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Psychiatry Flashcards

1
Q

what does aphonia mean?

A

inability to speak

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2
Q

Causes of aphonia

A

Recurrent laryngeal nerve palsy

Psychogenic

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3
Q

What is cotard syndrome?

A

Patient believes they are dead

May stop eating and drinking

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4
Q

What is De Clerambault’s syndrome?

A

Patient believes a famous person is in love with them

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5
Q

What is delusional parasitosis?

A

Patient has a fixed delusion that they are infested by bugs

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6
Q

Features of depression in the elderly

A

Physical complaints
Agitation
Insomnia

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7
Q

Management of depression in the elderly

A

SSRIs

Escitalopram (Lexapro). Fluoxetine (Prozac). Paroxetine (Paxil). Sertraline (Zoloft).

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8
Q

ECT - contraindications

A

Raised intracranial pressure

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9
Q

ECT short term side effects

A 
Headache
Nausea
Short term memory impairment
Memory loss of events prior to ECT
Cardiac arrhythmia
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10
Q

ECT long term side effects

A

impaired memory

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11
Q

Stages of normal grief

A 
Denial - may include hallucinations
Anger
Bargaining
Depression 
Acceptance
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12
Q

How long does normal grief take?

A

up to 12 months

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13
Q

What is delayed grief?

A

Grieving starts >2 weeks after death

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14
Q

What is circumstantiality in a mental state exam?

A

Inability to answer a question without giving excessive, unncessary detail. Person does return to the original point.

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15
Q

What is tangentiality in a mental state exam?

A

Wandering from a topic without returning to it

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16
Q

What is neoligisms in a mental state exam?

A

New word formations which might include the combining of two words

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17
Q

What is clang association in a mental state exam?

A

When ideas are related to each other only by the fact they sound similar or rhyme

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18
Q

What is a word salad in a mental state exam?

A

Incoherent speech where real words are strung together in nonsense sentences

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19
Q

What is Knight’s move thinking in a mental state exam?

A

severe type of loosening of associations, where there are unexpected and illogical leaps from one idea to another. This is a feature of schizophrenia

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20
Q

What is flight of ideas in a mental state exam?

A

There are leaps from one topic to another but with discernible links between them

A feature of mania

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21
Q

What is perseveration in a mental state exam?

A

Repetition of ideas or words despite an attempt to change the topic

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22
Q

What is echolalia in a mental state exam?

A

Repetition of someone else’s speech, including the question that was asked

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23
Q

Mirtazapine side effects

A

Sedation and increased appetite

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24
Q

What is Othello’s syndrome?

