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3a > Psychiatry > Flashcards

Psychiatry Flashcards

1
Q

what are the sx of paracetamol OD?

A

few early features but later: hepatomegaly, jaundice, encephalopathy, renal impairment

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2
Q

how do you manage paracetamol OD?

A

N acetylcysteine

Monitor ABGs for metabolic acidosis and INRs

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3
Q

what are the symptoms of aspirin od?

A

early: tinnitus, sweating, dehydration, hyperventilation, vertigo, N&V

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4
Q

how do you manage aspirin od?

A

correct dehydration
activated charcoal
monitor for acidosis (ABG, urine)
monitor heart

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5
Q

what are the risk factors of schizophrenia?

A

inner city living
drug use
migration

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6
Q

which is the safest antidepressant in pregnancy?

A

fluoxetine

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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

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8
Q

what investigations should you do in someone who has taken a paracetamol OD?

A 
serum paracetamol
AST
ALT
U&E
other toxicology
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9
Q

what are the symptoms of tricyclic antidepressant OD?

A

seizures, tachyc, dry mouth, nausea, headache, confusion, hypotension, arrythmia
give HCO3 and Mg

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10
Q

what are the symptoms of digoxin od?

A

vertigo, visual blurring, yellow vision, N&V

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11
Q

what are the 3 sx of opiate od?

A

pinpoint pupils, respiratory depression and decreased GCS

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12
Q

how is opiate od treated?

A

naloxone, vital signs, IV fluids, o2, ECG, imaging for brain damage

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13
Q

how is GAD, agoraphobia and social anxiety treated?

A

CBT, sertraline, BDZs and propranolol.

GAD can also have pregabalin

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14
Q

how is PTSD treated?

A

eye movement desensitisation and reprocessing, CBT, paroxetine (bc sedative)

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15
Q

what is somatisation disorder?

A

psychological distress manifested as physical symptoms, treat with CBT and discussion of what caused it

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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

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17
Q

what are the features of addiction?

A

psychological and physical dependence and tolerance

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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

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19
Q

how do you calculate units of alcohol?

A

LXabv

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20
Q

what are the short term symptoms of alcohol withdrawal?

A

nausea, sweating, tachycardia, hypertension

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21
Q

how does naltrexone work?

A

it blocks opioid receptors so it produces a similar effect to alcohol intoxication-used for cravings

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22
Q

how does disulfiram work?

A

acute sensitivity to alcohol, gives nausea, headache, chest pain, dizziness as drinking starts

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23
Q

what is the purpose of starting acamprosate?

A

started first in managing alcohol addiction-used to stop cravings

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24
Q

general management of an overdose?

A

BP, temperature, urine output
FBC, U&E, CK, coagulation, toxicology, LFT
ECG

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25
Q

what is the difference in use between naloxone and naltrexone?

A

naloxone-opioid overdose

naltrexone-alchohol addiction

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26
Q

withdrawal symptoms of opioids?

A

goosebumps, hypothermia, sweating, malaise, anxiety, cramps, insomnia, spasms, diarrhoea

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27
Q

what is the safest SSRI to use in pregnancy?

A

fluoxetine

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28
Q

what investigations should you do in someone who has an eating disorder?

A

bedside: thyroid and abdo exam, ECG, BP
bloods: FBC, U&Es (hypernatraemia), TFT, LFT, glucose

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29
Q

who is at risk of developing refeeding syndrome

A

decreased intake: alcoholism, eating disorder, elderly, depression, chemo
decreased absorption: ca

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30
Q

what will be elevated in refeeding syndrome?

A

glucose

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31
Q

risks of undernourishment?

A 
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
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32
Q

what are the 3 features of EUPD?

A

problems forming and maintaining relationships
maladaptive coping mechanisms
negative self image
almost always have comorbid depression or anxiety

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33
Q

what are the features of baby blues?

A

irritable
weepy
emotional lability

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34
Q

how is postnatal depression assessed?

A

Edinburugh post natal depression scale

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35
Q

how long does postnatal depression last?

A

at least 2w

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36
Q

what are the risk factors for postnatal depression?

A 
depression RFs: genes, substance abuse, loneliness, unemployement as well as:
unplanned pregnancy
poor support network
baby blues
other psych comorbidities
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37
Q

what is persistent delusional disorder?

A

one delusion held over 3m

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38
Q

define delirium

A

an acute state of confusion that fluctuates in intensity-caused by a medical problem or intoxication

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39
Q

what investigations should you do in delirium?

A

bedside: neuro exam, ECG, urine output, temperature, find infection source, urinalysis
bloods: FBC, U&E, LFT, TFT, CRP, ESR
imaging: CXR, CT head

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40
Q

what are the medications used for Alzheimer’s?

A

acetylcholinesterase inhibitors: rivastigmine, galantamine and NMDA receptor antagonists: memantine

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41
Q

SEs of rivastigmine?

A

N&V, decreased appetite, weight loss

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42
Q

name 2 features of cognitive impairment that have to be present for a diagnosis of dementia to be made?

A

present for at least 6 months

affecting functioning

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43
Q

what are the early and late sx of frontotemporal disease?

