Psychiatry Flashcards
1
Q
Timeline acute stress disorder
A
Within 4 weeks after traumatic event
2
Q
Management acute stress disorder
A
Trauma-focused cognitive behavioural therapy first line
Benzodiazepines sometimes for acute symptoms, use with caution
3
Q
Features acute alcohol withdrawal
A
Start within 6-12 hours
- Tremor
- Sweating
- Tachycardia
- Anxiety
Later, seizures and delirium tremens
4
Q
Peak incidence seizures in acute alcohol withdrawal
A
36 hours
5
Q
Peak incidence delirium tremens in acute alcohol withdrawal
A
48-72 hours
6
Q
Features delirium tremens
A
- Coarse tremor
- Confusion
- Delusions
- Auditory and visual hallucinations
- Fever
- Tachycardia
7
Q
First line treatment acute alcohol withdrawal
A
Long-acting benzodiazepines, e.g. chlordiazepoxide or diazepam, as reducing dose protocol
8
Q
Benzo of choice acute alcohol withdrawal with hepatic failure
A
Lorazepam
9
Q
Other treatments acute alcohol withdrawal
A
Carbamazepine
10
Q
Blood abnormalities anorexia
A
Hypokalaemia
Low FSH, LH, oestrogens, testosterone
Raised cortisol and GH
Impaired glucose tolerance
Hypercholesterolaemia
Hypercarotinaemia
Low T3
11
Q
Adverse effects typical antipsychotics
A
Extrapyramidal side effects
Hyperprolactinaemia
Antimuscarinic effects
Impaired glucose tolerance
Neuroleptic malignant syndrome
Prolonged QT interval
12
Q
Examples typical antipsychotics
A
Haloperidol
Chlorpromazine
13
Q
Adverse effects atypical antipsychotics
A
Metabolic effects inc hyperprolactinaemia
Weight gain
14
Q
Examples atypical antipsychotics
A
Clozapine
Risperidone
Olanzapine
Quetiapine
Amisulpride
Aripiprazole
15
Q
Extra-pyrdamidal SEs typical antipsychotics
A
- Parkinsonism
- Acute dystonia
- Akanthisia
- Tardive dyskinesa
16
Q
What is acute dystonia
A
Sustained muscle contraction
17
Q
Examples acute dystonias
A
Torticollis
Oculogyric crisis
18
Q
What is akathisia
A
Severe restlessness
19
Q
What is tardive dyskinseia
A
Late onset choreoathetoid movements, most common chewing and pouting of jaw
20
Q
Antimuscarinic SEs typical antipsychotics
A
Dry mouth
Blurred vision
Urinary retention
Constipation
21
Q
Features neuroleptic malignant syndrome
A
Pyrexia
Muscle stiffness
22
Q
Treatment neuroleptic malignant syndrome
A
Stop drug
Rehydration
Cooling
Treatment of rhabdomyolysis if present
23
Q
Atypical antipsychotic best SE profile
A
Aripiprazole (esp prolactin elevation)
24
Q
Mechanism of action benzodiazepines
A
Enhance effect of the inhibitory neurotransmitted GABA by increasing frequency of chloride channelsU
25
Features benzo withdrawal syndrome
Insomnia
Irritability
Anxiety
Tremor
Loss of appetite
Tinnitus
Perspiration
Perceptual disturbances
Seizure
26
First line management bulimia in adults
Bulimia-focused guided self help
27
Second line management for bulimia in adults
Individual eating disorder focused CBT
(Used if self help unacceptable, contraindicated, ineffective after 4 weeks)
28
Treatment bulimia in children
Bulimia focused family therapy
29
Adverse effects clozapine
AGRANULOCYTOSIS (1%), neutropenia (3%)
Reduced seizure threshold
Constipation
Myocarditis
Hypersalivation
30
Indications clozapine
Uncontrolled schizophrenia despite sequential use 2+ drugs, one of which is second gen, each for at least 6-8 weeks
31
Smoking and clozapine
Dose adjustment may be needed if smoking started or stopped during treatment
32
Cotard syndrome
Patient believe they (or part of their body) is dead or non-existent
33
Classification of depression
Less severe - PHQ-9 <16
More severe - PHQ-9 ≥16
34
Role of antidepressant medications in less severe depression
Should not offer as first line treatment unless its the persons preference
35
First line treatment more severe depression
Combination of individual CBT and antidepressant
36
ECT indications
Severe depression refractory to medication, e.g. catatonia
Psychotic depression
37
Contraindication ECT
Raised ICP
38
Short term SE ECT
Headache
Nausea
Short term memory impairment
Memory loss events prior to ECT
Cardiac arrhythmia
39
Long term SE ECT
Some patients report impaired memory
40
