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BRS Y2 > Psychiatry > Flashcards

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
subtypes of DSM-5 for MDD (3)
atypical features (increase slp n appetite with heightened modo reactivity) melancholic features (no mood reactivity with retardation and anhedonia) psychotic features (delusions or hallucination)
26
maniac criteria
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
27
how to diagnose type 1 bipolar
symptoms present for minimum 1 week with notable functional impairment
28
how to diagnose hypomanic episode
symptoms present for min 4 days without notable functional impairment
29
how to diagnose type 2 nipolar
no single manic episode occurr, only hypomanic episodes present with at least on MDD episode
30
how to diagnose uispecified bipolar
manic symptoms less than 4 days and other thredsholds not met
31
what happens if patient hospitalised, irresepctive of duration of manic symptoms
manic episode diagnosed
32
what happens if psychotic features present
hypomanic cannot be diagnosed
33
what happens in majority first episodes in bipolar 1
majority of first episodes are depressive
34
what are some scans that measure receptors and transmitters in human brain
PET imaging (positron emission tomography)
35
what are the components of mental state examination (MSE)
appearance and behaviour speech mood/affect thought (content and form) perceptions cognition insight
36
what are some organic or iatrogenic causes of mood disorder
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)
37
what are vascular depressions associated with
white matter hyperintensities can impact cognitive function causing pt more vulnerable to stressors
38
what is the main symptom of poststroke depression
retardation in thinking and behaviour
39
poststroke depression pathology
lesions in left frontal lobe or basal ganglia
40
differentials between BPAD and BPD
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
41
similarities in BPAD and BPD
rapid mood change unstable interpersonal relationships impulsive sexual behavior suicidality
42
differentials between BPAD and Schizoaffective disorder
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
43
similarities in BPAD and Schizoaffective disorder
both can present with psychosis and mood symptoms (depression and mania)
44
differentials between BPAD and ADHD
BPAD: not necessarily present in childhood, episodic, fam hx, amphetamines worsen mania, recurrent depressive episodes
45
similarities in BPAD and ADHD
hyperactivity impulsivity impaired cognition impaired executive function abnormal working and short term memory
46
what are examples of positive reinforcement in substance use
to gain positive state escapism get high stay awake like it
47
what are examples of negative reinforcement in substance use
to overcome adverse state boredom to get to sleep reduce anxiety feel better
48
what are the ICD-10 criteria for dependence syndrome of substance use
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
difference between addiction and dependence
addiction -- compulsive drug use despite harmful consequences; inability to stop using dependence: physical adaptation to a substance * can be dependent but not addicted
50
is glutamate system excitatory or inhibitory
excitatory
51
is GABA system excitatory or inhibitory
inhibitory
52
what is NMDA receptor
ligand-gated ion channels that mediate a Ca2+-permeable component of excitatory neurotransmission in the central nervous system (CNS)
53
how acute drinking of alcohol affect CNS
blocks excitatory system and impaired memory boots inhibitory system (anxiolysis and sedation)
54
how chronic alcohol exposure affect CNS
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
how to treat chronic alcohol exposure
treat with benzodiazepines to boost GABA function
56
what happens when there is upregulation fo excitatory system (NMDA receptor)
increase in Ca2+, toxic leading to hyperexcitability, seizures and cell death (atrophy)
57
what happens to chronic alcohol consumers in absence of alcohol
imablance in inhibitory and excitatory system (increase excitatory and reduce inhibitory) increase in Ca2+, toxic leading to hyperexcitability, seizures and cell death (atrophy)
58
what is the dopamine pathway referred as
pleasure reward motivation system
59
which part of brain is for natural rewards
ventral striatum
60
which system is key modulator pf reward
opioid system
61
