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1 - MSRA > Psychiatry > Flashcards

Psychiatry Flashcards

1
Q

Timeline acute stress disorder

A

Within 4 weeks after traumatic event

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2
Q

Management acute stress disorder

A

Trauma-focused cognitive behavioural therapy first line

Benzodiazepines sometimes for acute symptoms, use with caution

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3
Q

Features acute alcohol withdrawal

A

Start within 6-12 hours
- Tremor
- Sweating
- Tachycardia
- Anxiety

Later, seizures and delirium tremens

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4
Q

Peak incidence seizures in acute alcohol withdrawal

A

36 hours

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5
Q

Peak incidence delirium tremens in acute alcohol withdrawal

A

48-72 hours

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6
Q

Features delirium tremens

A
  • Coarse tremor
  • Confusion
  • Delusions
  • Auditory and visual hallucinations
  • Fever
  • Tachycardia
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7
Q

First line treatment acute alcohol withdrawal

A

Long-acting benzodiazepines, e.g. chlordiazepoxide or diazepam, as reducing dose protocol

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8
Q

Benzo of choice acute alcohol withdrawal with hepatic failure

A

Lorazepam

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9
Q

Other treatments acute alcohol withdrawal

A

Carbamazepine

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10
Q

Blood abnormalities anorexia

A

Hypokalaemia
Low FSH, LH, oestrogens, testosterone
Raised cortisol and GH
Impaired glucose tolerance
Hypercholesterolaemia
Hypercarotinaemia
Low T3

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11
Q

Adverse effects typical antipsychotics

A

Extrapyramidal side effects
Hyperprolactinaemia
Antimuscarinic effects
Impaired glucose tolerance
Neuroleptic malignant syndrome
Prolonged QT interval

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12
Q

Examples typical antipsychotics

A

Haloperidol
Chlorpromazine

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13
Q

Adverse effects atypical antipsychotics

A

Metabolic effects inc hyperprolactinaemia
Weight gain

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14
Q

Examples atypical antipsychotics

A

Clozapine
Risperidone
Olanzapine
Quetiapine
Amisulpride
Aripiprazole

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15
Q

Extra-pyrdamidal SEs typical antipsychotics

A
  • Parkinsonism
  • Acute dystonia
  • Akanthisia
  • Tardive dyskinesa
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16
Q

What is acute dystonia

A

Sustained muscle contraction

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17
Q

Examples acute dystonias

A

Torticollis
Oculogyric crisis

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18
Q

What is akathisia

A

Severe restlessness

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19
Q

What is tardive dyskinseia

A

Late onset choreoathetoid movements, most common chewing and pouting of jaw

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20
Q

Antimuscarinic SEs typical antipsychotics

A

Dry mouth
Blurred vision
Urinary retention
Constipation

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21
Q

Features neuroleptic malignant syndrome

A

Pyrexia
Muscle stiffness

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22
Q

Treatment neuroleptic malignant syndrome

A

Stop drug
Rehydration
Cooling
Treatment of rhabdomyolysis if present

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23
Q

Atypical antipsychotic best SE profile

A

Aripiprazole (esp prolactin elevation)

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24
Q

Mechanism of action benzodiazepines

A

Enhance effect of the inhibitory neurotransmitted GABA by increasing frequency of chloride channelsU

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25
Q

Features benzo withdrawal syndrome

A

Insomnia
Irritability
Anxiety
Tremor
Loss of appetite
Tinnitus
Perspiration
Perceptual disturbances
Seizure

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26
Q

First line management bulimia in adults

A

Bulimia-focused guided self help

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27
Q

Second line management for bulimia in adults

A

Individual eating disorder focused CBT

(Used if self help unacceptable, contraindicated, ineffective after 4 weeks)

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28
Q

Treatment bulimia in children

A

Bulimia focused family therapy

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29
Q

Adverse effects clozapine

A

AGRANULOCYTOSIS (1%), neutropenia (3%)
Reduced seizure threshold
Constipation
Myocarditis
Hypersalivation

