Psychiatry Flashcards
1
Q
what are the sx of paracetamol OD?
A
few early features but later: hepatomegaly, jaundice, encephalopathy, renal impairment
2
Q
how do you manage paracetamol OD?
A
N acetylcysteine
Monitor ABGs for metabolic acidosis and INRs
3
Q
what are the symptoms of aspirin od?
A
early: tinnitus, sweating, dehydration, hyperventilation, vertigo, N&V
4
Q
how do you manage aspirin od?
A
correct dehydration
activated charcoal
monitor for acidosis (ABG, urine)
monitor heart
5
Q
what are the risk factors of schizophrenia?
A
inner city living
drug use
migration
6
Q
which is the safest antidepressant in pregnancy?
A
fluoxetine
7
Q
what investigations should you do in someone who has self harmed?
A
toxicology urine and blood
breathylyser
FBC, U&E, LFT, INR
ECG
8
Q
what investigations should you do in someone who has taken a paracetamol OD?
A
serum paracetamol AST ALT U&E other toxicology
9
Q
what are the symptoms of tricyclic antidepressant OD?
A
seizures, tachyc, dry mouth, nausea, headache, confusion, hypotension, arrythmia
give HCO3 and Mg
10
Q
what are the symptoms of digoxin od?
A
vertigo, visual blurring, yellow vision, N&V
11
Q
what are the 3 sx of opiate od?
A
pinpoint pupils, respiratory depression and decreased GCS
12
Q
how is opiate od treated?
A
naloxone, vital signs, IV fluids, o2, ECG, imaging for brain damage
13
Q
how is GAD, agoraphobia and social anxiety treated?
A
CBT, sertraline, BDZs and propranolol.
GAD can also have pregabalin
14
Q
how is PTSD treated?
A
eye movement desensitisation and reprocessing, CBT, paroxetine (bc sedative)
15
Q
what is somatisation disorder?
A
psychological distress manifested as physical symptoms, treat with CBT and discussion of what caused it
16
Q
define addiction
A
disease state in which the ability to abstain is impaired by chemical and psychological disruption of the choice making apparatus
17
Q
what are the features of addiction?
A
psychological and physical dependence and tolerance
18
Q
what’s the difference between tolerance and physical dependence?
A
tolerance-diminished response to a drug
so physical dependence follows on-it’s needing more of a drug to feel its effects
19
Q
how do you calculate units of alcohol?
A
LXabv
20
Q
what are the short term symptoms of alcohol withdrawal?
A
nausea, sweating, tachycardia, hypertension
21
Q
how does naltrexone work?
A
it blocks opioid receptors so it produces a similar effect to alcohol intoxication-used for cravings
22
Q
how does disulfiram work?
A
acute sensitivity to alcohol, gives nausea, headache, chest pain, dizziness as drinking starts
23
Q
what is the purpose of starting acamprosate?
A
started first in managing alcohol addiction-used to stop cravings
24
Q
general management of an overdose?
A
BP, temperature, urine output
FBC, U&E, CK, coagulation, toxicology, LFT
ECG
25
what is the difference in use between naloxone and naltrexone?
naloxone-opioid overdose
| naltrexone-alchohol addiction
26
withdrawal symptoms of opioids?
goosebumps, hypothermia, sweating, malaise, anxiety, cramps, insomnia, spasms, diarrhoea
27
what is the safest SSRI to use in pregnancy?
fluoxetine
28
what investigations should you do in someone who has an eating disorder?
bedside: thyroid and abdo exam, ECG, BP
bloods: FBC, U&Es (hypernatraemia), TFT, LFT, glucose
29
who is at risk of developing refeeding syndrome
decreased intake: alcoholism, eating disorder, elderly, depression, chemo
decreased absorption: ca
30
what will be elevated in refeeding syndrome?
glucose
31
risks of undernourishment?
