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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
Q

Features of post concussion syndrome

A

Headache
Fatigue
Anxiety/depression
Dizziness

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26
Q

What is somatisation disorder?

A

Multiple physical symptoms for 2 years

Patient refuses to accept reassurance or negative test results

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27
Q

What is illness anxiety disorder? (hypochondriasis)

A

Persistent belief in presence of underlying serious disease .e.g cancer

Patient refuses to accept reassurance or negative test results

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28
Q

What is conversion disorder?

A

Loss of motor or sensory function

Not consciously feigned or seeking material gain

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29
Q

What is dissociative disorder?

A

Separating off certain memories from normal consciousness

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30
Q

What is factitious disorder?

A

Munchausen’s syndrome

intentional production of physical or psychological symptoms

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31
Q

What is malingering?

A

fraudulent symptoms to access financial or other gain

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32
Q

Protective factors for suicide

A

Family support
Having children at home
Religious belief

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33
Q

SSRIs - discontinuation symptoms

A 
Increased mood change
Restlessness
Difficulty sleeping
Unsteadiness
Sweating
GI symptoms
Paraesthesia
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34
Q

SSRIs - interactions

A

NSAIDs - if prescribed then give PPI
Warfarin/heparin - consider mirtazapine instead
Aspirin
Triptans

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35
Q

Citalopram - effect on QTc interval

A

Dose dependent QT interval rpolongation

Avoid if long QT syndrome or on other drugs that prolong QT

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36
Q

SSRIs - side effects

A

GI side effects
Increased risk of GI bleeds
Hyponatraemia
Increased anxiety and agitation after starting SSRI

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37
Q

Examples of SSRIs

A

Fluoxetine
Paroxetine
Citalopram

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38
Q

How often to review patient when starting SSRI?

A

review after 2 weeks

unless <30 years then review every week as higher risk of suicidal thoughts and self harm

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39
Q

Features of sleep paralysis

A

Paralysis shortly after waking up or shortly before falling asleep

Hallucinations during the paralysis

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40
Q

Management of sleep paralysis

A

Clonazepam

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41
Q

SSRIs risk during pregnancy

A

1st trimester small increased risk of congenital heart defect

3rd trimester risk of persistent pulmonary hypertension of the newborn

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42
Q

Mental health act - section 2

A

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

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43
Q

Mental health act - section 3

A

Admission for up to 6 months, can be renewed

Approved mental health professional along with 2 doctors

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44
Q

Mental health act - section 4

A

72 hour assessment order

Used in emergency when section 2 would cause delay

GP, nearest relative or approved mental health professional

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45
Q

Mental health act - section 5(2)

A

a patient who is voluntarily in hospital can be legally detained by a doctor for 72 hours

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46
Q

Mental health act - section 5(4)

A

Allows a nurse to detain a patient who is voluntarily in hospital for 6 hours

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47
Q

Mental health act - section 17(a)

A

Supervised community treatment

Can be used to recall patients to hospital if they do not comply

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48
Q

Mental health act - section 135

A

Court order allowing police to break into property to remove a person to a place of safety

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49
Q

Mental health act - section 136

A

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

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50
Q

Treatment for personality disorders

A

Dialectical behavioural therapy

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51
Q

Risks of antipsychotics in elderly patients

A

Increased risk of stroke

Increased risk of venous thromboembolism

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52
Q

Which screening questions to ask for depression?

A

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?

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53
Q

Which tools can be used to assess degree of depression?

A

HAD scale (hospital anxiety and depression)

PHQ-9 (patient health questionnaire)

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54
Q

In patients with subthreshold depressive symptoms, whom should you consider starting antidepressants?

A

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

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55
Q

Low intensity psychosocial interventions for mild depression?

A

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

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56
Q

Principles of individual guided self-help based on CBT therapy

A

Supported by trained practitioner

6-8 sessions face to face or by telephone

over 9-12 weeks

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57
Q

Principles of group based CBT

A

given by two trained practitioners

10-12 meetings of up to 10 participants

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58
Q

Switching from one SSRI that is not fluoxetine to another SSRI

A

First SSRI should be withdrawn before alternative started

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59
Q

Switching from fluoxetine to another SSRI

A

Withdraw fluoxetine then leave a gap of 4-7 days before starting alternative SSRI

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60
Q

Switching from SSRI to tricyclic antidepressant

A

Cross taper

EXCEPT fluoxetine which should be withrawn

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61
Q

Switching from SSRI that is not fluoxetine to venlafaxine

A

Cross taper cautiously

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62
Q

Switching from fluoxetine to venlafaxine

A

Withdraw fluoxetine then start venlafaxine

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63
Q

Which SSRI has the highest incidence of discontinuation symptoms?

A

Paroxetine

64
Q

Which antidepressants to use in patients with alcoholism?

A

Mirtazapine

65
Q

SSRI of choice post myocardial infarction?

