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4MB Medicine > Psychiatry > Flashcards

Psychiatry Flashcards

1
Q

What are the core features/symptoms of depression?

A

Low mood
Anergia
Anhedonia

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2
Q

List aetiology/risk factors for depression

A 
Genetics, family history
Stressful events/life
Alcohol/drug use
Chronic disease
Steroid use, Cushing's syndrome (HPA disruption)
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3
Q

List additional symptoms and signs of depression (not core features)

A 
Negative thoughts and speech
Insomnia, early morning wakening
Reduced appetite
Weight loss
Loss of libido
Inattention, poor concentration
Thought poverty, low pressure of speech
Reduced facial expressions
Limited body language
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4
Q

What is the criteria for mild-mod depression?

A

2/3 core symptoms + 4 additional symptoms

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5
Q

What is the criteria for severe depression?

A

3/3 core symptoms + 5 additional symptoms

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6
Q

What investigations would you order for suspected depression?

A

Largely clinical diagnosis based on history and mental state
Thyroid function test
Inflammatory markers
CT/MRI brain

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7
Q

List drug classes and examples of drugs used in depression

A

SSRI (fluoxetine, citalopram, sertraline, paroxetine)
TCA (amitryptiline, clomipramine, imipramine)
MAOi (phenelzine, moclobemide)
SNRI (venlafaxine, duloxetine)
NASSA (mirtazepine)
Anticonvulsants/mood stabilisers (lamotrigine, lithium, sodium valproate)

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8
Q

What are some notable side effects of SSRI?

A

GI upset
Short-term anxiety/suicidal ideation
Sexual dysfunction
Hyponatraemia

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9
Q

What are some notable side effects of TCA?

A

Sedation

Anticholinergic side effects (dry mouth, dizziness, blurred vision, urinary retention, constipation)

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10
Q

What are some notable side effects of MAOi?

A 
Hypertensive crisis
Postural hypotension
Drowsiness
Insomnia
Nausea, constipation
Reaction with tyramine foods
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11
Q

What factors influence suicidal thoughts/intent/behaviour?

A 
Male
Older
Living alone
Recent traumatic event
Unemployment, financial struggle
Major psych illness
Alcohol/drugs addiction
Family problems
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12
Q

What factors influence self harm?

A 
Female
Young
Social issues
Personality disorder
Alcohol abuse
Arguments
Stress
Child abuse
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13
Q

Define bipolar disorder

A

2 or more episodes of mood and behaviour disturbance involving hypomania/mania and depressive phases

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14
Q

What are the three types/classifications of bipolar disorder?

A

I: manic episode + previous hypomanic-depressive episodes
II: 2 or more hypomanic-depressive episodes (no mania)
III: drug-induced hypomania-depression

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15
Q

What is the difference in duration between hypomania and mania?

A

Hypomania lasts 4 consecutive days

Mania lasts 7 consecutive days

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16
Q

List aetiology/risk factors for bipolar disorder

A 
Genetics, family history
Infections
Hyperthyroidism
SLE
Stroke
Recreational drugs (amphetamines, cocaine, cimetidine, steroids, levodopa)
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17
Q

List clinical features of bipolar disorder

A 
Elated mood, euphoria
Usually depression occupies longer phases
Overactivity
Restlessness
Racing thoughts
High pressure speech
Irritability
Grandiose delusions
Flight of ideas
Inattention, insomnia
Increased libido
Irresponsible, reckless behaviour
Psychosis more associated with mania
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18
Q

Outline treatment of acute mania/hypomania

A

Antipsychotic (aripiprazole, olanzapine)_
Detention may be necessary
Mood-stabiliser (valproate)

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19
Q

Which drug is used for bipolar disorder treatment?

A

Lithium

May use lamotrigine/valproate if ineffective/intolerable

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20
Q

List aetiology/risk factors for anorexia nervosa

A 
Genetics, family history
Down-regulated HPA
Childhood problems
EUPD
Social/cultural/occupational factors
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21
Q

What are the specific criteria for diagnosing anorexia nervosa?

A

Body weight less than 85% expected or BMI less than 17.5
Fear of being fat even when underweight
Purging/vomiting behaviour to lose weight
Endocrine disturbance

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22
Q

List clinical features of anorexia

A 
Cold sensitivity
Fatigue
Impaired cognition
Constipation
Osteoporosis
Dizziness
Fullness after eating
Autonomic upset
Reduced libido, amenorrhoea
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23
Q

What questions would you particularly ask for investigating anorexia?

