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Psychiatry Flashcards

1
Q

Define Neuroses

A

Mild mental illness with no organic cause that involves symptoms of stress but no loss of touch with reality

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2
Q

Define Psychosis

A

Severe mental disorder in which thoughts and emotions are so impaired that contact with external reality is lost

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3
Q

Define Illusion

A

Misinterpretation of actual external stimulus e.g. Hearing wind and thinking it’s a baby crying

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4
Q

Define Hallucination

A

Internal perception without corresponding external stimulus

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5
Q

Define pseudohallucination

A

False perception which is perceived as occurring as part of ones internal experience not as part of the external world

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6
Q

Define overvalued idea

A

Form of abnormal belief, reasonable and understandable but unreasonably dominates the persons life

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7
Q

Define thought echo

A

Auditory hallucination in which the content is the patients current thoughts

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8
Q

Define though insertion

A

Delusional belief that thoughts are being placed into the patients head

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9
Q

Define thought withdrawal

A

Delusional belief that thoughts are being taken from the patients head

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10
Q

Define thought block

A

Sudden break in the chain of though - may be explained by thought withdrawal

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11
Q

Define thought broadcast

A

Delusional belief that ones thoughts are readily accessible to others

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12
Q

Define concrete thinking

A

Loss of ability to understand metaphorical ideas and abstract concepts - literal thinking - seen in schizophrenia and dementia

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13
Q

Define circumstantiality

A

Disorder of form of thought where irrelevant details and digressions overwhelm direction of thought process - seen in mania and anankastic PD

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14
Q

Define Confabulation

A

Describing plausibly false memories for a period where the patient has amnesia - seen in Korsakoffs, dementia and following alcohol palimpsest

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15
Q

Define perseveration

A

Continuing with a verbal response or action which was initially appropriate but ceases to be so - seen in organic disease and occasionally schizophrenia

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16
Q

Define depersonalisation

A

Subjective experience which the patient feels unreal

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17
Q

Define psychomotor retardation

A

Decreased spontaneous movement and slowness in instigating and completing voluntary movements - depressive illness

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18
Q

Define made acts, feelings and drives

A

Delusional belief that ones free will has been removed and an external source is controlling feelings and actions

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19
Q

Define somatic passivity

A

Delusional belief that sensations are being imposed upon the body by outside forces

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20
Q

Define conversion

A

Development of features suggestive of physical illness but which are attributed to psychiatric illness rather than organic pathology

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21
Q

Define Dissociation

A

Separation of unpleasant emotions or memories from conscious awareness with subsequent disruption to the normal integrated functioning of consciousness and memory

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22
Q

Define mannerism

A

Bizarre and pointless repetitive movement

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23
Q

Define derailment

A

Break in chain of association between meaning of thoughts - connection not apparent to patient or examiner

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24
Q

Define obsession

A

Idea, image or impulse which is recognised as the patients own but is repetitive, intrusive and distressing - can be resisted at the expensive of mounting anxiety, sometimes relieved by associated compulsions

