Psychiatry Flashcards
1
Q
How long must symptoms last before you can make a diagnosis of dementia?
A
6 months
2
Q
What are the cognitive symptoms of Alzheimer’s Disease?
A
Amnesia, Apraxia, Agnosia, Aphasia
3
Q
What type of amnesia is experienced in Alzheimer’s?
A
Short term memory loss
4
Q
Define Apraxia, Agnosia
A
Apraxia: Difficulty with motor planning e.g. putting on clothes
Agnosia: inability to interpret sensations and recognise things
5
Q
What are some non-cognitive symptoms of Alzheimer’s Disease?
A
Psychosis, depression, wandering
6
Q
What class of drug is used to treat Alzheimer’s Disease?
A
Acetyl Cholinesterase Inhibitors
7
Q
Name 2 Acetyl Cholinesterase Inhibitors. What condition do they treat?
A
Donepezil and Rivastigmine for Alzheimer’s
8
Q
What causes Vascular Dementia?
A
Multiple strokes or ischaemic change
9
Q
What characterises Pick’s disease? (Fronto-temporal Lobe dementia)
A
Personality change
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
11
Q
Name the triad of symptoms that occur with Lewy Body Dementia
A
- Fluctuating cognitive impairment
- Visual Hallucinations
- Parkinsonism (also accept REM sleep disturbance)
12
Q
What drug may be used to curb aggression in Parkinson’s patients?
A
Risperidone (antipsychotic)
13
Q
What drugs may be used to treat Lewy Body dementia? (Class and example)
A
Acetyl Cholinesterase Inhibitors e.g. Rivastigmine
14
Q
What is a limitation of the MMSE?
A
It cannot test the frontal lobe
15
Q
Name 2 tests used in dementia diagnosis/screening.
A
- Adenbrooke’s Cognitive Examination
2. Montreal Cognitive Assessment
16
Q
What physical tests need to be done if you suspect dementia?
A
FBC - to rule out reversible causes
Blood glucose
CT head
17
Q
What is the recommended alcohol limit?
A
14 units a week (+2 alcohol free days)
18
Q
What are contraindications to home detox?
A
- Previous failed home detox
- Unsupportive home environment
- Previous delirium tremens
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?
20
Q
Describe the features of dependence syndrome.
A
- A strong DESIRE to take the substance
- Difficulty in CONTROL over substance taking
- Biological WITHDRAWAL symptoms
- TOLERANCE
- NEGLECTING other pleasures
- PERSISTING in use despite harmful consequences
21
Q
Describe the features of Delirium Tremens
A
High fever
Lilliputian hallucinations
Grand mal seizures
22
Q
What medication may be used to treat withdrawal symptoms during a detox?
A
Chlordiazepoxide
23
Q
When is chlordiazepoxide indicated?
A
> 20 units of alcohol a day
24
Q
What drug is given to treat Vitamin B1 deficiency?
A
Thiamine (a.k.a. Vitamin B1!)
25
What is the triad of symptoms in Wernicke's Encephalopathy?
Confusion
Ataxia
Opthalmoplegia - paralysis of the eye muscles
26
What may happen if someone has prolonged thiamine deficiency?
Wernicke's Encephalopathy (which leads to Korsakoff's syndrome)
27
What drug is used in an acute opioid overdose?
Naloxone
28
How does Naloxone work?
Competitively inhibits opioid receptors
29
Define tolerance
when continued use of a drug no longer gives averse reaction OR diminished response to a drug after continued use
30
Define withdrawal
the symptoms which occur after abruptly stopping an addictive substance
31
What is chlordiazepoxide?
Long acting benzodiazipine
32
What drug may be given to reduce alcohol cravings?
Acamprostate calcium, naltrexone
33
Name a drug that induces sickness when alcohol is drunk
Disulfiram
34
Name 3 positive symptoms of Schizophrenia
Delusions, hallucinations, catatonic behaviour
35
Name 3 negative symptoms of Schizophrenia
Anhedonia, flat effect, "alogia" poverty of speech
36
What are Schneider's First rank symptoms? Name 3.
```
Thought Broadcast
3rd person auditory hallucinations
Physical hallucination
Thought withdrawal/insertion
Delusional perception
```
37
What is the most common type of schizophrenia? What characterises it
Paranoid - delusions and hallucination
38
What characterises hebephrenic schizophrenia?
Negatice symptoms e.g. flat affect, disorganised speech and behaviours, childlike, inappropriate emotion e.g. laughter
39
What is Schizoaffective disorder?
Hallucinations and delusions associated with a mood disorder
40
What is one mechanism of antipsychotic medication?
D2 receptor blocker
41
Give an example of a D2 receptor blocker
Clozapine
42
What is the main drug treatment for Schizoaffective disorder?
Haloperidol
43
What are 4 symptoms of a manic episode?
1. Delusions of grandeur
2. Pressure of speech
3. Racing thoughts
4. Poor decision making
44
How long must episodes of depression and mania last to make a diagnosis of Bipolar Disorder?