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30
Q

Indications clozapine

A

Uncontrolled schizophrenia despite sequential use 2+ drugs, one of which is second gen, each for at least 6-8 weeks

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31
Q

Smoking and clozapine

A

Dose adjustment may be needed if smoking started or stopped during treatment

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32
Q

Cotard syndrome

A

Patient believe they (or part of their body) is dead or non-existent

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33
Q

Classification of depression

A

Less severe - PHQ-9 <16
More severe - PHQ-9 ≥16

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34
Q

Role of antidepressant medications in less severe depression

A

Should not offer as first line treatment unless its the persons preference

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35
Q

First line treatment more severe depression

A

Combination of individual CBT and antidepressant

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36
Q

ECT indications

A

Severe depression refractory to medication, e.g. catatonia
Psychotic depression

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37
Q

Contraindication ECT

A

Raised ICP

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38
Q

Short term SE ECT

A

Headache
Nausea
Short term memory impairment
Memory loss events prior to ECT
Cardiac arrhythmia

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39
Q

Long term SE ECT

A

Some patients report impaired memory

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40
Q

Physical DDx anxiety disorder

A
  • Hyperthyroidism
  • Cardiac disease
  • Medication induced
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41
Q

Medications causing anxiety

A

Salbutamol
Theophylline
Corticosteroids
Antidepressants
Caffeine

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42
Q

Step-wise approach GAD

A
  1. Education about GAD + active monitoring
  2. Low intensity psychological interventions (self-help, psychoeducational groups)
  3. High intensity psychological intervention (CBT, applied relaxation) or drug treatment
  4. Highly specialist input
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43
Q

First line drug GAD

A

Sertraline

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44
Q

Second line drug GAD

A

Alternative SSRI or SNRI

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45
Q

Third line drug GAD

A

If can’t tolerate SSRI/SNRI, consider pregabalin

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46
Q

Stepwise treatment panic disorder

A
  1. Recognition and diagnosis
  2. Treatment in primary care - CBT or drug
  3. Review and consideration of alternative treatments
  4. Review and referral to specialist mental health services
  5. Care in specialist mental health services
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47
Q

First line drug panic disorder

A

SSRIs

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48
Q

Second line drug panic disorder

A

Imipramine or clomipramine

If SSRI contraindicated or no response after 12 weeks

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49
Q

Mania vs hypomania

A

Mania lasts at least 7 days, hypomania <7 days, typically 3-4 days
Mania causes severe functional impairment in social and work setting, hypomania can be high functioning and does not impair functional capacity in social or work setting
Mania may need hospital, hypomania unlikely
Mania may have psychotic symptoms, hypomania doesn’t

50
Q

Therapeutic range lithium

A

0.4-1.0

51
Q

SEs lithium

A

Nausea/vomiting, diarrhoea
Fine tremor
Nephrogenic diabetes insipidus
Thyroid enlargement, hypothyroidism
Weight gain
Idiopathic intracranial hypertension
Leucocytosis
Hyperparathyroidism → hypercalcaemia

52
Q

ECG changes lithium

A

T wave flattening/inversion

53
Q

When should lithium level be taken

A

12 hours post dose

54
Q

When to check lithium levels

A

Weekly when starting/dose change until stable, then 3 monthly

55
Q

Monitoring lithium

A

Lithium levels
Thyroid and renal function

56
Q

Pros of mirtazapine

A

Fewer side effects and interactions than many antidepressants, so good in older people who may be more effected or taking other medications
Side effects of sedation and increased appetite can be useful if suffering from insomnia and poor appetite

57
Q

Trait domains personality disorders

A

Negative affectivity
Detachment
Dissociality
Disinhibition
Anankastia
Borderline pattern

58
Q

Negative affectivity definition

A

Tendency to experience wide range of negative emotions - anxiety, depression, guilt, anger
Prone to mood swings, insecurity, emotional lability