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25
Define compulsion
Behaviour or action which is recognised as unnecessary and purposeless but cannot be resisted - need to perform act in order to avoid adverse event
26
Define akathisia
Subjective sense of uncomfortable desire to move, relieved by repeated movement, usually the legs. Side effect of neuroleptics
27
Define clang association
Connection between words is based on sound rather than meaning e.g. Rhyming. Seen in manic flight of ideas
28
Cotard syndrome
Psychotic depressive illness characterised by triad of depressed mood, nihilistic delusions and hypochondriacal delusions
29
Couvade syndrome
Conversion symptoms mimicking pregnancy in the partner of a pregnant woman
30
Define delusion
A fixed unshakeable belief held outside of social and cultural norms despite lack of evidence
31
Delusion of jealousy
Partner being unfaithful, monosymptomatic = Othello Syndrome
32
Fregoli Syndrome
Strangers are familiar people
33
Capgras Syndrome
Delusional belief that familiar people have been replaced by identical strangers
34
Define Ekbom syndrome
Monosymptomatic delusion of infestation
35
Define De Clerambault syndrome
Female (usually) believes a higher status individual is in love with them and soften accompanying persecutory delusion that people are conspiring to keep them apart
36
Define delusions of reference
Belief that external events or stimuli have been arranged in a way such that that have a particular significance, or convey a message, to the individual
37
Define grandiose delusions
Beliefs that one has special powers or is unusually rich or powerful
38
3 example of SSRI's
Sertraline, citalopram, fluoxetine
39
3 indications for SSRI's
Depression, panic disorder, obsessive compulsive disorder
40
What is the mechanism of SSRI's?
Inhibit neuronal reuptake of serotonin from the synaptic cleft therefore increasing its availability for transmission
41
Common side effects of SSRI's
GI upset, appetite and weight changes, suicidal thoughts and behaviours (first 2 weeks)
42
2 examples of tricyclics
Amitriptyline, lofepramine
43
2 indications for tricyclics
2nd line for mod/severe depression, neuropathic pain
44
How do tricyclics work?
Inhibit neuronal reuptake of serotonin and noradrenaline
45
Which receptors do tricyclics also block?
Muscaranic, histamine (H1), a-adrenergic (A1 + A2), dopamine (D2) - extensive adverse effects
46
Common side effects of tricyclics
Cholinergic - dry mouth, constipation H1 + A1 - sedation, hypotension, weight gain Arrhythmias, prolonged QT, QRS Dopamine - sexual dysfunction
47
Why shouldn't you give antidepressants alongside monoamine oxidase inhibitors?
Risk of serotonin syndrome
48
What class of drug is venlafaxine?
Serotonin and noradrenaline reuptake inhibitor - like TCA but less side effects
49
What are the side effects of venlafaxine?
Cardiac, need to control BP, contraindicated if previous MI
50
How does mirtazapine work?
Increases availability of monoamines for neurotransmission, s/e are dose dependent with sedation more prominent at a low dose and weight gain
51
3 examples of typical (1st gen) antipsychotics
Haloperidol, Chlopromazine, Prochlorperazine
52
4 indications for 1st gen antipsychotics
Severe psychomotor agitation Schizophrenia where 2nd gen are unsuitable Bipolar disorder - acute manic/hypomanic episode Nausea and vomiting in palliative care
53
What is the mechanism of 1st gen antipsychotics?
Blocks post synaptic dopamine (D2) receptors in mesolimbic/mesocortical pathway
54
Side effects of 1st gen antipsychotics
``` Extrapyramidal effects Acute dystonic reaction (hours/days) Akathisia (hours/days - treat with BDZ) Tardive dyskinesia - years Drowsiness, hypotension, ED, menstrual disturbance, galactorrhoea ```
55
4 examples of atypical antipsychotics (2nd gen)
Quetiapine, risperidone, olanzapine, clozapine
56
3 indications for 2nd gen antipsychotics
Schizophrenia when s/e from 1st gen or negative symptoms Psychomotor agitation Acute manic/hypomanic episode
57
How is the mechanism for 2nd gen antipsychotics different from 1st gen?
Lower risk of extrapyramidal s/e, looser binding to D2 receptors, higher affinity for other receptors
58
Adverse effects of 2nd gen antipsychotics
Sedation Metabolic disturbance - weight gain, diabetes, lipid changes Arrhythmias Breast changes and sexual dysfunction Clozapine - agranulocytosis/myocarditis - regular blood checks
59
5 examples of benzodiazepines
