Psychiatry 2 Flashcards by John Darlington

List some common side effects of lithium:

Tremor 
Thyroid enlargement - hypothyroidism
Weight gain 
Leucocytosis 
Hyperparathyroidism 
Nephrogenic Diabetic Insipidus

Once stable U&Es and TFTs should be checked every 6 months

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What are the symptoms of post concussion syndrome?

Headache
Fatigue
Anxiety/ depression
Dizziness

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What is a treatment option for personality disorders?

Dialectal Behavioural Therapy (DBT)

and mood stabilisers such as Lamotrigine

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What is the ECG abnormalities that can be seen in anorexia nervosa?

Long QT syndrome
Bradycardia

*thought to be due to hypomagnesium and hypocalcaemia

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What are some of the common side effects associated with anti-psychotics?

Common:

weight gain
hyperprolactomaia
reduced seizure threshold
glucose impairment

More serious:

Parkinsonian

Acute dystonia

Torticollis
oculogyric crisis

Tardive dyskinesia
- late onset chorea like movements

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What are some of the specific risks to elderly people using anti-psychotics?

VTE

Stroke

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Define catatonia:

Increased muscle tone at rest but abolished by voluntary muscle activity

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What are the similarities and differences between neuroleptic malignant syndrome and Serotonin syndrome?

Similar:

Fever
Tachycardia
Hypertension

NMS:

Rigidity
Raised CK and WBC
slower onset (days)

SS:

Hyperreflexia
Clonus
Diarrhea
rapid onset

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What is the treatment for Neuroleptic malignant syndrome?

Stop Anti-psychotic

IV fluids (reduce AKI due to raised CK levels)

Dantrolene
- muscle relaxant

Dopamine agonists
- bromocriptine

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What is the management of serotonin syndrome?

IV fluid

Benzodiazepines

Anti SSRIs
- chlorpromazine

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Highlight the key features of autism:

Difficulties with social communication and interaction

poor non-verbal communication
difficulty reciprocating behaviour
Poor joint communication/ attention

Restricted/ repetitive behaviours

rituals
hand flapping
fixed routines
specific knowledge in one subject

Core symptoms:

Global impairment of language
Impaired social relationships
Repetitive/ restricted behaviours

*symptoms must start before the age of the 3

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What are some signs of autism:

Delayed speech

Delayed response to name

Poor eye contact

Hand flapping

Dislike to additional stimuli

Delayed playing with others

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Name a screening tool used for autism:

Gilliam Autism Rating Scale (GARS)

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List the management for people with autism:

Speech and language therapist

Psychosocial intervention
- techniques to try and help child interact

Behavioural intervention
- look at areas to help calm the child down, including reorganising the environment to be less noisy

Sleep management
- often those with autism have poor sleep due to excessive stimulus

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How long can an emergency detention be used for?

72 hours

*cannot be appealed

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Name the other types of detention orders that can be used other than an emergency detention:

Short Term Detention Certificate :
- Approved medical practitioner (psychiatrist)
+
- Mental health officer

Assessment and treatment
Can last up to 28days
can be appealed

Compulsory Treatment Order:
- 2 medical recommendations
+
- mental health officer

*last up to 6 months

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What are some red flags regarding anorexia?

BMI <13

Weight loss of >1kg per week

Purpura

ECG abnormalities
- long QT

Unable to get up without using arms

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Name a very common side effect of antipsychotic medication, especially second generation:

Weight gain

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What is the name of the disorder in which people believe a famous person is in love with them?

Erotmania

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List some important risk factors towards suicide:

Male sex

Isolation

Low social econmic status

Unemployment

History/ family history of mental disorders

Drug and alcohol abuse

History of abuse

*previous suicide attempt

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What signs in a mental state examination may point to wards suicidal intention?

Appearance:

self harm
bizarre behaviour

Mood:
- low

Thoughts:

hopelessness
guilt
nihilistic delusions

Perception
- hallucinations

What things should be considered in a risk assessment of someone who attempted to commit suicide?

How serious was the intent

Was there careful preparation or impulsive

Likely hood of a rescue

Sense of relief or regret

Hopelessness

Recent escalation in self harming

Give some organic differentials to schizophrenia:

Drug induced

amphetamines
cannabis
Steroids

Temporal lobe epilepsy

Delirium

Diffuse brain disease

neurosyphilis
tumours

Name two questionnaires that can be used to screen for alcohol abuse:

Alcohol use disorders identification test - AUDIT

CAGE questions

What is the most important risk to consider in assessing someone with suicidal thoughts or attempted suicide?

Ongoing suicidal idealisation

What conditions are most associated with suicidal idealisation?