A 
Sick because you feel full?
Control over eating?
One stone loss in 3 months?
Fat belief when others say you're thin?
Food dominates your life?
(SCOFF)
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24
Q

What are the specific criteria for diagnosing bulimia nervosa?

A

BMI less than 17.5
Recurrent binge-eating behaviour
Preoccupation with weight
Purging mechanisms to overcome fatness

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25
Q

List clinical features of bulimia nervosa

A 
Storage of food
Eating large quantities
Vomiting, calluses on hands (Russell's sign)
Tetanic muscles
Swollen salivary glands
Endocrine disturbance
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26
Q

Outline treatment for eating disorders

A 
CBT, family therapy
Diet management, food diary
Treat complications
OCP can boost oestrogen
SSRI may help
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27
Q

List clinical features of generalised anxiety disorder

A

Psychological: worry, panic, irritability, reduced concentration, restlessness, distractability
CNS: numbness, tingling, fatigue, insomnia, dizziness, headache, tremor
Autonomic: palpitations, chest pain, hyperventilation, xerostomia, nausea, vomit
“lump in throat” “butterflies” “ringing” nail-biting thumb-sucking

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28
Q

What is the duration of symptoms for diagnosis of generalised anxiety disorder?

A

6 months or more

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29
Q

Outline non-pharmacological treatment of generalised anxiety disorder

A

Lifestyle - exercise, relaxation, meditation, avoid caffeine and anxiogens
CBT, mindfulness
Graded exposure desensitisation
Hypnosis

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30
Q

Outline pharmacological treatment of generalised anxiety disorder

A 
Anxiolytics (diazepam for less than 6 weeks)
SSRI (fluoxetine)
Pregabalin
Paroxetine for social anxiety
Venlafaxine
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31
Q

What is the time criteria for panic disorder?

A

Panic lasts up to 45 mins and peak anxiety occurs around 10 mins

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32
Q

List clinical features of panic disorder

A 
Hyperventilation
Restlessness
Palpitations
Sweating
Fear, horror
Helplessness
Numbness
Features of GAD
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33
Q

What is depersonalisation?

A

Perception that people/self are unreal or automated

e.g. body like cotton wool

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34
Q

What is derealisation?

A

Perception that one is detached from reality

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35
Q

What is a phobia?

A

Irrational fear that is uncontrollable, causing anxiety and avoidant behaviour

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36
Q

What is classical vs imagined conditioning with regards to developing phobias?

A

Classical: fear develops after stimulus caused emotional shock
Imagined: fear develops in childhood/development

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37
Q

Outline treatment of phobias

A

Graded exposure desensitisation
Flooding (not routinely done)
CBT
Paroxetine for social phobia

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38
Q

What are obsessions and compulsions?

A

Obsessions are stereotyped, purposeless behaviours that are unwanted
Compulsions are repeated rituals that reduce anxiety when performed

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39
Q

List clinical features of obsessive compulsive disorder

A 
Constant checking
Repetitive thoughts and actions
Superstitions
Perfectionism
Anxiety
40
Q

Outline treatment of obsessive compulsive disorder

A

CBT, exposure response therapy
SSRI (fluoxetine)
TCA (clomipramine)
Deep brain stimulation

41
Q

What is post-traumatic stress disorder?

A

Protracted response to stressful event/trauma, diagnosed 3 months after the event

42
Q

List aetiology/risk factors for PTSD

A 
Natural/human disasters, war
Accidents
Witness death
Sexual assault
Kidnap
43
Q

List clinical features of PTSD

A 
Nightmares
Flashbacks
Insomnia
Panic disorder signs become chronic
Emotional numbing
Detachment
Avoidant behaviour
Hyperarousal, hypervigilance
44
Q

Outline treatment of PTSD

A 
Focused psychotherapy, CBT
EMDR
Correct stress hormone dysregulation
SSRI (paroxetine)
TCA (amitryptilline)
BZD's
Venlafaxine
45
Q

What is a hallucination?

A

Perceptual experience that does not match reality

46
Q

What is a delusion?

A

Fixed firm belief that is illogical and not amenable to change in the face of evidence to the contrary

47
Q

What is schizophrenia?

A

Psychotic illness involving cognitive and behavioural disturbance

48
Q

What is the proposed pathophysiology of schizophrenia?