```
CVS: arrythmias, bradycardia, low BP
RS: resp muscle weakness
GI: constipation, pancreatitis
neuro: Wernicke's, seizures, fainting
MSK: rhabdomyolysis, weakness
endocrine: subfertility, osteoporosis, thyroid dysfunction, cortisol increased, hypoglycaemia,
poor sleep, pancytopenia
```
32
what are the 3 features of EUPD?
problems forming and maintaining relationships
maladaptive coping mechanisms
negative self image
almost always have comorbid depression or anxiety
33
what are the features of baby blues?
irritable
weepy
emotional lability
34
how is postnatal depression assessed?
Edinburugh post natal depression scale
35
how long does postnatal depression last?
at least 2w
36
what are the risk factors for postnatal depression?
```
depression RFs: genes, substance abuse, loneliness, unemployement as well as:
unplanned pregnancy
poor support network
baby blues
other psych comorbidities
```
37
what is persistent delusional disorder?
one delusion held over 3m
38
define delirium
an acute state of confusion that fluctuates in intensity-caused by a medical problem or intoxication
39
what investigations should you do in delirium?
bedside: neuro exam, ECG, urine output, temperature, find infection source, urinalysis
bloods: FBC, U&E, LFT, TFT, CRP, ESR
imaging: CXR, CT head
40
what are the medications used for Alzheimer's?
acetylcholinesterase inhibitors: rivastigmine, galantamine and NMDA receptor antagonists: memantine
41
SEs of rivastigmine?
N&V, decreased appetite, weight loss
42
name 2 features of cognitive impairment that have to be present for a diagnosis of dementia to be made?
present for at least 6 months
| affecting functioning
43
what are the early and late sx of frontotemporal disease?
fronto-so inhibition changes before temporal which is memory difficulties
44
which is the only kind of dementia you don't use acetylcholinesterase inhibitors for?
vascular
45
which SSRI is best in the elderly?
citalopram
46
what specific antidepressants should be used?
```
pregnant-fluoxetine
adolescents-fluoxetine
elderly-citalopram
anxiety-sertraline
cardiac disease-sertraline
PTSD-paroxetine
```
47
give causes of learning disability
genetic: Down's, phetylketonuria, fragile X
antenatal: infections, alcohol, hypoxia
perinatal: cerebral palsy
postnatal: infection, injury, impoverished environment
48
what are the features and aims of the mental health act?
defines mental health as any disorder or disability of the mind excluding drug use, alcohol use and sexual fetishes
only 16yo+
aims for public safety and the lowest restriction on the subject's safety
49
section 2
assessment but can also treat
for 28 days and cannot be renewed
needs 2 doctors and 1 AMHP
50
what is the evidence required to section someone?
that they are suffering from a mental disorder
| that they should be detained for their own and other's safety
51
what is a community treatment order?
like a section 3 in the community, means that they have to take the medication but they can still live in the community
lasts for 6m and can be renewed indefinately
52
how is a section 3 renewed?
by 6m then past a year can renew in year blocks
53
what sections can you treat under?
2, 3, community treatment order
54
what sections can you not treat under?
4, 5, 135, 136
55
what is required for a 135
social worker gets a warrant to enter patient's home
56
what are the features of a 135
place of greater safety for 72 hours
by the police-have to stay with them the whole time
can then assess for a 2 or 3
57
what does an advance directive need to have if it is to be followed?
in writing
signed and witnessed
include an expressed statement that it stands even if life is at risk
58
how do you register a lasting power of attorney
register with the office of public guardian
59
what happens if you feel a lasting power of attorney is not acting in the patient's best interests?
the office of public guardian can apply to the court of protection to investigate and remove them
60
what does the MCA 2005 cover
everyone over 16
allows LPAs and advance directives to be made
empowers those who lack capacity to make some decisions for themselves
61
when was the MHA made
2007
62
what 2 things are necessary for someone to be deemed to not have capacity?
suffering from an impairment in the functioning of their mind
impairment means that they don't have capacity according to (understand, retain, weigh up, communicate)
63
what are the 5 principles of the MCA?