A

Pathological jealousy that their partner is cheating on them

Socially unacceptable behaviour linked to these claims

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25
Features of post concussion syndrome
Headache Fatigue Anxiety/depression Dizziness
26
What is somatisation disorder?
Multiple physical symptoms for 2 years Patient refuses to accept reassurance or negative test results
27
What is illness anxiety disorder? (hypochondriasis)
Persistent belief in presence of underlying serious disease .e.g cancer Patient refuses to accept reassurance or negative test results
28
What is conversion disorder?
Loss of motor or sensory function Not consciously feigned or seeking material gain
29
What is dissociative disorder?
Separating off certain memories from normal consciousness
30
What is factitious disorder?
Munchausen's syndrome intentional production of physical or psychological symptoms
31
What is malingering?
fraudulent symptoms to access financial or other gain
32
Protective factors for suicide
Family support Having children at home Religious belief
33
SSRIs - discontinuation symptoms
``` Increased mood change Restlessness Difficulty sleeping Unsteadiness Sweating GI symptoms Paraesthesia ```
34
SSRIs - interactions
NSAIDs - if prescribed then give PPI Warfarin/heparin - consider mirtazapine instead Aspirin Triptans
35
Citalopram - effect on QTc interval
Dose dependent QT interval rpolongation Avoid if long QT syndrome or on other drugs that prolong QT
36
SSRIs - side effects
GI side effects Increased risk of GI bleeds Hyponatraemia Increased anxiety and agitation after starting SSRI
37
Examples of SSRIs
Fluoxetine Paroxetine Citalopram
38
How often to review patient when starting SSRI?
review after 2 weeks unless <30 years then review every week as higher risk of suicidal thoughts and self harm
39
Features of sleep paralysis
Paralysis shortly after waking up or shortly before falling asleep Hallucinations during the paralysis
40
Management of sleep paralysis
Clonazepam
41
SSRIs risk during pregnancy
1st trimester small increased risk of congenital heart defect 3rd trimester risk of persistent pulmonary hypertension of the newborn
42
Mental health act - section 2
Admission for assessment for up to 28 days Approved mental health professional makes application on recommendation of 2 doctors 1 of the doctors must be 'approved' under section 12(2) of mental health act
43
Mental health act - section 3
Admission for up to 6 months, can be renewed Approved mental health professional along with 2 doctors
44
Mental health act - section 4
72 hour assessment order Used in emergency when section 2 would cause delay GP, nearest relative or approved mental health professional
45
Mental health act - section 5(2)
a patient who is voluntarily in hospital can be legally detained by a doctor for 72 hours
46
Mental health act - section 5(4)
Allows a nurse to detain a patient who is voluntarily in hospital for 6 hours
47
Mental health act - section 17(a)
Supervised community treatment Can be used to recall patients to hospital if they do not comply
48
Mental health act - section 135
Court order allowing police to break into property to remove a person to a place of safety
49
Mental health act - section 136
Someone found in a public place who appears to have a mental disorder can be taken by police to place of safety only used for up to 24 hours
50
Treatment for personality disorders
Dialectical behavioural therapy
51
Risks of antipsychotics in elderly patients
Increased risk of stroke | Increased risk of venous thromboembolism
52
Which screening questions to ask for depression?
1) in the last month have you been often bothered by feeling down, depressed or helpless? 2) in the last month have you been bothered by having little interest or pleasure in doing things?
53
Which tools can be used to assess degree of depression?
HAD scale (hospital anxiety and depression) PHQ-9 (patient health questionnaire)
54
In patients with subthreshold depressive symptoms, whom should you consider starting antidepressants?
Previous moderate or severe depression Subthreshold symptoms for at least 2 years or that continue despite other interventions Chronic physical health problem where mild depression complicates care of physical health
55
Low intensity psychosocial interventions for mild depression?
Individual guided self-help based on CBT therapy Computerised CBT Structured group physical activity programme Group based CBT Group based peer support programme for patients with chronic physical health problems
56
Principles of individual guided self-help based on CBT therapy
Supported by trained practitioner 6-8 sessions face to face or by telephone over 9-12 weeks