A

Increased dopaminergic neurotransmission and activity

49
Q

List aetiology/risk factors for schizophrenia

A

Early cannabis use
Altered neurobiology and development
Abnormal brain architecture
Genetics (NRG-1 on c8, dysbindin on c6)

50
Q

List structural brain abnormalities in schizophrenia

A

Enlarged lateral ventricles
Reduced cortical volume, esp frontal lobe
Reduced hippocampal volume

51
Q

List clinical features of schizophrenia

A

Psychosis (hallucinations, delusions, thought disorder)

-ve symptoms (lack of volition, social withdrawal, apathy, self-neglect, blunted mood/affect)

52
Q

Outline treatment for schizophrenia

A 
Psychosocial intervention, CBT, family therapy
Antipsychotic
Acute management (de-escalate, oral/IM haloperidol +/- lorazepam)
53
Q

What is the ICD-10 criteria for dependence?

A 
Strong desire for the substance
Difficulty controlling use of substance
Physiological withdrawal state
Neglect other pleasure
Persist with substance despite evidence of harm
54
Q

List aetiology/risk factors for drug dependence

A 
Difficult social circumstances
Inherited vulnerability
Unemployment
Depression, anxiety, PTSD
Childhood abuse
55
Q

Give examples of stimulants

A 
Amphetamine
Mephedrone
Phencyclidine
Cocaine
MDMA
56
Q

Give examples of hallucinogens

A 
Cannabis
Solvents
LSD
Mescaline
Ketamine
57
Q

Give examples of depressants

A 
Heroin
Morphine
Codeine
Dihydrocodeine
Methadone
Benzodiazepines
58
Q

List clinical features of drug dependence

A 
Disturbed cognition
Altered consciousness and perception
Dangerous/odd behaviour
Arrests for larceny
Injection site abscesses/infection
Requests for drugs
Withdrawal symptoms
59
Q

Outline treatment for opiate dependence

A

Detox: methadone, bruprenorphine
Maintenance: lofexidine
Relapse prevention: naltrexone, acamprosate
Psychotherapy

60
Q

Describe risky and high risk alcohol consumption

A

Risky: 15-35 u/week regularly

High risk: more than 35 u/week regularly

61
Q

List clinical features of alcohol dependence

A 
Life revolves around drink
Restlessness
Irritability, sweaty
Jaundice
Memory impairment
Neuropathy
Fits, falls
Hallucination
Bleeding (varices, MW tears)
Anaemia
Arrhythmias
Hypertension
Withdrawal/delirium tremens
62
Q

List clinical features of delirium tremens

A 
Tachycardia
Hypotension
Tremor
Fits
Hallucinations
Aggressiveness, violence
63
Q

How can CAGE or TWEAC be used to identify alcohol dependence?

A

Cut-down prompts? Awareness? Guilty about drinking? Eye-opener in the morning?
Tolerance? Worry? Eye-openers? Amnesia? Cut-down attempts?

64
Q

Outline treatment of delirium tremens/alcohol withdrawal

A

Parenteral thiamine
Oral diazepam/chlordiazepoxide
Prophylaxis - B blocker, carbamazepine, phenytoin

65
Q

Outline treatment of alcohol dependence

A

Psychotherapy, CBT, AA meetings
Relapse prevention (naltrexone)
Post-detox abstinence, acamprosate

66
Q

What is personality disorder?

A

When personality is abnormal/deviates from social or cultural norm and causes harm to self and/or others

67
Q

Describe paranoid personality disorder and give an example of someone from Harry Potter who fits the description

A

Distrust of others and their motives, constantly suspicious and reluctant to confide or share info
Mad Eye Moody

68
Q

Describe schizoid personality disorder and give an example of someone from Harry Potter who fits the description

A

Detached from social relationships and restricted range of emotion
Severus Snape

69
Q

Describe histrionic personality disorder and give an example of someone from Harry Potter who fits the description

A

Excessive emotionality and attention-seeking behaviour

Draco Malfoy

70
Q

Describe antisocial personality disorder and give an example of someone from Harry Potter who fits the description

A

Disregard for rights and health of others with lack of remorse for others’ feelings
Bellatrix Lestrange

71
Q

Describe emotionally unstable personality disorder and give an example of someone from Harry Potter who fits the description

A

Pattern of unstable relationships, self-esteem with fluctuating mood
Lavender Brown

72
Q

Describe narcissistic personality disorder and give an example of someone from Harry Potter who fits the description