A

Sertraline

66
Q

Annual monitoring for patients on olanzapine

A 
Weight
Blood pressure
FBC
Renal function
LFT
fasting lipids
glucose
67
Q

Venlafaxine - what should be checked before starting and at each dose titration?

A

Blood pressure

68
Q

Likely cause of confusion in a patient on an SSRI?

A

Hyponatraemia

69
Q

What type of drug is imipramine?

A

Tricyclic antidepressant

70
Q

When checking lithium levels, how long after the dose should bloods be taken?

A

12 hours

71
Q

1st line treatment for agoraphobia

A

Sertraline

72
Q

What % of people with schizophrenia will complete suicide?

A

10%

73
Q

Alternative opioid replacement therapy to methadone which is given subcutaneously?

A

Buprenorphine

74
Q

Medication used in alcoholics as an “anti craving” medication

A

Acamprosate

75
Q

SSRI choice in children and adolescents

A

Fluoxetine

76
Q

When stopping an SSRI over how long should you withdraw it?

A

4 weeks

77
Q

Which personality disorder shows inappropriate sexual seductiveness?

A

Histrionic personality disorder

78
Q

What is a reflex halluncation?

A

When a normal stimuli precipitates a hallucination

e.g. voices only heard when lights turned out

79
Q

What is an autoscopic hallucination?

A

Visual allucination seeing oneself in external space

80
Q

What is an elementary halluncation?

A

Simple unstructured sounds e.g. buzzing or whistling

81
Q

What is capgras syndrome?

A

Person believes their friend or relative has been replaced by a double

82
Q

What is couvade syndrome?

A

‘sympathetic pregnancy’

83
Q

Which two tricyclic antidepressants are most dangerous in overdose?

A

Amitryptilline

Dosulepin

84
Q

Atypical antipsychotics - side effects

A

Weight gain
Hyperprolactinaemia
Clozapine causes agranulocytosis

85
Q

What are the advantages of atypical antipsychotics over typical antipsychotics?

A

Less extrapyramidal side effects

less hyperprolactinaemia

86
Q

Examples of atypical antipsychotics (4)

A

Clozapine
Risperidone
Olanzapine
Quetiapine

87
Q

Side effects of clozapine

A 
Agranulocytosis, neutropenia
Reduced seizure threshold
Constipation
Myocarditis
Hypersalivation
88
Q

Monitoring of patients on clozapine

A

FBC monitoring
Dose may need adjusting if starts or stops smoking
Baseline ECG

89
Q

Extrapyramidal side effects in typical antipsychotics

A

Parkinsonism
Acute dystonia
Akathisia (severe restlessness)
Tardive dyskinesia

90
Q

What does akathisia mean?

A

severe restlessness

91
Q

What drug can be used to manage acute dystonia?

A

procyclidine

92
Q

Side effects to typical antipsychotics

A 
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
Q

First rank symptoms of schizophrenia (4)

A

Auditory hallucinations
Thought disorder
Passivity phenomena
Delusional perceptions

94
Q

Schizophrenia - risk factors

A 
Family history
Black caribbean
Migration
Urban environment
Cannabis use
95
Q

Risk of schizophrenia if your monozygotic twin has it?

A

50%

96
Q

Risk of schizophrenia if your parent has it?

A

10-15%

97
Q

Risk of schizophrenia if your sibling has it?

A

10%

98
Q

Risk of schizophrenia if no relative affected

A

1%

99
Q

Schizophrenia - poor prognostic factors

A 
Strong family history
Gradual onset
Low IQ
Prodromal phase of social withdrawal
Lack of obvious precipitants
100
Q

Schizophrenia - management

A

oral atypical antipsychotics
CBT
cardiovascular risk factors

101
Q

Examples of tricyclic antidepressants

A

Amitriptyline
Lofepramine
Trazodone

102
Q

Tricyclic antidepressants - side effects

A 
Drowsiness
Dry mouth
Blurred vision
Constipation
Urinary retention
QT prolongation
103
Q

Psychosis - features

A

hallucinations
delusions
thought disorganisation

104
Q

Peak age of first psychotic episode

A

age 15-30

105
Q

PTSD features

A

Re-experiencing (flashbacks, nightmares)

Avoidance

Hyperarousal

Emotional numbing

106
Q

PTSD management

A

Trauma focused CBT

Eye movement desensitisation and reprocessing

1st line drugs - venlafaxine, SSRIs

107
Q

OCD - what are compulsions?

A

repetitive behaviours or mental acts the person feels driven to perform

108
Q

OCD - what are obsessions?

A

unwanted intrusive thoughts, images or urges

109
Q

OCD - management

A

CBT
exposure and response prevention
SSRI

110
Q

Conditions associated with OCD

A 
Depression
Schizophrenia
Sydenham's chorea
Tourette's
Anorexia nervosa
111
Q

Monitoring lithium levels

A

12 hours post dose

every week after starting and after every dose change

once levels stable then every 3 months

112
Q

Lithium - what other bloods should be monitored?