57
Principles of group based CBT
given by two trained practitioners 10-12 meetings of up to 10 participants
58
Switching from one SSRI that is not fluoxetine to another SSRI
First SSRI should be withdrawn before alternative started
59
Switching from fluoxetine to another SSRI
Withdraw fluoxetine then leave a gap of 4-7 days before starting alternative SSRI
60
Switching from SSRI to tricyclic antidepressant
Cross taper EXCEPT fluoxetine which should be withrawn
61
Switching from SSRI that is not fluoxetine to venlafaxine
Cross taper cautiously
62
Switching from fluoxetine to venlafaxine
Withdraw fluoxetine then start venlafaxine
63
Which SSRI has the highest incidence of discontinuation symptoms?
Paroxetine
64
Which antidepressants to use in patients with alcoholism?
Mirtazapine
65
SSRI of choice post myocardial infarction?
Sertraline
66
Annual monitoring for patients on olanzapine
``` Weight Blood pressure FBC Renal function LFT fasting lipids glucose ```
67
Venlafaxine - what should be checked before starting and at each dose titration?
Blood pressure
68
Likely cause of confusion in a patient on an SSRI?
Hyponatraemia
69
What type of drug is imipramine?
Tricyclic antidepressant
70
When checking lithium levels, how long after the dose should bloods be taken?
12 hours
71
1st line treatment for agoraphobia
Sertraline
72
What % of people with schizophrenia will complete suicide?
10%
73
Alternative opioid replacement therapy to methadone which is given subcutaneously?
Buprenorphine
74
Medication used in alcoholics as an "anti craving" medication
Acamprosate
75
SSRI choice in children and adolescents
Fluoxetine
76
When stopping an SSRI over how long should you withdraw it?
4 weeks
77
Which personality disorder shows inappropriate sexual seductiveness?
Histrionic personality disorder
78
What is a reflex halluncation?
When a normal stimuli precipitates a hallucination e.g. voices only heard when lights turned out
79
What is an autoscopic hallucination?
Visual allucination seeing oneself in external space
80
What is an elementary halluncation?
Simple unstructured sounds e.g. buzzing or whistling
81
What is capgras syndrome?
Person believes their friend or relative has been replaced by a double
82
What is couvade syndrome?
'sympathetic pregnancy'
83
Which two tricyclic antidepressants are most dangerous in overdose?
Amitryptilline | Dosulepin
84
Atypical antipsychotics - side effects
Weight gain Hyperprolactinaemia Clozapine causes agranulocytosis
85
What are the advantages of atypical antipsychotics over typical antipsychotics?
Less extrapyramidal side effects | less hyperprolactinaemia
86
Examples of atypical antipsychotics (4)
Clozapine Risperidone Olanzapine Quetiapine
87
Side effects of clozapine
``` Agranulocytosis, neutropenia Reduced seizure threshold Constipation Myocarditis Hypersalivation ```
88
Monitoring of patients on clozapine
FBC monitoring Dose may need adjusting if starts or stops smoking Baseline ECG
89
Extrapyramidal side effects in typical antipsychotics
Parkinsonism Acute dystonia Akathisia (severe restlessness) Tardive dyskinesia
90
What does akathisia mean?
severe restlessness
91
What drug can be used to manage acute dystonia?
procyclidine
92
Side effects to typical antipsychotics
``` Extrapyramidal side effects Antimuscarinic - dry mouth, blurred vision, urinary retention, constipation Weight gain Raised prolactin and galactorrhea Impaired glucose tolerance Neuroleptic malignant syndrome Reduced seizure threshold QT prolongation ```
93
First rank symptoms of schizophrenia (4)
Auditory hallucinations Thought disorder Passivity phenomena Delusional perceptions
94
Schizophrenia - risk factors
``` Family history Black caribbean Migration Urban environment Cannabis use ```
95
Risk of schizophrenia if your monozygotic twin has it?
50%
96
Risk of schizophrenia if your parent has it?
10-15%
97
Risk of schizophrenia if your sibling has it?
10%
98
Risk of schizophrenia if no relative affected
1%
99
Schizophrenia - poor prognostic factors
``` Strong family history Gradual onset Low IQ Prodromal phase of social withdrawal Lack of obvious precipitants ```
100
Schizophrenia - management
oral atypical antipsychotics CBT cardiovascular risk factors
101
Examples of tricyclic antidepressants
Amitriptyline Lofepramine Trazodone
102
Tricyclic antidepressants - side effects
``` Drowsiness Dry mouth Blurred vision Constipation Urinary retention QT prolongation ```
103
Psychosis - features
hallucinations delusions thought disorganisation
104
Peak age of first psychotic episode
age 15-30
105
PTSD features
Re-experiencing (flashbacks, nightmares) Avoidance Hyperarousal Emotional numbing
106
PTSD management
