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Medicine > Psychiatry > Flashcards

Psychiatry Flashcards

1
Q

What are the risk factors for self harm? 3 things

A

Psychiatric condition
Victims of domestic violence
Socioeconomic disadvantage
Eating disorders

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2
Q

What state must a patient be in to section them?

A 
A danger to themselves
Or
A danger to others
Or
Deteriorating to the point that they will become one of the above
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3
Q

What is section 2, how long does it last and who is required?

A 
Assessment and treatment 
28 days
Consultant psychiatrist
GP who knows the pt. 
Approved social worker (ASW)
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4
Q

What is section 3, how long does it last and who is required?

A 
Treatment ONLY
6 months but can be extended 
Consultant Psychiatrist
GP who knows pt.
Approved Social Worker (ASW)
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5
Q

What is section 4, how long does it last and who is required?

A

Emergency admission from community
72 hours
Doctor and ASW

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6
Q

What is section 5.2, how long does it last and who is required?

A

Emergency to detain pt. in hospital
72 hrs. Allows assessment from professionals.
Any doctor

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7
Q

What is section 5.4, how long does it last and who is required?

A

Detain pt. in emergency
6hrs
Nurse

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8
Q

What is section 136?

A

Section done by the police when there is suspicion of mental illness

Pt. held in place of safety until assessment

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9
Q

What is dementia?

A

Chronic generalised psychological impairment of intellect, memory and personality with NO effect on consciousness

Usually irreversible occurring 65+ y/o

Symptoms present >6 months

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10
Q

In schizophrenia, give 2 symptoms each of positive and negative?

A

Positive-
Thought disorder
Reality distortion

Negative-
Social withdrawal
Decreased emotional response
Cognitive dysfunction and dementia

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11
Q

What are Schneiders first rank symptoms of schizophrenia?

A

Delusional perception
Delusions of thought control
Delusions of control
Hallucinations

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12
Q

What is the criteria for diagnosing schizophrenia?

A

1 or more 1st rank symptoms/strong characteristic symptoms
Or
2 or more less characteristic symptoms

> 1 month after all other possible causes have been excluded

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13
Q

Give one thing that could precipitate schizophrenia?

A

Stress

Drug abuse

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14
Q

You suspect a pt. to have schizophrenia, what investigations will you do? 2 things

A

Drug screen-rule out organic cause
CT/EEG-rule out organic cause
Collateral history

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15
Q

How do you manage schizophrenia using a bio psychosocial model?

A

Bio-antipsychotic medication 1-2yrs
Psycho-CBT, family therapy
Social-relationships, occupation, social skills training

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16
Q

What are the typical side effects of antipsychotics?

A 
EPSE
Tardive dyskinesia
Dystonia
Akasthisia (restless leg)
Parkinsonian symptoms
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17
Q

Which antipsychotic needs regular monitoring and why?

A

Clozapine due to agranulocytosis

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18
Q

What are the core symptoms in depression?

A

Low mood
Low energy
Anhedonia (lack of enjoyment)

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19
Q

How is depression diagnosed?

A

2 core symptoms and additional symptom for >2 weeks

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20
Q

How do you manage depression in a bio psychosocial model?

A

Bio-Antidepressants, ECT
Psycho-Counselling, CBT, self help groups
Social-OT, home help, social skills training

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21
Q

What are the potential side effects of ECT?

A 
Loss of memory
Confusion
Headache
Nausea
Muscle pains
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22
Q

What are the risk factors for depression? 4 things

A 
Stress
Emotional distress
Close one death
Adverse life event
Family history
Alcohol/drug misuse
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23
Q

What is the difference between Mania and Hypomania?

A

Mania is an elated mood lasting >1-2 weeks WITH psychotic symptoms

Hypomania is elated mood for >4 days WITHOUT psychotic symptoms

24
Q

Give 2 common side effects of lithium?

A 
Tremor
Thinning of hair
Acne
Weight gain
Diabetes insipidus
25
Q

What is the first line treatment for an acute manic episode?

A

Atypical antipsychotic

26
Q

Give 2 physical symptoms of depression?

A

Sleep disturbance
Loss of appetite
Weight loss
Loss of libido

27
Q

Give 3 epidemiological risk factors for suicide?

A 
Male
Elderly
Unemployed
Low socioeconomic status
Loneliness/homeless
28
Q

Give 3 ways of determining the severity of suicidal intent?

A

Whether there is a wish to die
Any note or will written
Any planning
Methodology

29
Q

In paracetamol overdose, how will you manage it?

A

Activated charcoal within the hour
Or N acetylcysteine
Bloods-LFT, drug levels, FBC
Refer to Psychiatry team

30
Q

Pt admits to hearing voices. Give 3 further questions you would ask?

A 
Content?
3rd and 2nd person?
Running commentary?
Voice is your own or different person speaking?
Recognise voices?
31
Q

Give 2 examples of typical and atypical antipsychotics?

