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4th Year Key Summaries > Psychiatry > Flashcards

Psychiatry Flashcards

1
Q

Diagnostic criteria for schizophrenia

A

DEAD
D - disorders of thought possession (insertion, withdrawal, broadcasting)
E - experiences of passivity (other people are controlling their thoughts or impulses - passivity phenomenon)
A - auditory hallucinations (thought echo, running commentary, being constantly referred to in the third person)
D - delusions that persist (culturally inappropriate)

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2
Q

Negative schizophernia symptoms

A

LESS
L - loss of volition, underactivity and social withdrawal
E - emotional flatness, lose normal modulation of mood
S - speech is reduced, monosyllabic if at all
S - slowness of movement

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3
Q

Objective signs of opioid withdrawal

A 
Watering eyes
Dilated pupils
Rhinorrhoea
Agitiation
Perspiration
Respiratory depression
Piloerection
Tachycardia
Vomiting
Shivering
Yawning
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4
Q

Signs of depression

A

SLUMP
S - suicidal ideation or plans
L - lack of interest, enjoyment (anhedonia), energy, appetite or libido
U - unworthiness
M - morning wakening - EARLY
P - poor concentration, psychomotor retardation or agitation

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5
Q

First line psychological therapy for PTSD

A

CBT

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6
Q

Three core features of ADHD

A

Inattention/distractibility
Hyperactivity
Impulsivity

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7
Q

Diagnostic criteria of depression (not symptoms)

A

Symptoms present for most of every day for at least 2 weeks. NO MANIC OR HYPOMANIC EPISODES IN LIFETIME. Not attributable to neurological disease or substance use/abuse

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8
Q

Differential diagnosis of depression

9+

A 
Normal response
SAD
Dysthymia
Cyclothymia
BPD
Stroke/tumour/trauma
Endocrine - hypothyroid, addisons, hyperpara
Infection
Iatrogenic
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9
Q

Three core symptoms of depression

A

Low mood
Anhedonia
Fatigue

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10
Q

Additional symptoms of depression

A 
Loss of concentration
Poor memory
Sleep disturbance
Suicidal ideation
Appetite loss
Weight loss
Unreasonable guilt
Loss of confidence 
Psychomotor retardation
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11
Q

Criteria for mild, moderate and severe dementia

A

Mild - 2 core 2 additional
Mod - 2 core 4 additional
Sev - 3 core 4 additional, or any psychotic symptoms

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12
Q

Difference between acute stress disorder and PTSD

A

PTSD in symptoms persist longer than 1 month

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13
Q

First line treatment for bipolar disorder

A

Lithium

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14
Q

SSRI of choice in young people and children

A

Fluoxetine

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15
Q

Drugs which increase VTE and stroke risk in the elderly

A

Antipsychotics

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16
Q

Psychotic symptoms which differentiate mania from hypomania

A

Delusions of grandeur

Auditory hallucinations

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17
Q

Side effects of antipsychotics

A 
Parkinsonism
Acute dystonia
Akathsia 
Tardive dyskinesia
Antimuscarinic - dry mouth, blurred vision, urinary retention, constipation
Sedation
Weight gain
Prolonged QT
Neuroleptic malignant syndrome
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18
Q

Common side effects of TCAs

A 
Dry mouth
Drowsiness
Blurred vision
Constipation
Urinary retention
Long QT in overdose
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19
Q

Common SSRI side effects

A

GI upset
RIsk of GI blues - give PPI if also on NSAID
Anxiety/agitation
Drug interactions

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20
Q

Four groups of first rank symptoms in schizophrenia (ABCD)

A

Auditory hallucination
Broadcasting of thought
Controlled thought (passivity phenomena)
Delusional perceptions

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21
Q

Monozygotic concordance for schizophrenia

A

50%

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22
Q

Define mania

A

Pathological, inappropriate elevated mood

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23
Q

Does mania generally disrupt work/responsibilities? Does hypomania

A

Yes and no

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24
Q

Mania treatment

A

Antipsychotics
Mood stabilisers
Lithium
ECT

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25
Q

Tests before prescribing lithium

A

U&Es
TSH
Pregnancy test
Creatinine

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26
Q

Lithium side effects

A 
Reduced appetite
Nausea
Diarrhoea
THyroid abnormalities
Polyuria/polydypsia
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27
Q

Main danger with lithium and quantify

A

Toxicity
Mild - 1.5-2.0 - vomiting, diarrhoea, ataxia, diziness
Mod - 2.0-2.5 - blurred vision, delirium, convulsion, syncope
Sev - >2.5 - generalised convulsions, oliguria, renal failure