A

fronto-so inhibition changes before temporal which is memory difficulties

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44
Q

which is the only kind of dementia you don’t use acetylcholinesterase inhibitors for?

A

vascular

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45
Q

which SSRI is best in the elderly?

A

citalopram

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46
Q

what specific antidepressants should be used?

A 
pregnant-fluoxetine
adolescents-fluoxetine
elderly-citalopram
anxiety-sertraline
cardiac disease-sertraline
PTSD-paroxetine
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47
Q

give causes of learning disability

A

genetic: Down’s, phetylketonuria, fragile X
antenatal: infections, alcohol, hypoxia
perinatal: cerebral palsy
postnatal: infection, injury, impoverished environment

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48
Q

what are the features and aims of the mental health act?

A

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

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49
Q

section 2

A

assessment but can also treat
for 28 days and cannot be renewed
needs 2 doctors and 1 AMHP

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50
Q

what is the evidence required to section someone?

A

that they are suffering from a mental disorder

that they should be detained for their own and other’s safety

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51
Q

what is a community treatment order?

A

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

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52
Q

how is a section 3 renewed?

A

by 6m then past a year can renew in year blocks

53
Q

what sections can you treat under?

A

2, 3, community treatment order

54
Q

what sections can you not treat under?

A

4, 5, 135, 136

55
Q

what is required for a 135

A

social worker gets a warrant to enter patient’s home

56
Q

what are the features of a 135

A

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
Q

what does an advance directive need to have if it is to be followed?

A

in writing
signed and witnessed
include an expressed statement that it stands even if life is at risk

58
Q

how do you register a lasting power of attorney

A

register with the office of public guardian

59
Q

what happens if you feel a lasting power of attorney is not acting in the patient’s best interests?

A

the office of public guardian can apply to the court of protection to investigate and remove them

60
Q

what does the MCA 2005 cover

A

everyone over 16
allows LPAs and advance directives to be made
empowers those who lack capacity to make some decisions for themselves

61
Q

when was the MHA made

A

2007

62
Q

what 2 things are necessary for someone to be deemed to not have capacity?

A

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
Q

what are the 5 principles of the MCA?

A 
presumed
supported to make their own decisions
unwise decisions
best interests
least restrictive
64
Q

what does SNRI stand for and give examples

A

serotonin norepinephrine reuptake inhibitor

duloxetine and venlafaxine-shouldn’t use in CVD

65
Q

give side effects of SSRIs

A

suicidal thoughts
sexual dysfunction
N&V
serotonin syndrome

66
Q

what are the side effects of TCAs?

A

anticholinergic so constipation, dry mouth, tachycardia

67
Q

give some examples of TCAs

A

amitriptyline
dosulepin
clomipramine

68
Q

give some biological differentials to rule out in dementia

A 
syphilis
b12 deficiency
CSDH
hypothyroid
depression
delirium
normal pressure hydrocephalus
Addison's
medication
69
Q

what are MAOIs and what do they help increase

A

phenelzine and moclobemide
increase noradrenaline, adrenaline and dopamine
monoamine oxidase inhibitors

70
Q

what do cured meats, aged cheese and broad beans contain?

A

tyramine so CI with MAOIs because could cause hypertensive crisis

71
Q

what decreases as you increase the dose of mirtazapine?

A

the sedative effect, another effect is weight gain

72
Q

what are side effects of all antidepressants?

A

hyponatraemia and bleeding (plt dysfunction)

all CI with stomach ulcers

73
Q

what should you use in a depressed patient if they have a bleeding disorder or is taking antiplatelets or warfarin or NSAIDs?

A

mirtazipine

74
Q

which medications are best for long term conditions?

A

citalopram and sertraline but be careful with clotting

75
Q

how long after depressive symptoms go away should antidepressants be used for?

A

6 months

if history of relapse then 2 years

76
Q

what causes serotonin syndrome

A

SSRIs, coke, MDMA, MAOIs, SNRIs, tramadol, amphetamines

risk: St John’s wort

77
Q

what is the triad of symptoms in serotonin syndrome

A

altered mental status
myoclonus
autonomic dysfunction

78
Q

what investigations would you order in someone you suspected was suffering from serotonin syndrome?

A

bedside: urine tox, ECG
bloods: FBC, blood tox, CK

79
Q

what antidepressant od is likely to lead to arrythmias?

A

dosulepin
clomipramine
amitriptyline

80
Q

how do you manage serotonin syndrome

A

cooling measures
BDZs
fluids

81
Q

name mood stabalisers other than lithium

A

depakote

AEDs

82
Q

what must you tell patients when prescribing lithium

A

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
Q

what congenital abnormalities will AEDs cause

A

congenital heart disease

neural tube defects

84
Q

what congenital abnormality does lithium cause

A

Ebstein’s anomoly

85
Q

what is Ebstein’s anomaly?

A

2 leaflets of tricuspid valve are displaced into the right ventricle so right heart failure and cyanosis occurs

86
Q

when do you not have to get consent from a patient?

A

doctrine of necessity

emergency life saving treatment where it is not possible to get consent

87
Q

what is acute dystonic reaction and how is it treated?