A

Typical-Haloperidol or Chlorpromazine

Atypical-Quetiapine or Olanzapine

32
Q

Give 3 criteria in diagnosing Anorexia Nervosa?

A
  • Overestimation of actual body weight and size
  • Phobia of normal body
  • BMI <17.5
  • Amenorrhea
33
Q

Apart from restricting food intake, how else might an anorexic patient avoid weight gain? 2 things

A
  • Over exercise
  • Laxatives
  • Vomiting
  • Diuretic usage
34
Q

Give 3 clinical effects of Anorexia Nervosa?

A 
Vitamin deficiencies and electrolyte disturbance
Amenorrhea
Bradycardia
Alopecia
Osteopenia
Cold peripheries
35
Q

Give 7 physical symptoms of anxiety disorders?

A

Motor tension-muscle stiffness, headaches, tremor, muscle aches

Increased sympathetic drive-sweating, dizziness, frequent peeing, nausea, diarrhoea

Hyper vigilance-irritability, insomnia

36
Q

Name 2 pharmo and 2 non pharmo ways of treating generalised anxiety disorders?

A

Anxiolytics (benzodiazepines)
Antidepressants

CBT
Psychotherapy

37
Q

What are the 3 most common types of dementia?

A

Alzheimer’s
Vascular
Lewy body

38
Q

Below what MMSE score is a patient said to have dementia if repeated on multiple occasions?

A

23/30

39
Q

Give 2 CT changes seen in Alzeheimers?

A

Widening of sulci

Enlargement of ventricles

40
Q

Suggest 4 blood tests you would perform to exclude other causes of dementia?

A

FBC-WCC shows chronic infections

U+E -electrolyte disturbances can cause confusion

CRP-rule out autoimmune disease

Vit B12 and folate-Wernicke’s encephalopathy

41
Q

What is delirium?

A

Acute and fluctuating reversible disturbance in level of consciousness, attention and cognition due to physical illness

42
Q

Name 4 causes of delirium?

A 
Stroke
Brain tumour
Alcohol
Encephalitis
Meningitis
UTI
Acid base disturbance
43
Q

Give 2 ways you can differentiate between delirium and dementia?

A

Delirium is acute vs. Dementia insidious

Delirium is fluctuating vs. Dementia is stable or progressive

Delirium has impaired consciousness vs. Dementia normal consciousness

44
Q

Give 5 features of Alcohol dependancy?

A
  • Withdrawals
  • Cravings
  • Drinking despite negative consequences
  • Tolerance
  • Primacy-drinking before anything else
  • Rapid reinstatement
  • Narrowing of repertoire
45
Q

Give the 4 areas used to assess mental capacity?

A

Understanding written or verbal information needed for decision making

Retain the information long enough to make the decision

Weigh up the pros and cons

Communicate the decision

46
Q

Give 3 drugs used in the treatment of alcohol dependence?

A

Benzodiazepine-Chlordiazepoxide, diazepam

Thiamine and vitamin supplements (Vit B12)

Disulfiram

Fluid replacement

47
Q

If vitamins are not replaced in a patient with alcoholic dependancy, what could occur?

A

Wernickes encephalopathy

48
Q

Explain lithium monitoring in a manic patient?

A

Lithium can accumulate in cells and result in toxicity if in high levels.
So regular monitoring of the plasma concentrations is needed.

49
Q

What is the evidence of ECT efficacy?

A

2008 meta-analysis on the efficacy of ECT vs. a variety of treatment options

50
Q

At what plasma level of lithium would you stop treatment?

A

1.5mmol/L

51
Q

Give 2 other alternatives to the use of lithium as a mood stabiliser?

A

Carbamazepine (causes birth defects) and Valproic acid

52
Q

Give a non pharmo method of treating mood disorders?

A

Mood diary

53
Q

Name 3 presentations of depression where ECT use would be appropriate?

A

Depression unresponsive to medication

Previous good response to ECT

Depression associated with psychotic features, severe weight loss or early morning waking

54
Q

Suggest 2 changes in ECT use from the 50’s to now?

A

Sinusoidal current to Brief pulse ECT

Unmodified (no muscle relaxant) to Modified (muscle relaxant)

55
Q

Give 3 factors you would need to consider when interviewing young children?

A

Establishing a rapport

Age and development appropriate questions

Collateral history from parents/school

Flexible and responsive to patient

56
Q

Name 2 advantages and 2 disadvantages of interviewing families together?

A

AD

  • allows observation of family dynamics
  • allows everyone to be involved reducing chances of distortion
  • facilitates discussion over family issues

DIS

  • time consuming
  • individuals may withhold info
  • conflicting interests of parents and child
57
Q

What is the triad of impairement typically seen in autistic spectrum disorders?

A

Social interaction
Communication
Rigidity of thinking

Medicine (17 decks)

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