Physical DDx anxiety disorder
- Hyperthyroidism
- Cardiac disease
- Medication induced
41
Medications causing anxiety
Salbutamol
Theophylline
Corticosteroids
Antidepressants
Caffeine
42
Step-wise approach GAD
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
43
First line drug GAD
Sertraline
44
Second line drug GAD
Alternative SSRI or SNRI
45
Third line drug GAD
If can't tolerate SSRI/SNRI, consider pregabalin
46
Stepwise treatment panic disorder
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
47
First line drug panic disorder
SSRIs
48
Second line drug panic disorder
Imipramine or clomipramine
If SSRI contraindicated or no response after 12 weeks
49
Mania vs hypomania
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
Therapeutic range lithium
0.4-1.0
51
SEs lithium
Nausea/vomiting, diarrhoea
Fine tremor
Nephrogenic diabetes insipidus
Thyroid enlargement, hypothyroidism
Weight gain
Idiopathic intracranial hypertension
Leucocytosis
Hyperparathyroidism → hypercalcaemia
52
ECG changes lithium
T wave flattening/inversion
53
When should lithium level be taken
12 hours post dose
54
When to check lithium levels
Weekly when starting/dose change until stable, then 3 monthly
55
Monitoring lithium
Lithium levels
Thyroid and renal function
56
Pros of mirtazapine
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
Trait domains personality disorders
Negative affectivity
Detachment
Dissociality
Disinhibition
Anankastia
Borderline pattern
58
Negative affectivity definition
Tendency to experience wide range of negative emotions - anxiety, depression, guilt, anger
Prone to mood swings, insecurity, emotional lability
59
Detachment definition
Avoidance of social interactions, emotional withdrawal, and limited pleasure from relationships
May appear cold, aloof, isolated
60
Dissociality definition
Disregard for rights and feelings of others, lack of empathy, difficulty forming prosocial relationships
Impulsivity and manipulative behaviours common
61
Disinhibition definition
Impulsiveness, risk taking, and difficulty controlling behaviours
May struggle with planning and foresight → reckless or irresponsible actionsA
62
Anankastia definition
Preoccupation with orderliness, control, and perfectionism
Individuals may be rigid, stubborn, excessively focused on rules and details
63
Borderline pattern definition
Emotional instability, intense and unstable interpersonal relationships, fluctuating sense of identity, impulsivity
64
Management personality disorders
Psychological therapies, e.g. dialectical behaviour therapy
Treatment of co-existing psychiatric conditions
65
PTSD management
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
Role of drugs PTSD
Not routine first line treatment
If drug treatment used, venlafaxine or SSRI
In severe cases, risperidone
67
Alogia definition
Little information conveyed by speech
68
Tangentiality definition
Answers diverge from topic
69
Word salad definition
Linking real words incoherently → nonsensical content
70
Schneider's first rank symptoms (schizophrenia)
Auditory hallucinations
Thought disorders
Passivity phenomena
Delusional perceptions
71
Types of auditory hallucinations that count as Schneider's first rank symptoms
Two or more voices discussing patient in third person
Thought echo
Voices commenting on patient's behaviour
72
Thought disorder examples
Thought insertion
Thought withdrawal
Thought broadcastingPa
73
Passivity phenomena examples
Bodily sensations being controlled by external influence
Actions/impulses/feelings imposed on individual or influenced by others
74
Delusional perceptions definition
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
Other features schizophrenia
Impaired insight
Negative symptoms
Neologisms (made up words)
Catatonia
76
Negative symptoms of schizophrenia
Incongruity/blunting of affect
Anhedonia
Alogia (poverty of speech)
Avolition
Social withdrawal
77
Poor prognostic indicators schizophrenia
Strong family history
Gradual onset
Low IQ
Prodromal phase of social withdrawal
Lack of obvious precipitant
78
Section 2 MHA