Depression Schizophrenia Bipolar affective disorder Substance abuse

What symptoms may you see as side effects of anti-psychotic medication?

Tremor Rigidity Bradykinesia Weight gain

What is the prognosis of schizophrenia?

1/3 recover 1/3 relapse 1/3 have ongoing issues

What are some organic causes to schizophrenia?

Substance abuse - alcohol - drugs Encephalitis Tumours Brain injury Electrolyte imbalances Hyper/ hypothyroidism

What is the differential for OCD?

Anankastic/ obsessive compulsive personally disorder - they are not okay with the way they are (egosyntonic) Cluster C Generalised anxiety disorder

In scotland what act can be used to treat a patient who is unconscious?

Adult with Incapacity Act 2000

Give some differentials for a reduced GCS in someone presenting after falling over due to alcohol abuse?

Still intoxicated Head injury Delirium tremens Seizures Hypoglycaemic Additional substance abuse

How long can a nurse detain someone for?

2 hours with an additional 1 hour to allow drs to examine the patient.

What are the symptoms of a panic disorder:

Intense fear/ impeding doom Chest palpitations Sweating/ flushing Dizziness/ fainting Dyspnea Tingling around the lips and hands - calcium binding to albumin as H+ is released

What drug types can be used to treat depression?

SSRIs SNRIS Noradenraline Specific serotonergic receptor agonists - Mirtazapine TCAs

Which two autoimmune conditions are associated with developing OCD?

Sydenham's chorea - rheumatic fever PANDA - Group A step infection

What are the treatments for OCD?

Mild: - Low intensity CBT - Exposure therapy Moderate: - Intensive CBT - SSRI ``` Severe: - psychological therapy - different SSRI or - clomipramine ```

List some genetic disorders that predispose individuals to ADHD:

Tuboscloerosis Fragile X NF-1 Turner's syndrome

What is the diagnostic criteria for ADHD?

Symptoms of inattention, hyperactivity and impulsivity which is persistent. For those < 16 years old there needs to be >6 features For those > 17 years old there needs to be >5 features Features must be present in more than >2 environments and have begun early in life.

List some differentials into ADHD:

Sleep disorder - apnoea from adenoid enlargement Anxiety Depression Learning difficulties - dyslexia Drug abuse - either taken or seeking behaviour Hearing/ visual disorders Conduct disorder

Which questionnaire is useful for assessing symptoms of ADHD across different environments?

Conner's questionnaire

Upon starting medication for ADHD, what examinations and investigations first need to undertaken?

Base line weight and height - redone every 6 months Base line ECG - drugs can be cardiotoxic

What are the medications used in ADHD?

1st line: - methylphenidate - dexamphetamine * dopamine/ noradrenaline reuptake inhibitor * can be given as long acting or short acting 2nd line: - Atomoxetine * noradrenaline reuptake inhibitor * takes up to 6 weeks to work Bupropion can also be used. it is a Noradreanline - serotonin reuptake inhibitor *reduces seizure threshold.

Can you treat someone's physical conditions under the mental health act?

No. if someone is refusing treatment for their physical conditions and has been detained, you can only legally treat their mental disorder under the mental health act. in order to treat their physical illness you need an Adults with incapacity - which they may have due to their mental health issue

What criteria must the mental health act justify?

1. likely mental health disorder 2. Impaired decision making 3. there is a risk if left 4. there is treatment (even if just under observation this maybe enough to off put killing themselves) 5. Least restrictive option

What investigation can be done to help identify the aetiology of dementia, specifically used for Lewy body dementia?

Dat- SPECT scan radioisotope which binds to dopamine transporters found on the dopamine producing cells.

What are the core symptoms of lewy body dementia? What drug can be used in its management?

Visual hallucinations and other vivid hallucinations Memory disturbance REM sleep abnormalities Variability in presentation Motor signs of Parkinson's may begin later on Drug: - Rivastigmine

What are the core presenting symptoms of fronto-temporal dementia?

``` Language defect (attenuate, perseveration, mutism) - usually first to go ``` Exudative function dysfunction Impulse control dysfunction Lack of inhibition * memory is usually relatively well preserved. * associated with early onset * associated with MND

In addition to FBC and U&Es and urine dip etc what additional blood tests should be conducted into a confused patient?

``` B12 Folate TFTs Bone profile Glucose ```

What is a contraindication to donepezil and what is a major side effect of it?

Bradycardia Fronto-temporal dementia Vascular dementia Side effects: - effect on sleep

What drugs are contraindicated in individuals with fronto-temporal dementia?

Acetylcholinesterase inhibitors