Depression >2 weeks
| Mania >1 week
45
What is distinctive about Bipolar Type 2?
Hypomania episodes last at least 4 days
46
Name and describe the 3rd type of bipolar disorder.
Cyclothymia; milder mood changes, cycling over 2 years
47
Name a MOOD STABILISER used in the treatment of Bipolar
Lithium
48
Name an ANTI-PSYCHOTIC used in the treatment of bipolar disorder
Risperidone
49
Name an ANTI-CONVULSANT used in the treatment of bipolar disorder
Sodium Valporate, Lamotrigine
50
What are risk factors for postpartum depression?
Young maternal age
Previous history of depression
Complications during delivery
51
Name an SSRI contraindicated in pregnancy
paroxetine
52
Name 2 mood stabilisers
lithium
| valporate
53
What is the safest mood stabiliser in pregnancy?
Lamotrigine
54
What is the 1st line treatment for panic disorder?
SSRI + Benzodiazipine
55
How long must symptoms last before a PTSD diagnosis can be made?
1 month
56
Name the 4 symptoms of PTSD
1. Flashbacks
2. Avoidance
3. Mood disturbance
4. Hyperarousal
57
What axis, which may be disturbed in PTSD, is responsible for stress response?
Hypothalamic-Pituitary Access
58
What 2 drugs are licensed for PTSD?
Sertraline and paroxetine
59
What is necessary for a diagnosis of GAD?
Anxiety most of the time for 6 months + 4 physical symptoms
60
Give 4 symptoms of anxiety
Palpitations
Sweating
Dry mouth
Sweating
61
1st line treatment for GAD
Sertraline
62
Describe the obsessional symptoms of OCD
They are from the patients own mind, and cannot be resisted, they are unpleasant
63
How can an OCD diagnosis be made?
Obsessions must last >2 weeks AND cause distress/interfere with daily life
64
What is the main treatment for OCD?
CBT - exposure and response in a controlled environment
65
What is somatisation disorder?
Medically unexplainable physical symptoms
66
How can somatisatoin disorder be diagnosed?
> 6 months
| Symptoms in 4 places e.g. GI, sexual, neurologic
67
What are the cognitive symptoms of somatisation disorder?
Thoughts about death
| Worry about health
68
Cluster A personality disorders are linked to higher levels of which mental illness?
Schizophrenia
69
What are the 3 cluster A personality disorders?
1. Paranoid
2. Schizoid
3. Schizotypal
70
Briefly describe schizoid personality disorder
Not interested in social interaction/sex/forming relationships
Exhibit flat affect and emotional blunting
(D for Distant)
71
Briefly Describe the symptoms of Schizotypal personality disorder.
Magical thinking, delusions of reference.
| Strong desire to have social relationships but cannot maintain them
72
What illnesses are closely linked to Cluster B PDs?
Mood disorders and substance misuse
73
Which personality disorder do "psychopaths" have?
Antisocial PD
74
What is Linehan's biosocial model for BPD?
Emotionally vulnerable person + invalidating environment
75
People with BPD have problems in 3 main areas:
1. Identifying and labelling emotion
2. coping skills
3. Emotion modulation
76
What is the main treatment for BPD?
Dialectical Behavioural Therapy
77
What are the 4 cluster B personality disorders?
Antisocial, Narcissistic, Histrionic and Borderline
78
What characterises histrionic personality disorder?
Lying, attention seeking, telling dramatised stories
79
What illness has a genetic link with cluster C PDs?
Anxiety disorders
80
What is a "Section 12 approved doctor"?
A doctor who has worked in psychiatry for at least 6 months - needed for a section 2 and 3
81
How long does a section 2 last?
28 days
82
What is the purpose of a section 2?
Assessment
83
Who is usually the Advanced Mental Health Practitioner?
A social worker
84
Who is needed to section someone under a section 2?
1 doctor, 1 S12 approved doctor and an AMHP
85
How long does a section 3 last?
6 months
86
What is the purpose of a section 3?
Treatment
87
Which sections require 2 doctors and an AMHP to enact?
Section 2, 3
88
What would you do if there was no Section 12 approved doctor in an emergency?
Section tthe patient under Section 4 (emergency order) only a doctor and an AMHP required
89
How long does a section 4 last?
72 hours
90
Who is a section 5(2) for?
Patients already in a psychiatric ward
91
Which sections last only 72 hours?
Section 4 (emergency) and 5(2)
92
Can someone be coercively treated under a section 5(2) or 5(4)?
No
93
What are sections 135/136?
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
How long does a section 5(4) last? What is it?
6 hours
| Nursing holding power over patient already in a psychiatric unit
95
Which drugs cause Extra Pyramidal Side Effects (EPSEs)?
D2 receptor blockers (antipsychotics)
96
What are the 4 groups of EPSEs?
1. Tardive Dyskinesia
2. Akathisia
3. Acute Dystonia
4. Pseudoparkinsonism
97
What is acute dystonia?
Muscle spasms of the eyes, face, neck and back - causing tongue protrusion, eye rolling and grimace
98
What is torticolis? Immitate it.
