Psychiatry Flashcards

1
Q

where is post stroke psychosis commonly seen

A

right side middle cerebral artery lesions
affect frontal and temporal region

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2
Q

what is the most common psychotic symptom

A

delusion

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3
Q

definition of delusion

A

false fixed belief not understandable within the person’s sociocultural setting

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4
Q

what are the most common perceptual abnormalities of post stroke psychosis

A

auditory hallucination followed by visual

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5
Q

what are the risk of antipsychotic use with those with dementia

A

increased risk of stroke

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6
Q

what long term medical conditions are risk factors for development of mental disorders

A

CVD
MSK disorders
diabetes
COPD

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7
Q

how is delirium classified

A

hyperactive
hypoactive
mixed

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8
Q

Risk factors of delirium (5)

A

advancing age
cognitive impairment
poor nutrition
polypharmacy/alcohol misuse
frailty

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9
Q

common causes/ precipitating factors of delirium

A

physical illness
injury
infection
constipation
… (multi factorial)

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10
Q

management of delirium

A

anticipate and address modifiable risk factors
optimise treatment of underlying comorbidities
treat underlying causes
re-orientation strategies
normalise sleep-wake cycles
avoid falls
in extremis, short term pharmacological interventions

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11
Q

what is psychosis

A

difficulty perceiving and interpreting reality (failure of reality testing)

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12
Q

what are positive symptoms of psychosis

A

hallucinations
delusions

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13
Q

what are negative symptoms of psychosis

A

alogia (poverty of speech, slow to respond to questioning)
anhedonia
avolition/apathy (lack motivation and poor self care)
affective flattening (unchanged facial expressions, poor eye contact, limited emotional range and lack focal intonations)

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14
Q

what are disorgansation symptoms of psychosis

A

Bizarre behavior (inappropriate social behavior, aggression, repetitive stereotyped behavior)
formal thought disorder (lack of logical connection between thoughts)

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15
Q

onset of psychosis

A

can occur at any age
peak in adolescence /early 20s
peak later in women

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16
Q

is schizophrenia inheritable

A

yes, ~46% concordance in MZ twins

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17
Q

what are environmental risk factors of psychosis

A

drug use (esp cannabis)
prenatal / birth complications
maternal infections
migrant status
childhood trauma
socioeconomic deprivation

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18
Q

what to look for when someone with psychosis

A

bizarre or inappropriate clothing
psychomotor retardation/agitation
abnormal movements
self neglect
self harm injuries
echophenomena
stupor and mutism

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19
Q

difficulties with treating someone with poor insight into their psychosis

A

concordance with treatment
attendance to follow up
willingness to be admitted to hospital
impact on ability to have capacity to consent treatmentw

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20
Q

which NT system is most implicated in antipsychotics mechanisms

A

dopamine
but antipsychotics act on diff NT eg serotonin, Ach, hhistamine

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21
Q

which drug actions on dopamine receptors would most likely improve psychotic symptoms
antagonist/ partial agonist/agonist

A

antagonist

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22
Q

most antipsychotics are what

A

Dopamine antagonsits
newer agents are partial agonists

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23
Q

what are side effects of antipsychotics

A

EPSEs (extrapyramidal side effects) (eg parkinsonism acute
dystonic reactions
tardive dyskinesia
akathisia)
increased appetite, weight gain, diabetes, dysrhthymia, increase prolactin, constipation, agranulocytosis, sedation, neutropenia

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24
Q

what is DSM-5 criteria

A

2 weeks or more of depressed mood and presence of 4/8 symptoms
sleep alterations
appetite alteratios
anhedonia
decreased concentration
low energy
guilt
psychomotor changes
suicidal thoughts

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25
Q

subtypes of DSM-5 for MDD

A

atypical features (increase slp n appetite with heightened modo reactivity)
melancholic features (no mood reactivity with retardation and anhedonia)
psychotic features (delusions or hallucination)

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26
Q

maniac criteria

A

irritable mood/euphoric with 3/7
decreased need for sleep with increased energy
distractibility
grandiosity or inflated self esteem
fight of ideas or racing thoughts
increased talkativeness or pressured speech
increased goal directed activities or agitation
impulsive behaviour

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27
Q

how to diagnose type 1 bipolar

A

symptoms present for minimum 1 week with notable functional impairment

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28
Q

how to diagnose hypomanic episode

A

symptoms present for min 4 days without notable functional impairment

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29
Q

how to diagnose type 2 nipolar

A

no single manic episode occurr, only hypomanic episodes present with at least on MDD episode

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30
Q

how to diagnose uispecified bipolar

A

manic symptoms less than 4 days and other thredsholds not met

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31
Q

what happens if patient hospitalised, irresepctive of duration of manic symptoms

A

manic episode diagnosed

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32
Q

what happens if psychotic features present

A

hypomanic cannot be diagnosed

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33
Q

what happens in majority first episodes in bipolar 1

A

majority of first episodes are depressive

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34
Q

what are some scans that measure receptors and transmitters in human brain

A

PET imaging (positron emission tomography)