59
Q

Detachment definition

A

Avoidance of social interactions, emotional withdrawal, and limited pleasure from relationships
May appear cold, aloof, isolated

60
Q

Dissociality definition

A

Disregard for rights and feelings of others, lack of empathy, difficulty forming prosocial relationships
Impulsivity and manipulative behaviours common

61
Q

Disinhibition definition

A

Impulsiveness, risk taking, and difficulty controlling behaviours
May struggle with planning and foresight → reckless or irresponsible actionsA

62
Q

Anankastia definition

A

Preoccupation with orderliness, control, and perfectionism
Individuals may be rigid, stubborn, excessively focused on rules and details

63
Q

Borderline pattern definition

A

Emotional instability, intense and unstable interpersonal relationships, fluctuating sense of identity, impulsivity

64
Q

Management personality disorders

A

Psychological therapies, e.g. dialectical behaviour therapy
Treatment of co-existing psychiatric conditions

65
Q

PTSD management

A

Watchful waiting for mild symptoms lasting less than 4 weeks
Trauma focused CBT or eye movement desensitisation and reprocessing therapy

Single-session interventions aka debriefing not recommended

66
Q

Role of drugs PTSD

A

Not routine first line treatment
If drug treatment used, venlafaxine or SSRI
In severe cases, risperidone

67
Q

Alogia definition

A

Little information conveyed by speech

68
Q

Tangentiality definition

A

Answers diverge from topic

69
Q

Word salad definition

A

Linking real words incoherently → nonsensical content

70
Q

Schneider’s first rank symptoms (schizophrenia)

A

Auditory hallucinations
Thought disorders
Passivity phenomena
Delusional perceptions

71
Q

Types of auditory hallucinations that count as Schneider’s first rank symptoms

A

Two or more voices discussing patient in third person
Thought echo
Voices commenting on patient’s behaviour

72
Q

Thought disorder examples

A

Thought insertion
Thought withdrawal
Thought broadcastingPa

73
Q

Passivity phenomena examples

A

Bodily sensations being controlled by external influence
Actions/impulses/feelings imposed on individual or influenced by others

74
Q

Delusional perceptions definition

A

Two stage process - normal object is perceived, then sudden intense delusional insight into the objects meaning for the patient

E.g. traffic light is green therefore I am the King

75
Q

Other features schizophrenia

A

Impaired insight
Negative symptoms
Neologisms (made up words)
Catatonia

76
Q

Negative symptoms of schizophrenia

A

Incongruity/blunting of affect
Anhedonia
Alogia (poverty of speech)
Avolition
Social withdrawal

77
Q

Poor prognostic indicators schizophrenia

A

Strong family history
Gradual onset
Low IQ
Prodromal phase of social withdrawal
Lack of obvious precipitant

78
Q

Section 2 MHA

A

Admission for assessment up to 28 days, non renewable
Approved mental health professional (or rarely nearest relative) makes application on recommendation of 2 doctors
Treatment can be given against patients wishes

79
Q

Section 3 MHA

A

Admission for treatment up to 6 months, can be renewed
AMHP with 2 doctors, both must have seen patient in past 24 hours
Treatment can be given

80
Q

Section 4 MHA

A

72 hour assessment order
Used in emergency, when section 2 = unacceptable delay
GP and AMHP/nearest relative

81
Q

Section 5(2)

A

Voluntary patient in hospital legally detained by doctor for 72 hours

82
Q

Section 5(4)

A

Voluntary patient in hospital legally detained by nurse for 72 hours

83
Q

Section 17a

A

Supervised community treatment order, can be used to recall patient to hospital for treatment if they do not comply with conditions of order in the community, e.g. complying with medication

84
Q

Section 135

A

Court order, allows police to break into property to remove person to place of safety

85
Q

Section 136

A

Someone found in public place who appears to have mental disorder can be taken by police to place of safety
24 hours, while MHA assessment arranged