what is function of amphetamine
enhance release of dopamine and block reuptake of dopamine increase dopamine in synapse
62
cocaine effect to dopamine
block reuptake more in synapse
63
effect of alcohol and nicotine to dopamine
increase dopamine neuron firing in ventral tegmental area increase firing by reduce inhibition of release
64
what are the effects of opioid
analgesic effect create sense of euphoria in high dose regulate pain and mood
65
what are the types of treatment in psych medicine (4)
1. chemical (drugs/meds) 2. electrical stimulation (ECT for depression) 3. structural rearrangement (surgery) 4. talking therapies
66
what is the first drug for schizophrenia
chlorpromazine
67
pros and cons for classifying pscyhiatric drugs base on chemical structure
pro: each drug has unique structure, easy to allocate cons: no use in clinical decision making
68
pros and cons for classifying pscyhiatric drugs base on illness
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
what are the 2 different sorts of GABA receptors
GABA - A and GABA - B receptors
70
difference between GABA A and GABA B receptors
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
mechanism of Alprazolam
GABA A receptor agonist
72
function of Alprazolam
treatment for anxiety, panic disorder
73
mechanism of Baclofen
GABA B receptor agonist
74
function of Baclofen
decrease alcohol craving in alcohol dependent pt
75
what are the 4 targets for chemical treatments medicines used in psychiatry
1. receptors 2. enzymes 3. ion channel 4. NT reuptake sites
76
what are MAOIs for and mechanism
block enzyme activity treat anxiety and depression
77
what are acetylcholinesterase inhibitors for and mechanism
treat dementia block enzyme activity
78
what are lithium for and mechanism
treat mood stability block glycogen synthase kinase
79
what are receptor targeting meds
antagonists and agonists
80
mechanism for ion channel target meds
blk channels to reduce neuronal excitability
81
mechanism for sodium valporate and carbamazepine and use for what
block sodium channel treat epilepsy and mood stabilisation
82
mechanism for gabapentin and pregabalin
block calcium channels treat epilepsy and anxiety
83
what are fast acting NT for excitatory and inhibitory
excitatory: glutamate inhibitory: GABA
84
what are fast acting NT for
on-off switch memory movement vision
85
what are slow acting NT examples
dopamine, serotonin, NA, Ach endorphins and other peptides
86
what are slow acting NT for
modulators emotions, drives, valence of memory
87
usually what happens with glutamate in psychiatric disorder
excess in glutamate
88
what happens when XS glutamate
epilepsy alcoholism
89
treatment for XS glutamate
perampanel -- blocker acamprosate -- blocker ketamine -- blocker
90
usually what happens with GABA in psychiatric disorder
deficeiency
91
what happens when GABA deficiency
anxiety
92
treatment for GABA deficiency
benzodiazepines -- GABA enhancer
93
usually what happens with serotonin in psychiatric disorder
deficiency
94
what happens when serotonin deficiency
anxiety depression
95
treatment for serotonin deficiency
SRIs MAOIs
96
usually what happens with dopamine in psychiatric disorder
XS
97
what happens when dopamine XS
psychosis
98
treatment for XS dopamine
dopamine receptor blocker
99
usually what happens with NA in psychiatric disorder
XS
100
what happen when XS NA
nightmares
101
treatment for XS NA
prazosin -- blocker
102
usually what happens with Ach in psychiatric disorder
deficiency
103
what happen when Ach deficiency
impaired memory dementia
104
treatment for Ach deficiency
Acetylcholineeterase enzyme blockers
105
benefits of using partial agonist
improved safety in states of high NT or XS agonist meds can act as an antagonist but lower max efficacy
106
what are inverse agonists
opposite effects as agonists
107
what kind of drug is Amitriptyline
serotonin NA uptake blocker antidepressant non selective adverse effect from histamine and Ach receptor blockade
108
what kind of drug is citalopram
selective serotonin reuptake inhibitor adverse effects driven solely by increased serotonin
109
which part of the brain matures later than other cortical areas
prefrontal cortex
110
what are the core features of ADHD
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
what are behavioral and psychological symptoms in dementia (BPSD)
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

BRS Y2 (10 decks)

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