Psychiatry Flashcards
What are the symptoms of benzodiazepine withdrawal?
- Insomina
- Irritability
- Anxiety
- Tremor
- Loss of appetite
- Tinnitus
- Perspiration
- Perceptual disturbances
- Seizures
What is neologism?
Inventing words, or using a recognised word in the wrong context. Can be a feature of schizophrenia
What is the minimum duration for a depressive episode?
2 weeks
What is perseveration?
Repeating the same words/answers
What is echolalia?
Repeating exactly what someone has said
What is word salad?
Disorganised speech, sentences that do not make sense.
What is clang speech?
Using rhyming words
Describe antisocial personality disorder?
- Failure to conform to social norms with respect to lawful behavior
- Deception - repeatedly lying, use of aliases or conning others for personal profit or pleasure
- Impulsiveness
- Irritatibily and aggressiveness
- Reckless disregard for safety of self or others
- Lack of remorse
- Consistent irresponsibility
Describe the features of avoidant personality disorder?
- Avoidance of occupational activities which involve signifiant interpersonal contact due to fears of criticism or rejection
- Unwillingness to be involved unless certain of being liked
- Preoccupation with ideas that they are being criticised or rejected in social situations
- Restraint in intimate relationships due to the fear of being ridiculed
- Reluctance to take personal risks due to fears of embarrassment
- Views self as inept and inferior to others
- Social isolation accompanied by a craving for social contact
Describe the features of borderline personality disorder?
- Efforts to avoid real or imagined abandonment
- Unstable interpersonal relationships which alternate between idealisation and devaulation
- Unstable self image
- Impulsitiviy in potentially self-damaging area (spending, sex, substance abuse)
- Recurrent suicidal behaviour
- Affective instability
- Chronic feelings of emptiness
- Difficulty controlling temper
Describe the features of dependent personality disorder?
- Difficulty making everyday decisions without excessive reassurance from others
- Need for others to assume responsibility for major areas of their life
- Difficulty in expressing disagreement with other due to fears of losing support
- Lack of initiative
- Unrealistic fears of being left to care for themselves
- Urgent search for another relationship as a source of care and support when one ends
- Extensive efforts to obtain support from others
Describe the features of histrionic personality disorder?
- Inappropriate sexual seductiveness
- Ned to be the centre of attention
- Rapidly shifting and shallow expression of emotions
- Suggestibillity
- Physical appearance used for attention seeking purposes
- Impressionistic speech lacking detail
- Self dramatisation
- Relationships considered to be more intimate than they are
What are the features of narcissistic personality disorder?
- Grandiose sense of self importance
- Preoccupation with fantasies of unlimited success, power, or beauty
- Sense of entitlement
- Taking advantage of others to achieve own needs
- Lack of empathy
- Excessive need for admiration
- Chronic envy
- Arrogant and haughty attitude
What are the features of paranoid personality disorder?
- Hypersensitivity and an unforgiving attitude when insulted
- Unwarranted tendency to question the loyalty of friends
- Reluctance to confide in others
- Preoccupation with conspirational beliefs and hidden meaning
- Unwarranted tendency to perceive attacks on their character.
What are the features of schizoid personality disorder?
- Indifference to praise and criticism
- Preference for solitary activities
- Lack of interest in sexual interactions
- Lack of desire for companionship
- Emotional coldness
- Few interests
- Few friends or confidants other than family
What are the features of schizotypal personality disorder?
- Ideas of reference (differ from delusions in that some insight is retained)
- Odd beliefs and magical thinking
- Unusual perceptual disturbances
- Paranoid ideation and suspiciousness
- Odd, eccentric behaviour
- Lack of close friends other than family members
- Inappropriate affect
- Odd speech without being incoherent
In alcohol withdrawal, when would you:
- Start experiencing symptoms
- Seizures
- Delirium tremens
Symptoms: 6-12 hours
Seziures: 36 hours
Delirium tremens: 72 hours
What is the first-line mx of alcohol withdrawal?
Benzo’s, eg. chlordiazepoxide
Name a screening tool in assessing depression?
PHQ-9
What is the risk of developing schizophrenia if:
- Monozygotic twin affected
- Parent affected
- Sibling affected
- No relatives affected
- Monozygotic twin affected: 50%
- Parent affected: 10-15%
- Sibling affected: 10%
- No relatives affected: 1%
Other than family history, what are the risk factors for psychotic disorders?
- Black Caribbean
- Migration
- Urban environment
- Cannabis use
What is (S)omatisation disorder?
- Multiple physical (S)YMPTOMS present for at least 2 years
- Refuses to accept reassurance or negative test results
What is hypo(C)hondrial disorder?
- Persistent belief in the presence of an underlying serious DISEASE, e.g. (C)ancer
- Patient again refuses to accept reassurance or negative test results
What is conversion disorder?
- Typically involves loss of motor or sensory function
the patient doesn’t consciously feign the symptoms (factitious disorder) or seek material gain (malingering) - Patients may be indifferent to their apparent disorder - la belle indifference - although this has not been backed up by some studies
What is dissociative disorder?
Dissociation is a process of ‘separating off’ certain memories from normal consciousness
- In contrast to conversion disorder involves psychiatric symptoms e.g. Amnesia, fugue, stupor
- Dissociative identity disorder (DID) is the new term for multiple personality disorder as is the most severe form of dissociative disorder
What are the symptoms of SSRI discontinuation?
Which drug is particularly high incidence?
Paroxetine
- Increased mood change
- Restlessness
- Difficulty sleeping
- Unsteadiness
- Sweathing
- GI symptoms
- Paraesthesia
What drugs interact with SSRIs?
- NSAIDs (if necessary, co-prescribe a PPI)
- Warfarin/heparin - Avoid SSRIs and consider mirtazapine
- Aspirin
- Triptans
What is post-concussion syndrome? Features?
Seen after even minor head trauma
- Headache
- Fatigue
- Anxiety/depression
- Dizziness
What is the SSRI of choice in children and adolescents?
Fluoxetine
What is the mechanism of action of benzodiazepines?
Enhance the effect of (inhibatory) GABA by increasing the FREQUENCY of chloride channels.
What is the mechanism of action of barbiturates?
Enhance the effect of (inhibatory) GABA by increasing the DURATION of chloride channels
Why would you avoid prescription of antipsychotics in the elderly?
Increased risk of stroke and VTE
What is the first-line drug treatment in GAD?
SSRI - Sertraline
What are the common side-effects of TCAs?
- Drowsiness
- Dry mouth
- Blurred vision
- Constipation
- Urinary retention
If a patient makes a good response to antidepressant therapy how long should they continue on it? Why?
6 months after remission
Reduces the risk of relapse
NB. Gradually reduce dose over 4 weeks (Not necessary with fluoxetine)
What investigation is important to rule out organic causes in new, sudden onset psychosis in elderly patients?
CT head - exclude tumour, stroke or CNS infection
What are the adverse effects of atypical antipsychotics? (NB. first-line in schizophrenia, e.g. clozapine)
Weight gain
Clozapine - Agranulocytosis
Elderly patients: Stroke (esp olanzapine and risperidone), VTE
What are hypnogogic and hypnopompic hallucinations?
Hypnogogic: Occurring from wakefulness to sleeping
Hypnopompic: occurring from sleeping to waking
Give 4 risk factors and 2 protective factors for the development of GAD?
4 RF:
- Aged 35-54
- Being divorced or separated
- Living alone
- Being a lone parent
Protective:
- Aged 16-24
- Being married or cohabiting
What two tricyclics are most dangerous in overdose?
- Amitriptyline
- Dosulepin (dothiepin)
