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Specialities > Psychiatry 4 > Flashcards

Psychiatry 4 Flashcards

1
Q

What aspects of care are in a care programme approach?

A

Social workers
Community psychiatry nurse
Home care assessment
OT to help get the patient back into community

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2
Q

What is the main management of lithium overdose?

A

Organ support
- IV fluids to flush the lithium

  • continual monitoring
  • dialysis may be needed
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3
Q

Give some differentials for depression:

A

Adjustment disorder

Grief reaction

Cyclothymia

Organic causes
- hypothyroidism

Schizophrenia
- negative symptoms

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4
Q

What is the mnemonic for organic symptoms of depression?

A

CALS

  • concentration
  • Appetite
  • Libido
  • Sleep
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5
Q

What cognitive functions can be tested in delirium?

A

Orientation
Recall and delayed recall
Language - Naming objects

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6
Q

What diagnosis would you think if someone is suffering from recurrent panic attacks when out in public places?

A

Panic disorder with agoraphobia

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7
Q

What advice would you give when prescribing SSRIs to patients?

A

They can take 2-6 weeks to work and may increase suicide idealisation at first

*bring back <30’s in one week

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8
Q

How should changing an fluoxetine to another SSRI be done?

A

withdraw and leave a gap of 4-7 days before starting the new SSRI
- due to the long half life of the fluoxetine

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9
Q

What is the management of switching from an SSRI to TCA?

A

Cross coverage

- slowly reduce the SSRI which slowly increasing the dose of the TCA

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10
Q

Which antidepressant causes an increase in QTc?

A

citalopram

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11
Q

How should switching from fluoxetine I to an SNRI be managed and name an SNRI:

A

Withdrawal the SSRI and start the SNRI immediately, building up slowly

Venlafaxine is the most commonly used SNRI

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12
Q

How long should a patient be kept on anti-depressants for following recovery?

A

6 months

2 years if relapsing

1 year if anxiety

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13
Q

What blood tests should be conducted for those on SSRIs?

A

FBC
- for G.I Bleeding

U&Es
- hyponatraemia

ECG
- QTc prolongation

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14
Q

What is the medication options for anti-depressants?

A

1st line:

  • SSRI
  • ensure adequate dose before moving

2nd line:
- change SSRI

3rd line:
- SNRI
or
- NaSSA

4th line:

  • TCA
  • lithium
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15
Q

How should switching from an SSRI to an SNRI be managed and name an SNRI:

A

cross coverage

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16
Q

What are the classification of severity of depression?

A

Mild:
Core symptoms + 2 symptoms

Moderate:
Core symptoms + 4 symptoms

Severe:
Core symptoms +>4 symptoms
or
Psychotic features

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17
Q

What are the additional symptoms of depression?

A

Early morning wakening
Decreased appetite
Low libido
Psychomotor retardation (slow movement, reduce movement)

Poor concentration
Suicidal idealisation
Feelings of guilt

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18
Q

When starting antidepressants, how long after starting should individuals be followed up?

A

<25 years old: weekly to begin with and following any increases in dose

> 25 years old: 2 weekly to begin with and following any increase in dose

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19
Q

What drug is good in a depressed patient if they have poor sleep and/or appetite?

A

mirtazapine

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20
Q

What are the indications for ECT?

A

Catatonic patients

Life threatening depression
- not eating drinking

Severe mania

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21
Q

How often is ECT given? and what are some side effects?

A

Typically:
- twice weekly for 6-12 weeks

*>2 treatment tend to see improvement

Side effects:

  • short term memory loss - retrograde
  • episodic memory loss of previous memories
  • complications from GA

*reduce prior antidepressants

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22
Q

How does the dosage of SSRIs vary between anxiety and depression?

A

Anxiety a lower dose is started first

Depression higher dosage is started first

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23
Q

What is the syndrome in which some believes their partner/ lover is having an affair and what is a risk with it?

A

Othello syndrome

- risk of violence

24
Q

What is called when a person mimics your behaviour?

A

Echoprexia
- falls under appearance and behaviour.
typic of cationic behaviour

25
Q

What test can be done quickly to screen for delirium?

A

4AT

  • Alertness
  • Orientation - marks for making mistakes
  • Attention - months backwards
  • noticed change or fluctuation
26
Q

List some factors which suggest a suicide attempt is more serious:

A 
Method of attempt 
Precautions to be avoided 
Not seeking help before or after faield attempt 
Planning of attempt 
Notes
27
Q

What is the BMI equation?

A

Weight / (height)2

Weight Kg / Height, meters. squared

28
Q

What investgiations should you do when you are presented with someone with anorexia nervosa?

A

Bloods:

  • FBC/ MCV
  • B12/ Folate
  • U&Es (electrolyte abnormalities)
  • Glucose
  • Bone profile
  • Amylase
  • TFTs

ECG:

  • bradycardia
  • prolonged QT
  • Hypokalaemia
29
Q

What clinical signs may you see with anorexia nervosa?

A 
Low BMI 
Bradycardia/ hypotension 
Lanugo hair 
Brittle  nails/ dry hair 
Hyothermia 
Russels sign 
Parotid enlargement
30
Q

Why must lithium not be stopped abruptly?

A

It can induce severe mania.

31
Q

What is the upper limit of time benzodiazepines can be used for to treat generalised anxiety? and how are they withdrawn off?