```
presumed
supported to make their own decisions
unwise decisions
best interests
least restrictive
```
64
what does SNRI stand for and give examples
serotonin norepinephrine reuptake inhibitor
| duloxetine and venlafaxine-shouldn't use in CVD
65
give side effects of SSRIs
suicidal thoughts
sexual dysfunction
N&V
serotonin syndrome
66
what are the side effects of TCAs?
anticholinergic so constipation, dry mouth, tachycardia
67
give some examples of TCAs
amitriptyline
dosulepin
clomipramine
68
give some biological differentials to rule out in dementia
```
syphilis
b12 deficiency
CSDH
hypothyroid
depression
delirium
normal pressure hydrocephalus
Addison's
medication
```
69
what are MAOIs and what do they help increase
phenelzine and moclobemide
increase noradrenaline, adrenaline and dopamine
monoamine oxidase inhibitors
70
what do cured meats, aged cheese and broad beans contain?
tyramine so CI with MAOIs because could cause hypertensive crisis
71
what decreases as you increase the dose of mirtazapine?
the sedative effect, another effect is weight gain
72
what are side effects of all antidepressants?
hyponatraemia and bleeding (plt dysfunction)
| all CI with stomach ulcers
73
what should you use in a depressed patient if they have a bleeding disorder or is taking antiplatelets or warfarin or NSAIDs?
mirtazipine
74
which medications are best for long term conditions?
citalopram and sertraline but be careful with clotting
75
how long after depressive symptoms go away should antidepressants be used for?
6 months
| if history of relapse then 2 years
76
what causes serotonin syndrome
SSRIs, coke, MDMA, MAOIs, SNRIs, tramadol, amphetamines
| risk: St John's wort
77
what is the triad of symptoms in serotonin syndrome
altered mental status
myoclonus
autonomic dysfunction
78
what investigations would you order in someone you suspected was suffering from serotonin syndrome?
bedside: urine tox, ECG
bloods: FBC, blood tox, CK
79
what antidepressant od is likely to lead to arrythmias?
dosulepin
clomipramine
amitriptyline
80
how do you manage serotonin syndrome
cooling measures
BDZs
fluids
81
name mood stabalisers other than lithium
depakote
| AEDs
82
what must you tell patients when prescribing lithium
that they will need contraception
now need: ECG, pregnancy test, weight, heart rate, blood pressure, eGFR, TFTs, calcium, U&Es
need Li levels every 3 months
need U&Es and TFTs every 6 months
family planning
symptoms of toxicity (to stay hydrated): lethargy, intentional tremor, teratogenic, hypothyroid, insipidus, U&Es, metallic taste
83
what congenital abnormalities will AEDs cause
congenital heart disease
| neural tube defects
84
what congenital abnormality does lithium cause
Ebstein's anomoly
85
what is Ebstein's anomaly?
2 leaflets of tricuspid valve are displaced into the right ventricle so right heart failure and cyanosis occurs
86
when do you not have to get consent from a patient?
doctrine of necessity
| emergency life saving treatment where it is not possible to get consent
87
what is acute dystonic reaction and how is it treated?
after 1 time exposure to antipsychotic
sx: torticollis, opisthotonos, dystonia, facial grimacin
mx: stop drug+procycladine
88
what is neuroleptic malignant syndrome?
side effect of taking antipsychotics for some time
sx: labile bp, hyperthermia, muscle rigiditiy, sweating
ix: high CK and lactate
mx: stop drug+diazepam
89
what benzodiazepines are used in anxiety management?
temazepam
| nitrazepam
90
the 3 indications for ECT
moderate to severe depression
intractable mania
catatonia
91
what is needed for a diagnosis of PTSD?
sx present for at least a month
have experienced a life threatening event
re-experience the event
avoidance
92
what is acute stress reaction
symptoms of anxiety, confusion and disorientation following a life threatening event that subside within a month
93
what is adjustment disorder?
depression and anxiety and inability to cope with daily tasks following a life changing evnet
94
what is catatonia
state of stupor in which patient is entirely unresponsive or excited, it is associated with schizophrenia and can involve catalepsy (waxy flexability or rigid-not cataplexy), negativism, echolalia
95
what is the difference between somatisisation and hypochondria?
somatisisation is persistence of a symptom
| hypochondria is peristence of a disease despite reassurance
96
what is malingering
any somatisation, conversion or hypochondrial disorder for financial or personal gain
97
what are the 6 As of Alzheimer's?