A

thyroid and renal function every 6 months

113
Q

Lithium - side effects

A 
N+V
Diarrhoea
fine tremor
Nephrotoxicity
Thyroid enlargement may cause hypothyroidism
Weight gain
IIH
Hyperparathyroidism causing raised calcium
114
Q

Physical conditions or medication that may cause anxiety

A 
Hyperthyroidism
Cardiac disease
Salbutamol
Theophylline
Corticosteroids
Antidepressants
Caffeine
115
Q

Management of anxiety - step 1

A

education, montoring

116
Q

Management of anxiety - step 2

A

low intensity psychological interventions

117
Q

Management of anxiety - step 3

A

high intensity psychological interventions (CBT) or drugs

118
Q

Management of anxiety - step 4

A

specialist management

119
Q

1st line drug for anxiety

A

Sertraline

120
Q

2nd line drug for anxiety

A

alternative SSRI or SNRI (duloxetine, venlafaxine)

121
Q

3rd line drug for anxiety

A

pregabalin

122
Q

three leading causes of charles-bonnet syndrome

A

1) age related macular degeneration
2) glaucoma
3) cataracts

123
Q

Bipolar - 1st line medication

A

Lithium

124
Q

Bipolar - 2nd line medication

A

valproate

125
Q

Bipolar - management of mania

A

Stop antidepressant

Start antipsychotic e.g olanzapine or haloperidol

126
Q

Bipolar - management of depression

A

fluoxetine

127
Q

Type 1 bipolar

A

Mania and depression

128
Q

Type 2 bipolar

A

Hypomania and depression

129
Q

Features of mania

A

Severe functional impairment
Psychotic features
Lasts over 7 days

130
Q

Features of hypomania

A

Lasts 4 days

Decreased or increased function

131
Q

Management of anorexia nervosa in adults

A

Eating disorder focused CBT
Maudsley anorexia treatment for adults
Specialist supportive clinical management

132
Q

Management of anorexia nervosa in children and teenagers

A

Anorexia focused family therapy

CBT

133
Q

Features of anorexia nervosa

A

Low BMI
Bradycardia
Hypotension
Enlarged salivary glands

134
Q

Blood test findings in anorexia nervosa

A 
Low potassium
Low FSH, low LH, low oestrogen, low testosterone
Impaired glucose tolerance
Low T3
High cortisol, high growth hormone
Hypercholesterolaemia
Hypercarotinaemia
135
Q

Management of alcohol withdrawal

A

Chlordiazepoxide

Diazepam

136
Q

Features of alcohol withdrawal

A

tremor
sweating
tachycardia
anxiety

137
Q

Time frame for alcohol withdrawal after stopping alcohol

A

6-12 hours

138
Q

Time frame for seizures after stopping alcohol

A

36 hours

139
Q

Time frame for delirium tremens after stopping alcohol

A

48-72 hours

140
Q

Features of delirium tremens

A 
tremor
confusion
auditory and visual hallucinations
fever
tachycardia
141
Q

Management of acute stress disorder

A

trauma focused CBT

142
Q

Features of acute stress disorder

A 
<4 weeks since event
intrusive thoughts = flashbacks, nightmares
dissociation
negative mood
avoidance
hypervigilence, sleep disturbance
143
Q

DVLA - severe anxiety and depression, when should you tell DVLA and stop driving?

A 
Significant memory problems
Significant concentration problems
Agitation
Behavioural disturbance
Suicidal thoughts
144
Q

DVLA - acute psychotic disorder

A

Must not drive during acute illness

Must notify DVLA

145
Q

DVLA - hypomania or mania

A

Must not drive during acute illness

Must notify DVLA

146
Q

DVLA - schizophrenia

A

Must not drive during acute illness

Must notify DVLA

147
Q

DVLA - ADHD

A

May be able to drive

Must notify DVLA

148
Q

DVLA - mild cognitive impairment

A

May drive

Do not need to tell DVLA

149
Q

DVLA - dementia

A

May be able to drive

Must notify DVLA

150
Q

DVLA - mild learning disability

A

May be able to drive

Must notify DVLA

151
Q

DVLA - severe learning disability

A

Must not drive

Must notify DVLA

152
Q

DVLA - personality disorders

A

May be able to drive

Must notify DVLA

153
Q

DVLA - alcohol misuse

A

Can’t drive until 6 months controlled drinking or abstinence

154
Q

DVLA - alcohol dependency

A

Can’t drive until 12 months controlled drinking or abstinence

155
Q

DVLA - cannabis, amphetamines, ecstasy, LSD

A

Can’t drive until 6 months free

May need assessment and urine screen by DVLA

156
Q

DVLA - heroin, cocaine, methadone

A

Can’t drive until 6 months free

May need assessment and urine screen by DVLA

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