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My Phase 3a cards > Psychiatry > Flashcards

Psychiatry Flashcards

1
Q

How long must symptoms last before you can make a diagnosis of dementia?

A

6 months

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2
Q

What are the cognitive symptoms of Alzheimer’s Disease?

A

Amnesia, Apraxia, Agnosia, Aphasia

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3
Q

What type of amnesia is experienced in Alzheimer’s?

A

Short term memory loss

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4
Q

Define Apraxia, Agnosia

A

Apraxia: Difficulty with motor planning e.g. putting on clothes
Agnosia: inability to interpret sensations and recognise things

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5
Q

What are some non-cognitive symptoms of Alzheimer’s Disease?

A

Psychosis, depression, wandering

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6
Q

What class of drug is used to treat Alzheimer’s Disease?

A

Acetyl Cholinesterase Inhibitors

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7
Q

Name 2 Acetyl Cholinesterase Inhibitors. What condition do they treat?

A

Donepezil and Rivastigmine for Alzheimer’s

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8
Q

What causes Vascular Dementia?

A

Multiple strokes or ischaemic change

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9
Q

What characterises Pick’s disease? (Fronto-temporal Lobe dementia)

A

Personality change

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10
Q

What is the age of onset of Pick’s disease (Frontotemporal Lobe Dementia)

A

Young; age 50-60

There is no licensed treatment

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11
Q

Name the triad of symptoms that occur with Lewy Body Dementia

A
  1. Fluctuating cognitive impairment
  2. Visual Hallucinations
  3. Parkinsonism (also accept REM sleep disturbance)
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12
Q

What drug may be used to curb aggression in Parkinson’s patients?

A

Risperidone (antipsychotic)

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13
Q

What drugs may be used to treat Lewy Body dementia? (Class and example)

A

Acetyl Cholinesterase Inhibitors e.g. Rivastigmine

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14
Q

What is a limitation of the MMSE?

A

It cannot test the frontal lobe

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15
Q

Name 2 tests used in dementia diagnosis/screening.

A
  1. Adenbrooke’s Cognitive Examination

2. Montreal Cognitive Assessment

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16
Q

What physical tests need to be done if you suspect dementia?

A

FBC - to rule out reversible causes
Blood glucose
CT head

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17
Q

What is the recommended alcohol limit?

A

14 units a week (+2 alcohol free days)

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18
Q

What are contraindications to home detox?

A
  1. Previous failed home detox
  2. Unsupportive home environment
  3. Previous delirium tremens
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19
Q

What are the 4 questions of the CAGE questionnaire?

A

c - have you felt like you should cut down on your drinking?
a - do you ever get annoyed when people comment on the amount you drink?
g - do you ever feel guilty about the amount you drink?
e - do you ever have a drink as soon as you wake up?

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20
Q

Describe the features of dependence syndrome.

A
  1. A strong DESIRE to take the substance
  2. Difficulty in CONTROL over substance taking
  3. Biological WITHDRAWAL symptoms
  4. TOLERANCE
  5. NEGLECTING other pleasures
  6. PERSISTING in use despite harmful consequences
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21
Q

Describe the features of Delirium Tremens

A

High fever
Lilliputian hallucinations
Grand mal seizures

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22
Q

What medication may be used to treat withdrawal symptoms during a detox?

A

Chlordiazepoxide

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23
Q

When is chlordiazepoxide indicated?

A

> 20 units of alcohol a day

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24
Q

What drug is given to treat Vitamin B1 deficiency?

A

Thiamine (a.k.a. Vitamin B1!)

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25
Q

What is the triad of symptoms in Wernicke’s Encephalopathy?

A

Confusion
Ataxia
Opthalmoplegia - paralysis of the eye muscles

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26
Q

What may happen if someone has prolonged thiamine deficiency?

A

Wernicke’s Encephalopathy (which leads to Korsakoff’s syndrome)

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27
Q

What drug is used in an acute opioid overdose?

A

Naloxone

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28
Q

How does Naloxone work?

A

Competitively inhibits opioid receptors

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29
Q

Define tolerance

A

when continued use of a drug no longer gives averse reaction OR diminished response to a drug after continued use

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30
Q

Define withdrawal

A

the symptoms which occur after abruptly stopping an addictive substance

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31
Q

What is chlordiazepoxide?

A

Long acting benzodiazipine

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32
Q

What drug may be given to reduce alcohol cravings?