Diazepam, lorazepam, chlordiazepoxide, midazolam, temazepam
60
5 indications for BDZs
``` Seizures and status epilepticus Alcohol withdrawal Sedation Short term anxiety relief Short term insomnia relief ```
61
Adverse effects of BDZs
Dose dependent drowsiness, coma, sleepiness Airway obstruction and death Dependence -> withdrawal similar to alcohol
62
Indications for lithium
Prophylaxis for bipolar disorder | Acute mania
63
Side effects of lithium
GI upset Tremor, ataxia, dysarthria Polyuria, long term use renal damage Thyroid enlargement
64
What needs to be monitored in a patient on lithium treatment?
U+Es, thyroid function tests, lithium levels (every 3/12)
65
Define reflex hallucination
Stimulus in one modality experienced in another
66
Define hypnopompic hallucination
Hallucination phone waking | Hypnogognic - hallucination before falling asleep
67
Peak incidence of schizophrenia
18-25 in men | 25-30 in women
68
Symptoms in the prodromal period of schizophrenia
Depression, anxiety, social withdrawal, self neglect, loss of interest
69
Genetic risk if both parents have schizophrenia?
45%
70
4 predisposing factors for schizophrenia
Increased stress Increased emotion - positive or negative Increased criticism Drugs - alcohol and cannabis
71
6 positive symptoms of schizophrenia
``` Auditory hallucinations Thought disorder Incongruity of affect Mannerisms Passivity Catalonia ```
72
What are the negative symptoms of schizophrenia?
Lead to reduced functioning and are a poor prognostic sign, often difficult to distinguish from depression (weight, sleep and guilt/hopelessness are absent) Alogia, blunting of affect, poverty of content of thought, abolition, slowness of though and movement
73
What are the first rank symptoms of schizophrenia?
Delusions Thought disorders (insertion, withdrawal, broadcast) Auditory hallucinations
74
How would you investigate a potential case of schizophrenia?
``` Drug screening EEG - epilepsy Fasting glucose - diabetes Neuro exam - organic cause Bloods - baselines before starting meds CT/MRI - SOL ```
75
Management of schizophrenia
``` Based on risk - detained under MHA---managed at home Antipsychotics Clozapine for treatment resistant Psychotherapists help negative symptoms Social care ```
76
3 risks of a patient with schizophrenia
To self - Suicide Self neglect To others - Children, public, partner (delusional jealousy)
77
Mental health act section 2
``` To assess Up to 28 days Signed by 2 doctors and social worker 1 dr to know patient Treatment can be given against will ```
78
Mental health act section 3
Up to 6 months Can be renewed Treatment for 3 months then must consent or 3rd dr to approve
79
Section 135
Police can remove person to place of safety for 72 hours Can use force If social worker has obtained warrant Cannot treat
80
Section 136
Don't need warrant Can remove from public place Cannot treat
81
What is the upper limit for lithium
1.2mMol/L
82
Side effects of lithium therapy
Fine tremor, hypothyroidism, T wave, widening of QRS
83
Symptoms of lithium toxicity
Early - coarse tremor, GI upset, dehydration | Later - hypertonicity, ataxia, drowsiness
84
Management of lithium toxicity
Education, dose adjustment, forced diuresis, IV isotonic saline, haemodialysis
85
What is neuroleptic malignant syndrome?
Rare but life threatening idiosyncratic reaction to anti psychotics
86
Symptoms of NMS
``` Fever Autonomic instability Leucocytosis Tremor Elevated CK Rigidity Can cause rhabdomyolysis, seizures, resp failure ```
87
How would you treat NMS?
BDZs for behaviour, Dantrolene for muscle spasms, hydration and alkalisation of urine if rhabdomyolysis (IV sodium bicarbonate)
88
Describe acute dystonic reaction
Painful muscle spasms producing repetitive, twisting movements which develop following exposure to antipsychotics (48hours-1week)
89
Symptoms of serotonin syndrome
Altered mental state, agitation, tremor, shivering, hyperreflexia
90
Treatment of serotonin syndrome
If overdose - gastric lavage/activated charcoal IV access to allow volume correction and reduce risk of rhabdomyolysis Resolves in 24/36 hours
91
What drugs can cause serotonin syndrome
Amfetamines, SSRIs, MAOIs, TCAs, lithium
92
3 differences between NMS and serotonin syndrome
Onset NMS days to weeks SS rapid Activity NMS bradykinesia SS hyperkinesia Progression NMS 24-72 hours SS rapid Rigidity NMS lead pipe, severe SS less severe

Phase 3A (2 decks)

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