuccessfully
- the though of carrying out the act is not itself pleasurable
- the thoughts and impulses must be unpleasantly repetitve

107
Q

first line treatment of mild OCD

A

CBT and exposure and response prevention

108
Q

first line drug treatment of severe OCD

A

SSRI

109
Q

2nd line drug treatment of severe OCD

A

clomipramine

110
Q

drug treatment of body dysmorphic disorder

A

fluoxetine

111
Q

what is PTSD

A

a mental condition that results from traumatic experiences with ongoing distressing symptoms and impaired function

112
Q

what are the 4 key symptoms of PTSD

A

re-experiencing: flashbacks, nightmares, repetivite and disturbing images
avoidance- of places, people, situations that remind them of event
Hyperarousal- hypervigilance to threat, exaggerated startle resposnse, sleep problems
emotional numbing- lack of ability to experience emotions, feeling detached

113
Q

first line treatment for PTSD

A

trauma focused CBT or eye movement desensitisation and reprocessing

114
Q

what drugs may be used to treat PTSD

A

venlafaxine or sertraline

115
Q

how long do PTSD symptoms need to have lasted for

A

4 weeks

116
Q

difference between PTSD and acute stress reaction

A

acute stress reaction is present for less than 4 weeks, PTSD is over 4 weeks

117
Q

What is somatisation disorder

A

a disorder where a patient presents with multiple physical symptoms that have been present for over 2 years but have no apparent organic cause
Symptoms may include cardiac (chest pain), GI (diarrhoea, vomiting), MSK and neuro (headache, dizziness)

The patient will refuse to accept negative tests

118
Q

What is hypochondriasis

A

illness anxiety disorder
where a patient has persistent belief that they have an underlying condition (e.g. cancer)
patient will refuse to accept negative tests

119
Q

what is conversion disorder

A

a condition where a patient presents with symptoms of a disease of the brain and nerves
- may include vision loss, weakness, paralysis
- the patient is not consciously feigning symptoms and often expresses la belle indifference

120
Q

What is la belle indifference

A

where there is absence of psychological distress when a patient presents with symptoms of a serious medical illness

121
Q

what is factitious disorder

A

intentional production of physical or psychological symptoms
also called munchausens

122
Q

What is malingering

A

fraudulent simulation or exaggeration of symptoms with the intention of financial gain

123
Q

what is delirium

A

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

124
Q

RF for delirium

A

old age
dementia
visual or hearing impairment
functional impairment
immobility
past history of delirium
decreased oral intake
polypharmacy
coexisting medical conditions
frailty
surgery

125
Q

predisposing factors for delirium

A

drugs (sedatives, opiates, TCA’s, stimulants, alcohol)
primary neurological injury (stroke, haemorrhage)
acute illness (infection- pneumonia, UTI)
metabolic disturbance
surgery
iatrogenic events
pain
prolonged sleep deprivation
drug withdrawal

126
Q

3 types of delirium

A

hypoactive- lethargy, decreased motor activity, incoherent speech
hyperactive - restlessness, agitation, hallucinations, inappropriate behaviour
mixed

127
Q

what features would suggest delirium over dementia ?

A

acute onset
agitation or fear
impairment of consciousness
delusions
fluctuating symptoms (worse at night)
abnormal perceptions (illusions and hallucinations)

128
Q

what quick test can be used to screen for delirium and what are its components

A

the 4A’s test
Alertness
a short test of orientation
attention
acute and fluctuating changes

129
Q

what drug treatment may be used for delirium

A

haloperidol first line

130
Q

What are three types of phobia disorders

A

specific phobia
social phobia
agoraphobia

131
Q

what is specific phobia and give some examples

A

intense anxiety triggered by a specific object or situation leading to avoidance behaviour

common examples include animals, heights, thunder, flying, blood exposure

132
Q

what is social phobia

A

fear of scrutiny by others in relatively small groups leading to the avoidance of social situations- can be specific to things such as public speaking or can be generalised

133
Q

What is agoraphobia

A

fear of open spaces and associated factors like the presence of crowds or perceived difficulty of immediate easy escape to a safe place

134
Q

first line management of phobias

A

CBT

first line drug treatment is SSRIs

135
Q
A

3A (32 decks)

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