```
apraxia
amnesia
aphasia
agnosia
apathy
Anticholinesterase inhibitors
```
98
what is associated with poor prognosis in schizophrenia/
gradual onset
low iq
prodromal phase of isolation
lack of obvious precipitant
99
what are the 6 features of dependence syndrome?
```
craving
difficulty controlling use
withdrawal
tolerance
neglect of other activities
persistent use in spite of consequences
need 3/6
```
100
drugs to reduce opioid use
buprenorphine and methadone SEs: mood swings, resp depression
101
what can you use in hospital to screen depression?
hospital anxiety and depression score
102
what symptoms will someone have if they are moderately depressed?
2 core and 3 other
its 2+2
2+3 and 3+4
103
what are the 6ss of SSRIs?
```
sleep disturbance
size- weight gain
suicidal thoughts
sexual dysfunction
stomach upset
serotonin syndrome
```
104
what are the side effects of SNRIs?
```
SHAT
SSRI SEs
hypertension
agitation
tachycardia
```
105
what is the management of serotonin syndrome
stop drug
bdz and cooling and fluids
cyproheptadine
106
what ecg sign might you find with lithium toxicity?
inverted t waves
107
how do you manage someone with alcohol withdrawal?
```
ABCDE
treat hypoglycaemia
chloridiazepoxide
carbemazepine/phenytoin for seziures
thiamine
```
108
with a new diagnosis of bipolar-what is it important to check the patient hasn't been prescribed?
SSRIs-rapid cycling
109
what receptor do typical antipsychotics like haloperidol and chlorpromazine work on
D2 only
110
what is needed for a diagnosis of panic disorder?
more than 4 attacks per month or one very severe each month then spend the rest of the time worrying about it
111
what are types of schizophrenia?
paranoid
hebephrenic
residual
112
whats the difference between depression and dementia
biological symptoms
different hallucinations
dementia has slower onset and longer history
113
what is needed for a diagnosis of schizophrenia?
1 first rank or 2 2nd rank for a month and evidence in disturbance of functioning for 6 months
114
what needs to be ruled out in a diagnosis of depression
cushings, addisons, folate deficiency, hypercalcaemia, BB, AEDs, digoxin, MS, barbituates, alcohol
115
how long does depression have to last for a diagnosis?
happen daily 2 weeks but adjustment disorder can last for up to 4 weeks
116
what should N acetylcysteine be given with?
glucose
117
what is needed for a diagnosis of GAD?
10=6m of peristent worry about everyday issues+4 somatic symptoms
118
how is phaechromocytoma diagnosed?
24hr catecholemine and metanephrine collection
119
which pathway is involved in the psychopathology of addiction?
mesolimbic-there is increased dopamine release in the pathway
120
what is used for alcohol withdrawal acutely?
chlordiazepoxide
121
differentials of anorexia?
```
Crohn's
coeliac
GIST
depression
hypothalamic tumour
```
122
what might you find on investigation of an anorexic patient?
high CCK
| low bp
123
3 features of EUPD?
unstable relationships
maladaptive coping mechanisms
a negative self image
124
what is associated with ADHD
epilepsy
FASD
low birthweight
125
ADHD sx
inattention (difficulty concentrating, careless mistakes, short attention span)
hyperactivity (excessive talking and figeting)
impulsivity
126
give the aims of CBT
unlearning maladaptive coping mechanisms
127
how is ASD treated?
applied behavioural analysis
| social support
128
features of EUPD?
```
fear of abandonment
unstable relationships
self harm
impulsivity
chronic feelings of emptiness
unhelpful use of substances
disturbed or uncertain self image
```