86
Q

Preferred SSRIs

A

Citalopram and fluoxetine

87
Q

When is sertraline first choice

A

Post MI

88
Q

SSRI in children/adolescent

A

Fluoxetine

89
Q

SE SSRIs

A

GI symptoms (most common)
Increased risk of GI bleeding
Increased anxiety and agitation

90
Q

SSRis with highest propensity drug interactions

A

Fluoxetine
Paroxetine

91
Q

SSRI causing QT prolongation

A

Citalopram
Escitalopram

92
Q

CIs citalopram, escitalopram

A

Congenital long QT
Pre-existing QT prolongation
Use of other drugs prolonging QT

93
Q

Interactions SSRIs

A

NSAIDs
Warfarin/heparin
Aspirin
Triptans (serotonin syndrome)
MAOIs (serotonin syndrome)

94
Q

When to review after commencing SSRI

A

2 weeks
1 week if under 25 or increased risk of suicide

95
Q

How long should antidepressants be continued for in depression?

A

At least 6 months (reduces risk of relapse)

96
Q

SSRI highest risk discontinuation symptoms

A

Paroxetine

96
Q

How to stop SSRI

A

Gradually reduce dose over 4 week period (unless fluoxetine)

97
Q

Discontinuation symptoms SSRIs

A
  • Increased mood change
  • Restlessness
  • Difficulty sleeping
  • Unsteadiness
  • Sweating
  • GI symptoms - pain, cramping, diarrhoea, vomiting
  • Parasthesia
98
Q

SSRI in pregnancy

A

Risk vs beenfit
First trimester - small increased risk of congenital heart defects
Third trimester - persistent pulmonary hypertension of newborn

99
Q

Which SSRI increases risk of congenital malformation

A

Paroxetine (esp in 1st tri)

100
Q

Circumstantiality definition

A

Inability to answer a question without giving excessive, unnecessary detail, but does return to original point

101
Q

Tangentiality definition

A

Wandering from a topic without returning to it

102
Q

Neologisms definition

A

New word formations, might include combining two words

103
Q

Clang associations definitions

A

Idea’s related to each other only by the fact they sound similar or rhyme

104
Q

Word salad definition

A

Completely incoherent speech where real words are strung together into nonsense sentences

105
Q

Knight’s move thinking definition

A

Severe type of loosening of associations, wehre there are unexpected and illogical leaps from one idea to another

106
Q

Flight of ideas definition

A

Thought disorder where leaps from one topic to another but with discernible links between them

107
Q

Perseveration definition

A

Repetition of ideas or words despite attempt to change the topic

108
Q

Echolalia definition

A

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

109
Q

SE’s TCAs

A

Drowsiness
Dry mouth
Blurred vision
Constipation
Urinary retention
Postural hypotension
Long QT

110
Q

TCA least dangerous in overdose

A

Lofepramine

111
Q

TCA most dangerous in overdose

A

Amitriptyline
Dosulepin

112
Q

More sedative TCAs

A

Amitriptryline
Clomipramine
Dosulepin

113
Q

Less sedative TCAs

A

Imipramine
Lofepramine
Nortriptyline

114
Q

Somatisation disorder definition

A

Multiple physical symptoms present for at least 2 years, patient refuses to accept reassurance/negative test results

115
Q

Illness anxiety disorder (hypochondriasis) definition

A

Persistent belief in presence of underlying serious disease, e.g. cancer. Refuses to accept reassurance/negative test results

116
Q

Functional neurological disorder (conversion disorder) definition

A

Typically loss of motor or sensory function, doesn’t consciously fake symptoms

117
Q

Dissociative disorder definition

A

Separating off certain memories from normal consciousness, involves psychiatric symptoms, e.g. amnesia, fugue, stupor

118
Q

Factitious disorder definition

A

Intentional production of physical or psychological symptoms

119
Q
A

1 - MSRA (17 decks)

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