A

Inflated sense of self-importance with deep need for admiration, often with underlying fragile self-esteem
Luscious Malfoy

73
Q

Describe avoidant personality disorder and give an example of someone from Harry Potter who fits the description

A

Social inhibition and feelings of personal inadequacy

Neville Longbottom

74
Q

Describe dependent personality disorder and give an example of someone from Harry Potter who fits the description

A

Need to be in care or with people, leading to clinging/submissive behaviour
Ron Weasley

75
Q

Describe obsessive personality disorder and give an example of someone from Harry Potter who fits the description

A

Preoccupation with perfection and orderliness with little flexibility
Dolores Umbridge

76
Q

What is delirium?

A

Acute confusional state with cognitive impairment and fluctuating course

77
Q

List aetiology/risk factors for delirium

A 
Elderly in hospital
Head injury
Infection
Alcohol excess, withdrawal
Sleep deprivation
Unfamiliar environment
Surgery
Drugs (BZD, opioids, anticonvulsants, digoxin, levodopa, illicit drugs)
78
Q

List clinical features of delirium

A 
Inattention
Abnormal perception and mood
Worse at night
Impaired memory
Incoherent speech
Hallucinations
Fear, terror
79
Q

What tool is used to assess delirium?

A

4AT (Alertness, Attention, AMT4 (age, dob, place, year), Acute onset)

80
Q

Outline treatment of delirium

A

Treat underlying cause
Optimise environment and review drugs
Haloperidol/risperidone if severe (oral/IM)
BZD if alcohol withdrawal

81
Q

What is the IQ cut-off for mild learning disability? What would you notice in the patient?

A

IQ between 50 and 70

Useful development of language, LD noticed in school

82
Q

What is the IQ cut-off for moderate learning disability? What would you notice in the patient?

A

IQ between 35 and 49

Most can talk and get by but basic function

83
Q

What is the IQ cut-off for severe learning disability? What would you notice in the patient?

A

IQ between 20 and 34

Limited social activity

84
Q

What is the IQ cut-off for profound learning disability? What would you notice in the patient?

A

IQ less than 20

Simple speech is difficult, need special counselling and schooling

85
Q

List aetiology/risk factors for learning disability

A

Brain trauma
Antenatal trouble (infection, alcohol, hypoxia, hypothyroidism)
Genetics (Down’s, fragile X)

86
Q

List clinical features of learning disability

A 
Sensory/motor disability
Epilepsy
Incontinence
Below expected intellect, struggle at school
Abnormal behaviour in public
87
Q

Outline management of learning disability

A

Speech and language therapy
Support nutrition, care, learning, social areas
Antipsychotic may lower seizure threshold
Behavioural therapy

88
Q

What is attention deficit hyperactivity disorder (ADHD)?

A

Behavioural disorder incorporating triad of inattention, hyperactivity and impulsive behaviour

89
Q

List aetiology/risk factors for ADHD

A

Reduced frontal lobe function
Premature birth
Genetics
Smoking/alcohol during pregnancy

90
Q

List clinical features of ADHD

A 
Unable to focus/listen to detail
Unable to follow instructions or finish tasks
Restlessness
Disorganised
Forgetfulness
Insomnia
Mood disorder
Family stress
91
Q

Outline management of ADHD

A 
Cognitive and behavioural therapy
Parental education
School support
Stimulant drugs (methylphenidate (Ritalin) or dexamfetamine)
Atomoxetine
Antidepressant
TCA
Antipsychotic
92
Q

What is autism spectrum disorder?

A

Lifelong developmental disorder affecting social interaction, communication and behaviour

93
Q

List clinical features of social interaction in autism

A

Unaware of feelings/existence of others (treat people like furniture)
Abnormal response to hurt
Impaired imitation
Lack of empathy

94
Q

List clinical features of communication in autism

A 
Limited facial expressions and gestures
Avoids gaze
No social smiles or babbling in infancy
Stiffens when held, doesn't like to be hugged
Lack of speech
No interest in stories or fantasy play
Repetitive speech
Doesn't pick up on social cues/sarcasm
95
Q

List clinical features of behaviour in autism

A 
Stereotypical movements
Preoccupied with parts of objects
Inflexible thoughts
Distress over changes in environment
Routine
Precision, fixative behaviour
96
Q

What is the criteria for diagnosing autism?

A

6 or more symptoms, including 2 from social interaction, 1 from behaviour, 1 from communication

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