Acute dystonia: Neck spasm, look up and to the side
99
What is akathisia?
Restlessness, inability to stay still
100
What is tardive dyskinesia?
Involuntary facial movements:
- grimacing
- tongue protruding
- lip smacking
101
Where is dopamine made?
Substantia nigra
102
Where is serotonin made?
Raphe nucleus
103
What are antipsychotics NOT good at?
Improving the negative symptoms of Schizophrenia e.g. blunt affect
104
How long should antipsychotic treatment be continued for?
2 Years
105
How can you treat parkinsonism, dystonia and akathisia
anti-cholinergic drugs e.g. Procyclidine
106
Give an example of a Tricyclic antidepressant?
Amitriptyline
107
What class of drug is mirtazipine?
NaSSA: Noradrenergic and specific serotonergic antidepressant
108
What are the side effects of TCAs?
1. Anticholinergic: Fever, dry mouth, constipation
2. Weight gain and sedation
3. Postural hypotension
109
What drug would you use in a depressed 17 year old at high risk of overdose?
Fluoxetine
110
What effect might TCAs e.g. amitriptyline have on the heart?
Cardiotoxic - prolonged QT, contraindicated in those who have had a recent heart attack
111
What are the 4 mood stabilisers?
Lithium
Lamotrigine
Sodium Valproate
Carbamazepine
112
Which mood stabiliser is used as a prophylaxis fro depressive episodes in bipolar?
Lamotrigine
113
Which epilepsy drugs may also be used as mood stabilisers?
Lamotrigine, Carbamazepine and Valproate
114
Which mood stabiliser has a narrow therapeutic index?
Lithium
115
Which routine investigations should be done before commencing lithium?
FBC, U&E, TFT, Pregnancy test and ECG
116
What might you see on an ECG of someone taking lithium?
T Wave flattening
117
What abnormality would you see in a blood test in a patient taking carbamazepine or valproate?
Deranged LFTs/raised liver enzymes
118
What are 2 other potential complications of carbamazepine and valproate?
Increased bleeding time, thrombocytopenia
119
What is the main risk with Lamotrigine?
Steven-Johnson syndrome: disease of mucous membranes
120
Name a Typical antipsychotic
Haloperidol
121
Name 4 atypical antipsychotics:
Clozapine
Respiridone
Olanzapine
Quetiapine
122
Give examples of anti-cholinergic side effects, and drugs which cause them
Dry mouth, constipation, sweating
| TCAs, the antipsychotics
123
What are the anti-histaminergic side effects?
Weight gain and sedation
124
What is metabolic syndrome?
1. Diabetes
2. Obesity
3. Hypertension
4. Hyperlipidaemia
125
Which drugs cause metabolic syndrome?
Atypical antipsychotics
126
Why is clozapine reserved as 3rd line treatment for psychosis?
1. Cardiomyopathy
2. Agranulocytosis
3. Myocarditis
127
How would you monitor a patient on clozapine?
Monthly full blood count - risk of low neutrophils (agranulocytosis)
128
When might neuroleptic malignant syndrome develop?
4-11 days after commencing an antipsychotic
129
What are the 4 symptoms of neuroleptic malignant syndrome?
1. Fever
2. Lead pipe body
3. Altered mental state
4. Autonomic dysfunction
130
What drug is used to treat Neuroleptic Malignant Syndrome?
Bromocriptine
131
What drug is used to treat serotonin syndrome?
Cyproheptadine
132
How fast is the onset of serotonin syndrome?
Acute - 1 to 2 doses
133
Describe some symptoms of serotonin syndrome
tremor, hyperreflexia, clonus
134
Give 4 symptoms of lithium toxicity
dysarthria, ataxia, tremor and vomiting
135
How do benzodiazepines work?
Open GABA channels, increase activity of GABA
136
When is ECT indicated for depression?
Very severe, suicide risk, stupor, treatment resistant
137
What are the main adverse effects of ECT?
Amnesia, prolonged seizure
138
What drug can be used to treat tardive dyskinesia? (Involuntary tongue movements and grimacing?
Tetrabenazine
139
What symptoms are present in schizoid personality disorder?
The negative symptoms of schizophrenia
140
Which atypical antipsychotic has the most tolerable side-effect profile?
Aripiprazole
141
What may happen to a foetus if the mother is taking an SSRI?
They may get persistant pulmonary hypertension syndrome
142
What is the mechanism of action of venlafaxine?
SNRI
143
What are 2 major complications of atypical antipsychotics in the elderly population
Sroke and VTE
144
Define Illusion
misconception of a sensory stimulus (e.g. thinking a coat hanger with a coat on it is a person) these are normal
145
Define Hallucination
experience in the absence of a stimulus
146
What are hypnopompic and hypnogogic hallucinations?
```
pompic = hallucination as you wake up
gogic = hallucination as you go to sleep
```
147
Define reflex hallucination
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
Extracampine hallucination
An impossible hallucination, "I can hear someone talking to me from Australia"
149
Delusions
A belief held strongly despite being contradicted by reality