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28
Q

3 anticonvulsants used

A

Valproic acid
Carbamazepine
Lamotrigine

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29
Q

Side effects of valproate

A 
Thrombocytopaenia
Platelet dysfunction
Nausea
Vomiting 
Weight loss
30
Q

3 general drugs/classes which lengthen QT interval

A

Amiodarone
Ciprofloxacin
Antipsychotics

31
Q

3 general drugs/classes which cause parkinsonism

A

Metaclopramide

Antipsychotics

32
Q

Order for long term treatment

A

Compulsory treatment order

33
Q

Who can grant a compulsory treatment order

A

Mental health tribunal

34
Q

Length of short term detention order

A

Up to 28 days

35
Q

Required grounds for compulsory treatment order

A

Disorder significantly impairs decision making

Lack of long term treatment would cause serious deterioration

36
Q

Grounds for short term detention order

A

Significant risk to own or others health if not detained in hospital

37
Q

Who can grant a short term detention order

A

Approved medical practitioner

38
Q

Length of emergency detention order

A

Up to 72 hours

39
Q

Grounds for emergency detention order

A

Mental disorder demonstrably present

Decision making impaired

40
Q

Who can grant an emergency detention order

A

Any medical practitioner

41
Q

Treatment for alcohol withdrawal state and two key risks

A

Benzodiazapines - addiction and respiratory depression when used with alcohol

42
Q

Act under which detention/treatment orders can be granted

A

Mental Health, Care and Treatment (Scotland) Act 2003

43
Q

Define psychosis

A

Severe forms of mental illness which are characterised by a lack of insight. Represents an inability to distinguish between symptoms of delusion, hallucination and disordered thinking from reality

44
Q

Psychotic manifestations

A

Hallucinations

Delusional beliefs

45
Q

Most common cause of psychosis

A

Schizophrenia

46
Q

Positive symptoms in schizophrenia

A

Delusions
Hallucinations
Disordered thinking

  • those symptoms which appear to represent an excess or distortion of normal functions
47
Q

Diagnostic criteria for schizophrenia

A 
Two or more of the following:
Delusions
Hallucinations
Disordered speech
Disorganised/catatonic behaviour
Negative symptoms

Occurring for at least 1 month and with a functional decline of 6 months or more

Do not occur concurrently with substance abuse or a mood disorder episode

48
Q

What are the two major affective psychoses

A

Depressive episode with psychotic symptoms

  • delusions of guilt, worthlessness and persecution
  • derogatory auditory hallucinations

Manic episode with psychotic symptoms

  • delusions of grandeur, super powers etc
  • gross over-activity, irritability and behavioural disturbance, manic excitement
49
Q

Percentage recovery after first episode of psychosis

A

80

50
Q

Good prognostic factors in schizophrenia

A 
Absence of family history
Clear precipitating event
Sudden onset
Mood disturbance
Prompt treatment
51
Q

Poor prognostic factors in schizophrenia

A 
Slow, insidious onset
Persistence of negative symptoms
Family history
Parental substance abuse
Onset in childhood
52
Q

How to remember the personality clusters

A

A- weird
B- wild
C- worried

53
Q

Cluster A PDs

A

Paranoid
Schizoid
Schizoidal

54
Q

Cluster B PDs

A

Borderline
Antisocial
Narcissistic
Histrionic

55
Q

Cluster C PDs

A

Avoidant
Dependent
Obsessive-compulsive

56
Q

Key therapies for GAD

A

SSRIs

TCAs

57
Q

Key therapies for OCD

A

SSRIs

TCAs

58
Q

Key treatments for PTSD

A

Trauma focused CBT

SSRI/TCA

59
Q

3 pillars of ADHD

A

Hyperactivity
Impulsivity
Distractibility

60
Q

How many PDs

A

10

61
Q

ABCD of dementia

A

A - activities of daily living
B - behavioural and psychiatric symptoms of dementia
C - cognitive impairment
D - decline

62
Q

What is a key thing to obtain in assessing a patient for dementia

A

A collateral history

63
Q

Most common form of dementia

A

Alzheimers 60%

64
Q

Cognitive scoring systems

A

MMSE

MOCA

65
Q

Drug treatment for Alzheimer’s dementia - mild to mod and mod to sev, effects

A

Mild-mod: Anticholinesterase inhibitors

  • donezepil
  • rivagstigmine
  • galantamine

Slow decline and improve non-cognitive symptoms but do not halt progression

Mod-sev: Memantine

66
Q

Signs of Alzheimer’s dementia

A 
Recent memory loss
Executive function changes
Word finding and naming difficulties
Confusion
Getting lost, disorientation
Misplacing things
67
Q

Signs of Lewy Body dementia

A

Vivid visual hallucinations
Autonomic instability
Parkinson’s features (shuffling gait, bradykinesia, and falls)

Rapid eye movement sleep disorder may be present

68
Q

Signs of vascular dementia

A 
Often described as stepwise progression
Look for history of atherosclerotic/cardioembolic disease
May closely follow stroke
Slowed processing
Disinhibition
Behaviour preservation
Difficulty initiating movement
69
Q

Risk factors for suicide

A 
Older age
Male gender
Mental illness
Co-morbid physical illness
Chronic pain
Use of drugs or alcohol
Social isolation
Previous suicidal behaviour
High lethality of method used (& ongoing availability of method)
Physical and sexual abuse
70
Q

Indicators of a serious suicide attempt

A 
Use of violent means
e.g. hanging, jumping from a height
They thought it would kill them
They planned to do it in advance
e.g. making a will, leaving a suicide note
They were unlikely to be discovered
Alcohol or illicit drugs involved
(increases chance of death, but person less likely to have intended to die)
No obvious precipitant
e.g. argument with partner
71
Q

Treatment options for depression

A

Antidepressants
ECT
CBT
IPT

72
Q

Drug often used in treatment resistant schizophrenia and its class

A

Clozapine - atypical antipsychotic

4th Year Key Summaries (5 decks)

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