Trauma focused CBT Eye movement desensitisation and reprocessing 1st line drugs - venlafaxine, SSRIs
107
OCD - what are compulsions?
repetitive behaviours or mental acts the person feels driven to perform
108
OCD - what are obsessions?
unwanted intrusive thoughts, images or urges
109
OCD - management
CBT exposure and response prevention SSRI
110
Conditions associated with OCD
``` Depression Schizophrenia Sydenham's chorea Tourette's Anorexia nervosa ```
111
Monitoring lithium levels
12 hours post dose every week after starting and after every dose change once levels stable then every 3 months
112
Lithium - what other bloods should be monitored?
thyroid and renal function every 6 months
113
Lithium - side effects
``` N+V Diarrhoea fine tremor Nephrotoxicity Thyroid enlargement may cause hypothyroidism Weight gain IIH Hyperparathyroidism causing raised calcium ```
114
Physical conditions or medication that may cause anxiety
``` Hyperthyroidism Cardiac disease Salbutamol Theophylline Corticosteroids Antidepressants Caffeine ```
115
Management of anxiety - step 1
education, montoring
116
Management of anxiety - step 2
low intensity psychological interventions
117
Management of anxiety - step 3
high intensity psychological interventions (CBT) or drugs
118
Management of anxiety - step 4
specialist management
119
1st line drug for anxiety
Sertraline
120
2nd line drug for anxiety
alternative SSRI or SNRI (duloxetine, venlafaxine)
121
3rd line drug for anxiety
pregabalin
122
three leading causes of charles-bonnet syndrome
1) age related macular degeneration 2) glaucoma 3) cataracts
123
Bipolar - 1st line medication
Lithium
124
Bipolar - 2nd line medication
valproate
125
Bipolar - management of mania
Stop antidepressant | Start antipsychotic e.g olanzapine or haloperidol
126
Bipolar - management of depression
fluoxetine
127
Type 1 bipolar
Mania and depression
128
Type 2 bipolar
Hypomania and depression
129
Features of mania
Severe functional impairment Psychotic features Lasts over 7 days
130
Features of hypomania
Lasts 4 days | Decreased or increased function
131
Management of anorexia nervosa in adults
Eating disorder focused CBT Maudsley anorexia treatment for adults Specialist supportive clinical management
132
Management of anorexia nervosa in children and teenagers
Anorexia focused family therapy | CBT
133
Features of anorexia nervosa
Low BMI Bradycardia Hypotension Enlarged salivary glands
134
Blood test findings in anorexia nervosa
``` Low potassium Low FSH, low LH, low oestrogen, low testosterone Impaired glucose tolerance Low T3 High cortisol, high growth hormone Hypercholesterolaemia Hypercarotinaemia ```
135
Management of alcohol withdrawal
Chlordiazepoxide | Diazepam
136
Features of alcohol withdrawal
tremor sweating tachycardia anxiety
137
Time frame for alcohol withdrawal after stopping alcohol
6-12 hours
138
Time frame for seizures after stopping alcohol
36 hours
139
Time frame for delirium tremens after stopping alcohol
48-72 hours
140
Features of delirium tremens
``` tremor confusion auditory and visual hallucinations fever tachycardia ```
141
Management of acute stress disorder
trauma focused CBT
142
Features of acute stress disorder
``` <4 weeks since event intrusive thoughts = flashbacks, nightmares dissociation negative mood avoidance hypervigilence, sleep disturbance ```
143
DVLA - severe anxiety and depression, when should you tell DVLA and stop driving?
``` Significant memory problems Significant concentration problems Agitation Behavioural disturbance Suicidal thoughts ```
144
DVLA - acute psychotic disorder
Must not drive during acute illness | Must notify DVLA
145
DVLA - hypomania or mania
Must not drive during acute illness | Must notify DVLA
146
DVLA - schizophrenia
Must not drive during acute illness | Must notify DVLA
147
DVLA - ADHD
May be able to drive | Must notify DVLA
148
DVLA - mild cognitive impairment
May drive | Do not need to tell DVLA
149
DVLA - dementia
May be able to drive | Must notify DVLA
150
DVLA - mild learning disability
May be able to drive | Must notify DVLA
151
DVLA - severe learning disability
Must not drive | Must notify DVLA
152
DVLA - personality disorders
May be able to drive | Must notify DVLA
153
DVLA - alcohol misuse
Can't drive until 6 months controlled drinking or abstinence
154
DVLA - alcohol dependency
Can't drive until 12 months controlled drinking or abstinence
155
DVLA - cannabis, amphetamines, ecstasy, LSD
Can't drive until 6 months free | May need assessment and urine screen by DVLA
156
DVLA - heroin, cocaine, methadone
Can't drive until 6 months free | May need assessment and urine screen by DVLA

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