A

Acamprostate calcium, naltrexone

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33
Q

Name a drug that induces sickness when alcohol is drunk

A

Disulfiram

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34
Q

Name 3 positive symptoms of Schizophrenia

A

Delusions, hallucinations, catatonic behaviour

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35
Q

Name 3 negative symptoms of Schizophrenia

A

Anhedonia, flat effect, “alogia” poverty of speech

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36
Q

What are Schneider’s First rank symptoms? Name 3.

A 
Thought Broadcast
3rd person auditory hallucinations
Physical hallucination
Thought withdrawal/insertion
Delusional perception
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37
Q

What is the most common type of schizophrenia? What characterises it

A

Paranoid - delusions and hallucination

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38
Q

What characterises hebephrenic schizophrenia?

A

Negatice symptoms e.g. flat affect, disorganised speech and behaviours, childlike, inappropriate emotion e.g. laughter

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39
Q

What is Schizoaffective disorder?

A

Hallucinations and delusions associated with a mood disorder

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40
Q

What is one mechanism of antipsychotic medication?

A

D2 receptor blocker

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41
Q

Give an example of a D2 receptor blocker

A

Clozapine

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42
Q

What is the main drug treatment for Schizoaffective disorder?

A

Haloperidol

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43
Q

What are 4 symptoms of a manic episode?

A
  1. Delusions of grandeur
  2. Pressure of speech
  3. Racing thoughts
  4. Poor decision making
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44
Q

How long must episodes of depression and mania last to make a diagnosis of Bipolar Disorder?

A

Depression >2 weeks

Mania >1 week

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45
Q

What is distinctive about Bipolar Type 2?

A

Hypomania episodes last at least 4 days

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46
Q

Name and describe the 3rd type of bipolar disorder.

A

Cyclothymia; milder mood changes, cycling over 2 years

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47
Q

Name a MOOD STABILISER used in the treatment of Bipolar

A

Lithium

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48
Q

Name an ANTI-PSYCHOTIC used in the treatment of bipolar disorder

A

Risperidone

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49
Q

Name an ANTI-CONVULSANT used in the treatment of bipolar disorder

A

Sodium Valporate, Lamotrigine

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50
Q

What are risk factors for postpartum depression?

A

Young maternal age
Previous history of depression
Complications during delivery

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51
Q

Name an SSRI contraindicated in pregnancy

A

paroxetine

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52
Q

Name 2 mood stabilisers

A

lithium

valporate

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53
Q

What is the safest mood stabiliser in pregnancy?

A

Lamotrigine

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54
Q

What is the 1st line treatment for panic disorder?

A

SSRI + Benzodiazipine

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55
Q

How long must symptoms last before a PTSD diagnosis can be made?

A

1 month

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56
Q

Name the 4 symptoms of PTSD

A
  1. Flashbacks
  2. Avoidance
  3. Mood disturbance
  4. Hyperarousal
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57
Q

What axis, which may be disturbed in PTSD, is responsible for stress response?

A

Hypothalamic-Pituitary Access

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58
Q

What 2 drugs are licensed for PTSD?

A

Sertraline and paroxetine

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59
Q

What is necessary for a diagnosis of GAD?

A

Anxiety most of the time for 6 months + 4 physical symptoms

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60
Q

Give 4 symptoms of anxiety

A

Palpitations
Sweating
Dry mouth
Sweating

61
Q

1st line treatment for GAD

A

Sertraline

62
Q

Describe the obsessional symptoms of OCD

A

They are from the patients own mind, and cannot be resisted, they are unpleasant

63
Q

How can an OCD diagnosis be made?

A

Obsessions must last >2 weeks AND cause distress/interfere with daily life

64
Q

What is the main treatment for OCD?

A

CBT - exposure and response in a controlled environment

65
Q

What is somatisation disorder?

A

Medically unexplainable physical symptoms

66
Q

How can somatisatoin disorder be diagnosed?

A

> 6 months

Symptoms in 4 places e.g. GI, sexual, neurologic

67
Q

What are the cognitive symptoms of somatisation disorder?

A

Thoughts about death

Worry about health

68
Q

Cluster A personality disorders are linked to higher levels of which mental illness?

A

Schizophrenia

69
Q

What are the 3 cluster A personality disorders?

A
  1. Paranoid
  2. Schizoid
  3. Schizotypal
70
Q

Briefly describe schizoid personality disorder

A

Not interested in social interaction/sex/forming relationships
Exhibit flat affect and emotional blunting
(D for Distant)

71
Q

Briefly Describe the symptoms of Schizotypal personality disorder.