A

after 1 time exposure to antipsychotic

sx: torticollis, opisthotonos, dystonia, facial grimacin
mx: stop drug+procycladine

88
Q

what is neuroleptic malignant syndrome?

A

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
Q

what benzodiazepines are used in anxiety management?

A

temazepam

nitrazepam

90
Q

the 3 indications for ECT

A

moderate to severe depression
intractable mania
catatonia

91
Q

what is needed for a diagnosis of PTSD?

A

sx present for at least a month
have experienced a life threatening event
re-experience the event
avoidance

92
Q

what is acute stress reaction

A

symptoms of anxiety, confusion and disorientation following a life threatening event that subside within a month

93
Q

what is adjustment disorder?

A

depression and anxiety and inability to cope with daily tasks following a life changing evnet

94
Q

what is catatonia

A

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
Q

what is the difference between somatisisation and hypochondria?

A

somatisisation is persistence of a symptom

hypochondria is peristence of a disease despite reassurance

96
Q

what is malingering

A

any somatisation, conversion or hypochondrial disorder for financial or personal gain

97
Q

what are the 6 As of Alzheimer’s?

A 
apraxia
amnesia
aphasia
agnosia
apathy
Anticholinesterase inhibitors
98
Q

what is associated with poor prognosis in schizophrenia/

A

gradual onset
low iq
prodromal phase of isolation
lack of obvious precipitant

99
Q

what are the 6 features of dependence syndrome?

A 
craving
difficulty controlling use
withdrawal
tolerance
neglect of other activities
persistent use in spite of consequences
need 3/6
100
Q

drugs to reduce opioid use

A

buprenorphine and methadone SEs: mood swings, resp depression

101
Q

what can you use in hospital to screen depression?

A

hospital anxiety and depression score

102
Q

what symptoms will someone have if they are moderately depressed?

A

2 core and 3 other
its 2+2
2+3 and 3+4

103
Q

what are the 6ss of SSRIs?

A 
sleep disturbance
size- weight gain
suicidal thoughts
sexual dysfunction
stomach upset
serotonin syndrome
104
Q

what are the side effects of SNRIs?

A 
SHAT
SSRI SEs
hypertension
agitation
tachycardia
105
Q

what is the management of serotonin syndrome

A

stop drug
bdz and cooling and fluids
cyproheptadine

106
Q

what ecg sign might you find with lithium toxicity?

A

inverted t waves

107
Q

how do you manage someone with alcohol withdrawal?

A 
ABCDE
treat hypoglycaemia
chloridiazepoxide
carbemazepine/phenytoin for seziures
thiamine
108
Q

with a new diagnosis of bipolar-what is it important to check the patient hasn’t been prescribed?

A

SSRIs-rapid cycling

109
Q

what receptor do typical antipsychotics like haloperidol and chlorpromazine work on

A

D2 only

110
Q

what is needed for a diagnosis of panic disorder?

A

more than 4 attacks per month or one very severe each month then spend the rest of the time worrying about it

111
Q

what are types of schizophrenia?

A

paranoid
hebephrenic
residual

112
Q

whats the difference between depression and dementia

A

biological symptoms
different hallucinations
dementia has slower onset and longer history

113
Q

what is needed for a diagnosis of schizophrenia?

A

1 first rank or 2 2nd rank for a month and evidence in disturbance of functioning for 6 months

114
Q

what needs to be ruled out in a diagnosis of depression

A

cushings, addisons, folate deficiency, hypercalcaemia, BB, AEDs, digoxin, MS, barbituates, alcohol

115
Q

how long does depression have to last for a diagnosis?

A

happen daily 2 weeks but adjustment disorder can last for up to 4 weeks

116
Q

what should N acetylcysteine be given with?

A

glucose

117
Q

what is needed for a diagnosis of GAD?

A

10=6m of peristent worry about everyday issues+4 somatic symptoms

118
Q

how is phaechromocytoma diagnosed?

A

24hr catecholemine and metanephrine collection

119
Q

which pathway is involved in the psychopathology of addiction?

A

mesolimbic-there is increased dopamine release in the pathway

120
Q

what is used for alcohol withdrawal acutely?

A

chlordiazepoxide

121
Q

differentials of anorexia?

A 
Crohn's
coeliac
GIST
depression
hypothalamic tumour
122
Q

what might you find on investigation of an anorexic patient?

A

high CCK

low bp

123
Q

3 features of EUPD?

A

unstable relationships
maladaptive coping mechanisms
a negative self image

124
Q

what is associated with ADHD

A

epilepsy
FASD
low birthweight

125
Q

ADHD sx

A

inattention (difficulty concentrating, careless mistakes, short attention span)
hyperactivity (excessive talking and figeting)
impulsivity

126
Q

give the aims of CBT

A

unlearning maladaptive coping mechanisms

127
Q

how is ASD treated?

A

applied behavioural analysis

social support

128
Q

features of EUPD?

A 
fear of abandonment
unstable relationships
self harm
impulsivity
chronic feelings of emptiness
unhelpful use of substances
disturbed or uncertain self image

3a (11 decks)

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