A

2 weeks.

if been on for a long time - reduce dose 1/8th every 2 weeks

32
Q

Which Anti-depressant/ anti-anxiety medication should be avoided in pregnancy?

A

Paroxetine
- congenital malformations

Benzodiazepines
- causes cleft lip abnormalities in first semester

33
Q

List two risk factors for post-partum depression:

A

Previous history of depression

Family history of depression

34
Q

What is the most common cause of death during pregnancy and 1year after pregnancy?

A

Suicide

35
Q

Is lithium contraindicated in pregnancy and breast feeding?

A

Yes

- high concentrations enter pass through both

36
Q

What are the differences in MMSE scores?

A

> 27 normal

24- 27: mild cognitive impairment

21- 23: Mild dementia

10-20: moderate

<10: severe dementia

37
Q

What are some poor prognostic factors for schizophrenia?

A

Late onset
Drug use
Drug resistant
Negative symptoms - have a poorer prognosis

38
Q

List several blood tests you would do in order to try and establish a reversible cause for dementia:

A 
FBC - macrocytosis? 
U&Es - electrolyte abnormaliteis 
Bone profile - Ca2+? 
LFTs - alcohol, encephalopathy? 
Thyroid function 
Glucose 
B12
39
Q

What would be some differentials for first presentation of schizophrenia?

A

Illicit drug abuse

Delirium

Personality disorder

Temporal lobe epilepsy

40
Q

What is the definition of dementia?

A

An acquired loss of higher cerebral functioning in >2 more domains which include:

  • episodic memory
  • executive function
  • visuospatial function
  • Language
  • aprexia/ agnosia (poor recognition)

It must be severe enough to have a significant impact on the individual and be in the absence of reduced consciousness (separating it from delirium)

41
Q

What imaging may be conducted into dementia and why?

A

Head CT

  • rule out neoplasms
  • rule out hydrocephalus
  • rule out sub-durals

CT angiogram
- assess for vascular status of the brain

Brain MRI
- establish specific atrophy patterns

Amyloid Radio-nuclear scan
- picks up amyloid deposits

42
Q

What are some of the causes of dementia?

A

Degenerative:

  • Alzheimer’s
  • Lewy body
  • Fronto-temporal
  • Huntington’s
  • vCJD

Vascular

Metabolic:

  • Uricemia
  • Liver failure

Toxic:
- heavy metal poisoning

Endocrine:

  • Hypothyroidism
  • Hypoparathyroidism

Infections:

  • HIV
  • Syphilis
  • TB

Trauma:
- subdural

43
Q

List some investigations you could conduct in a patient with dementia to try and establish the cause:

A

Bloods:

  • U&Es (renal)
  • LFTs
  • TFTs
  • Bone profile (Ca2+)
  • Vitamin B12
  • HIV serology
  • Syphilis serology

Imaging

<65 years old:

  • Genetic studies for AD genes and Huntington genes
  • EEG
44
Q

Why are those with Down’s syndrome at increased risk of Alzheimer’s disease?

A

They have increased copies of Amyloid precursor protein

- APP is found on chromosome 21 therefore they have 3 copies.

45
Q

What are some risk factors for Alzheimer’s disease?

A

1st degree relative with AD

Down’s syndrome
- 3 copies of APP

Homozygosity for ApoE E4 allele

Head injuries

Smoking

46
Q

Which two types of dementias should NOT receive acetylcholinesterase inhibitors?

A

Fronto-temporal

Vascular

47
Q

What are some poor prognostic factors for schizophrenia?

A

Pre-dromal social withdrawing

Prolonged illness

Gradual onset

Family history

Medication resistant

48
Q

How often are Depot injections given and list a type of anti-psychotic medication typically used for it:

A

IM injection
- once monthly

Risperidone

49
Q

Are pseudo-hallucinations part of a normal grief reaction?

A

Yes

- even seeing the loved one can be normal

50
Q

If a patient is going for ECT what should occur to their current anti-depressant medication?

A

Dose should be reduced

51
Q

Which antidepressant should be avoided in early pregnancy and why, and list some complications of SSRI use in late pregnancy:

A

Paroxetine
- congenital abnormalites

Third trimester
- resistant pulmonary hypertension

52
Q

Highlight some areas where children differ from adults with regard to their presentation of depression:

A

Difficulty dealing with criticism
- low self esteem which is easily damaged

Mood variability

  • periods of crying
  • anger out bursts
  • irritability

Behavioural issues

  • can often be mistaken for ADHD
  • poor school work

Somatic symptoms

  • headaches
  • stomach aches

Self harm
- more likely to self harm which may be due to immaturity in dealing with emotions

53
Q

What is the genetic defect in Huntington’s disease and list some features seen with it:

A

Tri-nucleotide repeat of CAG (>39)

  • Genetic anticipation is seen
  • AD inheritance

Features:

  • early dementia
  • Chorea
  • dystonic movements
  • changes in personality
54
Q

In anorexia nervosa what does the Growth hormone and cortisol levels look like?

A

Raised.

55
Q

What are some of the genes linked to ADHD and list some risk factors:

A

DRD4
DRD5
*dopamine receptors

Risk factors:

  • family history
  • Low social economic status
  • Head injury
  • Brain injury - HIE, meningitis
  • Spina-bifida

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