A

Magical thinking, delusions of reference.

Strong desire to have social relationships but cannot maintain them

72
Q

What illnesses are closely linked to Cluster B PDs?

A

Mood disorders and substance misuse

73
Q

Which personality disorder do “psychopaths” have?

A

Antisocial PD

74
Q

What is Linehan’s biosocial model for BPD?

A

Emotionally vulnerable person + invalidating environment

75
Q

People with BPD have problems in 3 main areas:

A
  1. Identifying and labelling emotion
  2. coping skills
  3. Emotion modulation
76
Q

What is the main treatment for BPD?

A

Dialectical Behavioural Therapy

77
Q

What are the 4 cluster B personality disorders?

A

Antisocial, Narcissistic, Histrionic and Borderline

78
Q

What characterises histrionic personality disorder?

A

Lying, attention seeking, telling dramatised stories

79
Q

What illness has a genetic link with cluster C PDs?

A

Anxiety disorders

80
Q

What is a “Section 12 approved doctor”?

A

A doctor who has worked in psychiatry for at least 6 months - needed for a section 2 and 3

81
Q

How long does a section 2 last?

A

28 days

82
Q

What is the purpose of a section 2?

A

Assessment

83
Q

Who is usually the Advanced Mental Health Practitioner?

A

A social worker

84
Q

Who is needed to section someone under a section 2?

A

1 doctor, 1 S12 approved doctor and an AMHP

85
Q

How long does a section 3 last?

A

6 months

86
Q

What is the purpose of a section 3?

A

Treatment

87
Q

Which sections require 2 doctors and an AMHP to enact?

A

Section 2, 3

88
Q

What would you do if there was no Section 12 approved doctor in an emergency?

A

Section tthe patient under Section 4 (emergency order) only a doctor and an AMHP required

89
Q

How long does a section 4 last?

A

72 hours

90
Q

Who is a section 5(2) for?

A

Patients already in a psychiatric ward

91
Q

Which sections last only 72 hours?

A

Section 4 (emergency) and 5(2)

92
Q

Can someone be coercively treated under a section 5(2) or 5(4)?

A

No

93
Q

What are sections 135/136?

A

Police sections.
135 = person in a public place suspected of having a mental illness
136 = patient may need to move away from home into a place of safety e.g. psychiatric unit

94
Q

How long does a section 5(4) last? What is it?

A

6 hours

Nursing holding power over patient already in a psychiatric unit

95
Q

Which drugs cause Extra Pyramidal Side Effects (EPSEs)?

A

D2 receptor blockers (antipsychotics)

96
Q

What are the 4 groups of EPSEs?

A
  1. Tardive Dyskinesia
  2. Akathisia
  3. Acute Dystonia
  4. Pseudoparkinsonism
97
Q

What is acute dystonia?

A

Muscle spasms of the eyes, face, neck and back - causing tongue protrusion, eye rolling and grimace

98
Q

What is torticolis? Immitate it.

A

Acute dystonia: Neck spasm, look up and to the side

99
Q

What is akathisia?

A

Restlessness, inability to stay still

100
Q

What is tardive dyskinesia?

A

Involuntary facial movements:

  • grimacing
  • tongue protruding
  • lip smacking
101
Q

Where is dopamine made?

A

Substantia nigra

102
Q

Where is serotonin made?

A

Raphe nucleus

103
Q

What are antipsychotics NOT good at?

A

Improving the negative symptoms of Schizophrenia e.g. blunt affect

104
Q

How long should antipsychotic treatment be continued for?

A

2 Years

105
Q

How can you treat parkinsonism, dystonia and akathisia

A

anti-cholinergic drugs e.g. Procyclidine

106
Q

Give an example of a Tricyclic antidepressant?

A

Amitriptyline

107
Q

What class of drug is mirtazipine?

A

NaSSA: Noradrenergic and specific serotonergic antidepressant

108
Q

What are the side effects of TCAs?

A
  1. Anticholinergic: Fever, dry mouth, constipation
  2. Weight gain and sedation
  3. Postural hypotension
109
Q

What drug would you use in a depressed 17 year old at high risk of overdose?

A

Fluoxetine

110
Q

What effect might TCAs e.g. amitriptyline have on the heart?

A

Cardiotoxic - prolonged QT, contraindicated in those who have had a recent heart attack

111
Q

What are the 4 mood stabilisers?