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
Section 3 MHA
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
Section 4 MHA
72 hour assessment order
Used in emergency, when section 2 = unacceptable delay
GP and AMHP/nearest relative
81
Section 5(2)
Voluntary patient in hospital legally detained by doctor for 72 hours
82
Section 5(4)
Voluntary patient in hospital legally detained by nurse for 72 hours
83
Section 17a
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
Section 135
Court order, allows police to break into property to remove person to place of safety
85
Section 136
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
Preferred SSRIs
Citalopram and fluoxetine
87
When is sertraline first choice
Post MI
88
SSRI in children/adolescent
Fluoxetine
89
SE SSRIs
GI symptoms (most common)
Increased risk of GI bleeding
Increased anxiety and agitation
90
SSRis with highest propensity drug interactions
Fluoxetine
Paroxetine
91
SSRI causing QT prolongation
Citalopram
Escitalopram
92
CIs citalopram, escitalopram
Congenital long QT
Pre-existing QT prolongation
Use of other drugs prolonging QT
93
Interactions SSRIs
NSAIDs
Warfarin/heparin
Aspirin
Triptans (serotonin syndrome)
MAOIs (serotonin syndrome)
94
When to review after commencing SSRI
2 weeks
1 week if under 25 or increased risk of suicide
95
How long should antidepressants be continued for in depression?
At least 6 months (reduces risk of relapse)
96
SSRI highest risk discontinuation symptoms
Paroxetine
96
How to stop SSRI
Gradually reduce dose over 4 week period (unless fluoxetine)
97
Discontinuation symptoms SSRIs
- Increased mood change
- Restlessness
- Difficulty sleeping
- Unsteadiness
- Sweating
- GI symptoms - pain, cramping, diarrhoea, vomiting
- Parasthesia
98
SSRI in pregnancy
Risk vs beenfit
First trimester - small increased risk of congenital heart defects
Third trimester - persistent pulmonary hypertension of newborn
99
Which SSRI increases risk of congenital malformation
Paroxetine (esp in 1st tri)
100
Circumstantiality definition
Inability to answer a question without giving excessive, unnecessary detail, but does return to original point
101
Tangentiality definition
Wandering from a topic without returning to it
102
Neologisms definition
New word formations, might include combining two words
103
Clang associations definitions
Idea's related to each other only by the fact they sound similar or rhyme
104
Word salad definition
Completely incoherent speech where real words are strung together into nonsense sentences
105
Knight's move thinking definition
Severe type of loosening of associations, wehre there are unexpected and illogical leaps from one idea to another
106
Flight of ideas definition
Thought disorder where leaps from one topic to another but with discernible links between them
107
Perseveration definition
Repetition of ideas or words despite attempt to change the topic
108
Echolalia definition
Repetition of someone else's speech, including the question that was asked
109
SE's TCAs
Drowsiness
Dry mouth
Blurred vision
Constipation
Urinary retention
Postural hypotension
Long QT
110
TCA least dangerous in overdose
Lofepramine
111
TCA most dangerous in overdose
Amitriptyline
Dosulepin
112
More sedative TCAs
Amitriptryline
Clomipramine
Dosulepin
113
Less sedative TCAs
Imipramine
Lofepramine
Nortriptyline
114
Somatisation disorder definition
Multiple physical symptoms present for at least 2 years, patient refuses to accept reassurance/negative test results
115
Illness anxiety disorder (hypochondriasis) definition
Persistent belief in presence of underlying serious disease, e.g. cancer. Refuses to accept reassurance/negative test results
116
Functional neurological disorder (conversion disorder) definition
Typically loss of motor or sensory function, doesn't consciously fake symptoms
117
Dissociative disorder definition
Separating off certain memories from normal consciousness, involves psychiatric symptoms, e.g. amnesia, fugue, stupor
118
Factitious disorder definition
Intentional production of physical or psychological symptoms
119
