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Specialities > Psychiatry 2 > Flashcards

Psychiatry 2 Flashcards

1
Q

List some common side effects of lithium:

A 
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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2
Q

What are the symptoms of post concussion syndrome?

A

Headache
Fatigue
Anxiety/ depression
Dizziness

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3
Q

What is a treatment option for personality disorders?

A

Dialectal Behavioural Therapy (DBT)

and mood stabilisers such as Lamotrigine

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4
Q

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

A

Long QT syndrome
Bradycardia

*thought to be due to hypomagnesium and hypocalcaemia

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5
Q

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

A

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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6
Q

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

A

VTE

Stroke

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7
Q

Define catatonia:

A

Increased muscle tone at rest but abolished by voluntary muscle activity

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8
Q

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

A

Similar:

  • Fever
  • Tachycardia
  • Hypertension

NMS:

  • Rigidity
  • Raised CK and WBC
  • slower onset (days)

SS:

  • Hyperreflexia
  • Clonus
  • Diarrhea
  • rapid onset
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9
Q

What is the treatment for Neuroleptic malignant syndrome?

A

Stop Anti-psychotic

IV fluids (reduce AKI due to raised CK levels)

Dantrolene
- muscle relaxant

Dopamine agonists
- bromocriptine

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10
Q

What is the management of serotonin syndrome?

A

IV fluid

Benzodiazepines

Anti SSRIs
- chlorpromazine

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11
Q

Highlight the key features of autism:

A

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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12
Q

What are some signs of autism:

A

Delayed speech

Delayed response to name

Poor eye contact

Hand flapping

Dislike to additional stimuli

Delayed playing with others

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13
Q

Name a screening tool used for autism:

A

Gilliam Autism Rating Scale (GARS)

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14
Q

List the management for people with autism:

A

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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15
Q

How long can an emergency detention be used for?

A

72 hours

*cannot be appealed

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16
Q

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

A

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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17
Q

What are some red flags regarding anorexia?

A

BMI <13

Weight loss of >1kg per week

Purpura

ECG abnormalities
- long QT

Unable to get up without using arms

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18
Q

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

A

Weight gain

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19
Q

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

A

Erotmania

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20
Q

List some important risk factors towards suicide:

A

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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21
Q

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

A

Appearance:

  • self harm
  • bizarre behaviour

Mood:
- low

Thoughts:

  • hopelessness
  • guilt
  • nihilistic delusions

Perception
- hallucinations

22
Q

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

A

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

23
Q

Give some organic differentials to schizophrenia:

A

Drug induced

  • amphetamines
  • cannabis
  • Steroids

Temporal lobe epilepsy

Delirium

Diffuse brain disease

  • neurosyphilis
  • tumours
24
Q

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

A

Alcohol use disorders identification test - AUDIT

CAGE questions

25
Q

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

A

Ongoing suicidal idealisation

26
Q

What conditions are most associated with suicidal idealisation?

A

Depression

Schizophrenia

Bipolar affective disorder

Substance abuse

27
Q

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

A

Tremor

Rigidity

Bradykinesia

Weight gain

28
Q

What is the prognosis of schizophrenia?

A

1/3 recover

1/3 relapse

1/3 have ongoing issues

29
Q

What are some organic causes to schizophrenia?

A

Substance abuse

  • alcohol
  • drugs

Encephalitis

Tumours

Brain injury

Electrolyte imbalances

Hyper/ hypothyroidism

30
Q

What is the differential for OCD?

A

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

Cluster C

Generalised anxiety disorder

31
Q

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

A

Adult with Incapacity Act 2000

32
Q

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

A

Still intoxicated

Head injury

Delirium tremens

Seizures

Hypoglycaemic

Additional substance abuse

33
Q

How long can a nurse detain someone for?

A

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

34
Q

What are the symptoms of a panic disorder:

A

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

35
Q

What drug types can be used to treat depression?

A

SSRIs

SNRIS

Noradenraline Specific serotonergic receptor agonists
- Mirtazapine

TCAs

36
Q

Which two autoimmune conditions are associated with developing OCD?

A

Sydenham’s chorea
- rheumatic fever

PANDA - Group A step infection

37
Q

What are the treatments for OCD?

A

Mild:

  • Low intensity CBT
  • Exposure therapy

Moderate:

  • Intensive CBT
  • SSRI
Severe:
- psychological therapy 
- different SSRI 
or 
- clomipramine
38
Q

List some genetic disorders that predispose individuals to ADHD:

A

Tuboscloerosis
Fragile X
NF-1
Turner’s syndrome

39
Q

What is the diagnostic criteria for ADHD?

A

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.

40
Q

List some differentials into ADHD:

A

Sleep disorder
- apnoea from adenoid enlargement

Anxiety

Depression

Learning difficulties
- dyslexia

Drug abuse
- either taken or seeking behaviour

Hearing/ visual disorders

Conduct disorder

41
Q

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

A

Conner’s questionnaire

42
Q

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

A

Base line weight and height
- redone every 6 months

Base line ECG
- drugs can be cardiotoxic

43
Q

What are the medications used in ADHD?

A

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.

44
Q

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

A

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

45
Q

What criteria must the mental health act justify?

A
  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
46
Q

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

A

Dat- SPECT scan

radioisotope which binds to dopamine transporters found on the dopamine producing cells.

47
Q

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

A

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

48
Q

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

A 
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
49
Q

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

A 
B12
Folate 
TFTs 
Bone profile 
Glucose
50
Q

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

A

Bradycardia

Fronto-temporal dementia
Vascular dementia

Side effects:
- effect on sleep

51
Q

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

A

Acetylcholinesterase inhibitors

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