A

Lithium
Lamotrigine
Sodium Valproate
Carbamazepine

112
Q

Which mood stabiliser is used as a prophylaxis fro depressive episodes in bipolar?

A

Lamotrigine

113
Q

Which epilepsy drugs may also be used as mood stabilisers?

A

Lamotrigine, Carbamazepine and Valproate

114
Q

Which mood stabiliser has a narrow therapeutic index?

A

Lithium

115
Q

Which routine investigations should be done before commencing lithium?

A

FBC, U&E, TFT, Pregnancy test and ECG

116
Q

What might you see on an ECG of someone taking lithium?

A

T Wave flattening

117
Q

What abnormality would you see in a blood test in a patient taking carbamazepine or valproate?

A

Deranged LFTs/raised liver enzymes

118
Q

What are 2 other potential complications of carbamazepine and valproate?

A

Increased bleeding time, thrombocytopenia

119
Q

What is the main risk with Lamotrigine?

A

Steven-Johnson syndrome: disease of mucous membranes

120
Q

Name a Typical antipsychotic

A

Haloperidol

121
Q

Name 4 atypical antipsychotics:

A

Clozapine
Respiridone
Olanzapine
Quetiapine

122
Q

Give examples of anti-cholinergic side effects, and drugs which cause them

A

Dry mouth, constipation, sweating

TCAs, the antipsychotics

123
Q

What are the anti-histaminergic side effects?

A

Weight gain and sedation

124
Q

What is metabolic syndrome?

A
  1. Diabetes
  2. Obesity
  3. Hypertension
  4. Hyperlipidaemia
125
Q

Which drugs cause metabolic syndrome?

A

Atypical antipsychotics

126
Q

Why is clozapine reserved as 3rd line treatment for psychosis?

A
  1. Cardiomyopathy
  2. Agranulocytosis
  3. Myocarditis
127
Q

How would you monitor a patient on clozapine?

A

Monthly full blood count - risk of low neutrophils (agranulocytosis)

128
Q

When might neuroleptic malignant syndrome develop?

A

4-11 days after commencing an antipsychotic

129
Q

What are the 4 symptoms of neuroleptic malignant syndrome?

A
  1. Fever
  2. Lead pipe body
  3. Altered mental state
  4. Autonomic dysfunction
130
Q

What drug is used to treat Neuroleptic Malignant Syndrome?

A

Bromocriptine

131
Q

What drug is used to treat serotonin syndrome?

A

Cyproheptadine

132
Q

How fast is the onset of serotonin syndrome?

A

Acute - 1 to 2 doses

133
Q

Describe some symptoms of serotonin syndrome

A

tremor, hyperreflexia, clonus

134
Q

Give 4 symptoms of lithium toxicity

A

dysarthria, ataxia, tremor and vomiting

135
Q

How do benzodiazepines work?

A

Open GABA channels, increase activity of GABA

136
Q

When is ECT indicated for depression?

A

Very severe, suicide risk, stupor, treatment resistant

137
Q

What are the main adverse effects of ECT?

A

Amnesia, prolonged seizure

138
Q

What drug can be used to treat tardive dyskinesia? (Involuntary tongue movements and grimacing?

A

Tetrabenazine

139
Q

What symptoms are present in schizoid personality disorder?

A

The negative symptoms of schizophrenia

140
Q

Which atypical antipsychotic has the most tolerable side-effect profile?

A

Aripiprazole

141
Q

What may happen to a foetus if the mother is taking an SSRI?

A

They may get persistant pulmonary hypertension syndrome

142
Q

What is the mechanism of action of venlafaxine?

A

SNRI

143
Q

What are 2 major complications of atypical antipsychotics in the elderly population

A

Sroke and VTE

144
Q

Define Illusion

A

misconception of a sensory stimulus (e.g. thinking a coat hanger with a coat on it is a person) these are normal

145
Q

Define Hallucination

A

experience in the absence of a stimulus

146
Q

What are hypnopompic and hypnogogic hallucinations?

A 
pompic = hallucination as you wake up
gogic = hallucination as you go to sleep
147
Q

Define reflex hallucination

A

When the stimulus provokes a hallucination in a different modality e.g. something audible provoking a physical sensation “when you write, I can hear your pen on my heart”

148
Q

Extracampine hallucination

A

An impossible hallucination, “I can hear someone talking to me from Australia”

149
Q

Delusions

A

A belief held strongly despite being contradicted by reality

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