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35
Q

what are the components of mental state examination (MSE)

A

appearance and behaviour
speech
mood/affect
thought (content and form)
perceptions
cognition
insight

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36
Q

what are some organic or iatrogenic causes of mood disorder

A

endocrine (thyroid related, hypoglycaemia, cushing’s syndrome, addison’s)
systemic (viral bacterial infection)
deficiencies (V B12, folic acid)
neurological (MS, AD, parkinson’s)
medications (B blockers, steroids, AB)

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37
Q

what are vascular depressions associated with

A

white matter hyperintensities
can impact cognitive function causing pt more vulnerable to stressors

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38
Q

what is the main symptom of poststroke depression

A

retardation in thinking and behaviour

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39
Q

poststroke depression pathology

A

lesions in left frontal lobe or basal ganglia

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40
Q

differentials between BPAD and BPD

A

BPAD: episodic, inheritable, mood less affect by environment
BPD: mood changes over hrs or days rather than days/weeks
poor self image, fear of abandonment, feel empty, Hx of self harm and trauma

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41
Q

similarities in BPAD and BPD

A

rapid mood change
unstable interpersonal relationships
impulsive sexual behavior
suicidality

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42
Q

differentials between BPAD and Schizoaffective disorder

A

BPAD: episodic, hallucinations (rarely chronic)
Schizoaffective disorder : episodic delusion / hallucinations (residual symptoms more likely)
more prominent disorganisation of thought, paranoid delusional beliefs and auditory hallucinations

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43
Q

similarities in BPAD and Schizoaffective disorder

A

both can present with psychosis and mood symptoms (depression and mania)

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44
Q

differentials between BPAD and ADHD

A

BPAD: not necessarily present in childhood, episodic, fam hx, amphetamines worsen mania, recurrent depressive episodes

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45
Q

similarities in BPAD and ADHD

A

hyperactivity
impulsivity
impaired cognition
impaired executive function
abnormal working and short term memory

46
Q

what are examples of positive reinforcement in substance use

A

to gain positive state
escapism
get high
stay awake
like it

47
Q

what are examples of negative reinforcement in substance use

A

to overcome adverse state
boredom
to get to sleep
reduce anxiety
feel better

48
Q

what are the ICD-10 criteria for dependence syndrome of substance use

A
  1. a strong desire or sense of compulsion to take
  2. difficulties in controlling in terms of its onset, termination and level of use
  3. physiological withdrawal state when substance use has stopped or reduced
  4. evidence of tolerance (take more to get same effect)
  5. progressive neglect of alternative interests
  6. persisting with substance use despite clear evidence of overtly harmful consequences
49
Q

difference between addiction and dependence

A

addiction – compulsive drug use despite harmful consequences; inability to stop using
dependence: physical adaptation to a substance
* can be dependent but not addicted

50
Q

is glutamate system excitatory or inhibitory

A

excitatory

51
Q

is GABA system excitatory or inhibitory

A

inhibitory

52
Q

what is NMDA receptor

A

ligand-gated ion channels that mediate a Ca2+-permeable component of excitatory neurotransmission in the central nervous system (CNS)

53
Q

how acute drinking of alcohol affect CNS

A

blocks excitatory system and impaired memory
boots inhibitory system (anxiolysis and sedation)

54
Q

how chronic alcohol exposure affect CNS

A

results in neuroadaptation, cause GABA and glutamate remain in balance in presence of alcohol
upregulate excitatory system and reduce function in inhibitory system – tolerance
GABA-A receptor switch in subunits to make it less sensitive to alcohol

55
Q

how to treat chronic alcohol exposure

A

treat with benzodiazepines to boost GABA function

56
Q

what happens when there is upregulation fo excitatory system (NMDA receptor)

A

increase in Ca2+, toxic leading to hyperexcitability, seizures and cell death (atrophy)

57
Q

what happens to chronic alcohol consumers in absence of alcohol

A

imablance in inhibitory and excitatory system (increase excitatory and reduce inhibitory)
increase in Ca2+, toxic leading to hyperexcitability, seizures and cell death (atrophy)

58
Q

what is the dopamine pathway referred as

A

pleasure reward motivation system

59
Q

which part of brain is for natural rewards

A

ventral striatum

60
Q

which system is key modulator pf reward

A

opioid system

61
Q

what is function of amphetamine

A

enhance release of dopamine and block reuptake of dopamine
increase dopamine in synapse

62
Q

cocaine effect to dopamine

A

block reuptake
more in synapse

63
Q

effect of alcohol and nicotine to dopamine

A

increase dopamine neuron firing in ventral tegmental area
increase firing by reduce inhibition of release

64
Q

what are the effects of opioid

A

analgesic effect
create sense of euphoria in high dose
regulate pain and mood

65
Q

what are the types of treatment in psych medicine (4)

A
  1. chemical (drugs/meds)
  2. electrical stimulation (ECT for depression)
  3. structural rearrangement (surgery)
  4. talking therapies
66
Q

what is the first drug for schizophrenia

A

chlorpromazine

67
Q

pros and cons for classifying pscyhiatric drugs base on chemical structure

A

pro: each drug has unique structure, easy to allocate
cons: no use in clinical decision making

68
Q

pros and cons for classifying pscyhiatric drugs base on illness

A

pros: easy to choose a drug
cons: many meds work in several diagnosis, most pyschiatric disorders hv multiple symptoms and a single med cannot treat them all

69
Q

what are the 2 different sorts of GABA receptors

A

GABA - A and GABA - B receptors

70
Q

difference between GABA A and GABA B receptors

A

GABA A receptor: ligand-gated chloride channel which mediates fast inhibitory signals through rapid postsynaptic membrane hyperpolarization,
GABA B receptor produces slow and prolonged inhibitory signals via G proteins and second messengers

71
Q

mechanism of Alprazolam

A

GABA A receptor agonist

72
Q

function of Alprazolam

A

treatment for anxiety, panic disorder

73
Q

mechanism of Baclofen

A

GABA B receptor agonist

74
Q

function of Baclofen

A

decrease alcohol craving in alcohol dependent pt

75
Q

what are the 4 targets for chemical treatments medicines used in psychiatry

A
  1. receptors
  2. enzymes
  3. ion channel
  4. NT reuptake sites
76
Q

what are MAOIs for and mechanism

A

block enzyme activity
treat anxiety and depression

77
Q

what are acetylcholinesterase inhibitors for and mechanism

A

treat dementia
block enzyme activity

78
Q

what are lithium for and mechanism

A

treat mood stability
block glycogen synthase kinase

79
Q

what are receptor targeting meds

A

antagonists and agonists

80
Q

mechanism for ion channel target meds

A

blk channels to reduce neuronal excitability

81
Q

mechanism for sodium valporate and carbamazepine and use for what

A

block sodium channel
treat epilepsy and mood stabilisation

82
Q

mechanism for gabapentin and pregabalin

A

block calcium channels
treat epilepsy and anxiety

83
Q

what are fast acting NT for excitatory and inhibitory

A

excitatory: glutamate
inhibitory: GABA

84
Q

what are fast acting NT for

A

on-off switch
memory
movement
vision

85
Q

what are slow acting NT examples

A

dopamine, serotonin, NA, Ach
endorphins and other peptides

86
Q

what are slow acting NT for

A

modulators
emotions, drives, valence of memory

87
Q

usually what happens with glutamate in psychiatric disorder

A

excess in glutamate

88
Q

what happens when XS glutamate

A

epilepsy
alcoholism

89
Q

treatment for XS glutamate

A

perampanel – blocker
acamprosate – blocker
ketamine – blocker

90
Q

usually what happens with GABA in psychiatric disorder

A

deficeiency

91
Q

what happens when GABA deficiency

A

anxiety

92
Q

treatment for GABA deficiency

A

benzodiazepines – GABA enhancer

93
Q

usually what happens with serotonin in psychiatric disorder

A

deficiency

94
Q

what happens when serotonin deficiency

A

anxiety
depression

95
Q

treatment for serotonin deficiency

A

SRIs
MAOIs

96
Q

usually what happens with dopamine in psychiatric disorder

A

XS

97
Q

what happens when dopamine XS

A

psychosis

98
Q

treatment for XS dopamine

A

dopamine receptor blocker

99
Q

usually what happens with NA in psychiatric disorder

A

XS

100
Q

what happen when XS NA

A

nightmares

101
Q

treatment for XS NA

A

prazosin – blocker

102
Q

usually what happens with Ach in psychiatric disorder

A

deficiency

103
Q

what happen when Ach deficiency

A

impaired memory
dementia

104
Q

treatment for Ach deficiency

A

Acetylcholineeterase enzyme blockers

105
Q

benefits of using partial agonist

A

improved safety
in states of high NT or XS agonist meds can act as an antagonist
but lower max efficacy

106
Q

what are inverse agonists

A

opposite effects as agonists

107
Q

what kind of drug is Amitriptyline

A

serotonin NA uptake blocker
antidepressant
non selective
adverse effect from histamine and Ach receptor blockade

108
Q

what kind of drug is citalopram

A

selective serotonin reuptake inhibitor
adverse effects driven solely by increased serotonin

109
Q

which part of the brain matures later than other cortical areas

A

prefrontal cortex

110
Q

what are the core features of ADHD

A

persistent pattern of inattention and/or hyperactivity-impulsivity
present for at least 6 months
inappropirate for their developmental level
interferes with functioning or development
several symptoms present before 12
several symptoms present in 2 or more settings
symptoms are not better explained by another mental disorder

111
Q

what are behavioral and psychological symptoms in dementia (BPSD)

A

common in late stage dementia
apathy, mood disturbances, hallucinations, delusions, irritability, agitation, aggression, sleep changes
often precipitating symptoms which lead to pt with dementia being detained

112
Q
A