Psychiatry Flashcards
1
Q
What are the three core symptoms of Depression?
A
1) Low mood
2) Anhedonia (loss of interest)
3) Decreased energy
2
Q
What additional symptoms (other than the core symptoms) may someone have in depression?
A
Guilt, feeling of worthlessness, low confidence, reduced concentration, low self-esteem, decreased appetite, decreased sleep, thoughts of self-harm
3
Q
What is the name of the scoring system that can be used for Depression?
A
Patient Health Questionnaire 9 (PHQ-9)
4
Q
Give some examples of SSRI’s
A
Sertraline
Fluoxetine
Citalopram
Paroxetine
5
Q
Give some examples of SNRIs
A
Venlafaxine
Duloxetine
6
Q
Give two examples of tricyclic antidepressants
A
Amitriptyline
Imipramine
7
Q
List some general/common side effects related to SSRIs
A
Headache, anorexia, nausea, indigestion, anxiety, sexual dysfunction
8
Q
List some serious side-effects of SSRIs
A
Increased risk of suicidal ideation, risk of bleeding, hypontraemia, risk of withdrawal, risk of prolonged QT (Citalopram)
9
Q
List some side effects experienced with tricyclic antidepressants
A
Antimuscarinic - Dry mouth, blurred vision, constipation, urinary retention, cognitive and memory impairment, increased body temperature; Dizziness, sexual dysfunction, arrhythmia’s, seizures
10
Q
What are the symptoms of rapid withdrawal from antidepressants?
A
Electric shock-like sensations, dizziness, increased mood change, restlessness, difficulty sleeping, sweating, abdominal symptoms, altered sensations
11
Q
What is the serious complication that can occur due to antidepressant use?
A
Serotonin syndrome
12
Q
What are the causes of serotonin syndrome?
A
- Therapeutic use of antidepressants
- Drug interactions
- Intentional overdose of antidepressants
13
Q
What are the symptoms of Serotonin Syndrome?
A
Tachycardia, hypertension, hyperthermia, agitation, ocular clonus, dilated pupils, tremor, akathisia, muscle rigidity, bilateral Babinski, dry mucous membranes, flushed skin, increased bowel sounds
14
Q
What is the management of Serotonin Syndrome?
A
- Stop serotinergic agents
- Benzodiazepines for agitation
- Cardiac monitoring
- IV fluids
- Cooling
15
Q
What non-pharmaceutical therapies are there for Depression?
A
- Counselling
- CBT
- ECT
16
Q
What are the indications for ECT?
A
- Depression
- Catatonia
- Mania
17
Q
What are the potential side-effects of ECT?
A
Short-term: Headache, aching muscles, temporary amnesia,, death from anaesthetic (1 in 10,000)
Long-term: Long-term amnesia, change in personality
18
Q
Define Generalised Anxiety Disorder
A
Generalised, persistent, excessive anxiety or worry about a number of events that an individual finds difficult to control that lasts for at least 3 weeks
19
Q
Mr J has comes to see you as he has been feeling very apprehensive for the past 4 weeks. When questioned he reports having nothing specific that is troubling him, he reports difficulty sleeping due to feeling anxious and constantly feels like something bad is going to happen. He appears tense as he sits talking to you. What is the likely diagnosis?
A
Generalised Anxiety Disorder
20
Q
What is the treatment for GAD?
A
- CBT
- Sertraline (SSRI)
- Additional: applied relaxation, psychoeducation
21
Q
Define Panic Disorder
A
Recurrent episodic and severe panic attacks which occur unpredictably and are not restricted to any particular situation
22
Q
Mrs H comes to see you as she has had a number of “episodes” where she has felt very anxious. On further discussion Mrs H reports that during this episodes she experiences palpitation, she feels like her heart is racing, she becomes increasingly breathless and she has noticed in her most recent episode that she got a tingling sensation in her hand. These episodes last for about 5 minutes. What is the most likely diagnosis?
A
Panic Disorder
23
Q
What is Anticipatory fear?
A
This is where an individual develops a fear of having another panic attack
24
Q
What is the management for a Panic Disorder?
A
- CBT
- SSRIs
- Tricyclic antidepressants e.g. imipramine or clomipramine
- Pregabalin or clonazepam
25
Name the three main categories of phobias
- Specific phobias
- Agoraphobia
- Social phobia
26
What is agoraphobia?
The fear and avoidance of places or situations from which escape may be difficult or in which help may not be available in the event of a panic attack
27
What is the diagnostic criteria for agoraphobia?
Anxiety that is restricted to crowds, public places, traveling from home or travelling alone and is therefore avoided
28
What is the management of agoraphobia?
- CBT
| - SSRIs
29
What is social phobia?
Persistent fear of social situations in which the individual is exposed to unfamiliar people or to possible scrutiny by others and fears they will be humiliated
30
What is the management for social phobia?
- CBT
- Self-help
- Graded self-exposure
- Social skills training
- SSRIs (not used first-line)
31
What is the management for specific phobias?
- Graded exposure
| - Benzodiazepines (if phobia is only encountered occasionally e.g. flying)
32
What are obsessions?
Obsessions can be thoughts, images, impulses, doubts which are unwelcome, persistent, recurrent, intrusive, senseless and uncomfortable for the individual. The individual will attempt to suppress or neutralise them and can recognise that they are absurd.
33
What are compulsions?
Repetitive, purposeful physical or mental behaviours performed with reluctance in response to an obsession
34
Ms K comes is referred to you as she has been having a difficult time recently. She reports that she has been cleaning the house quite a lot and has been becoming increasingly anxious about cleanliness. When asked she reports spending 3 hours a day cleaning and has been struggling with friends coming round as she is worried they may not be clean. She has also started asking her husband to shower as soon as he gets in from work. What is the most likely diagnosis?
Obsessive compulsive disorder
35
What is the management for OCD?
- CBT
| - SSRIs or Clomipramine
36
Ms T comes to you as she has been struggling over the past month following a car accident she had. The car accident involved her and her children and lead to their temporary hospitalisation. She reports getting anxious and sweaty and can often feel her heart racing whenever she has had to get into a car since, however she says she has only done this twice since the accident. While initially she only felt anxious when being in a car, two weeks ago she started having nightmares in which she relived the accident and has on a number of occasions become very anxious upon hearing her child crying saying she felt like she was "experiencing it all over again". What is the most likely diagnosis?
Post Traumatic Stress Disorder
37
What are the four main features of PTSD?
- Hyperarousal
- Intrusions
- Avoidance
- Maladaptive behaviours
38
What treatments are available for PTSD?
- Trauma-focussed CBT
- Eye Movement Desensitisation and Reprocessing Therapy (EMDR)
- Antidepressant e.g. Paroxetine or Mirtazapine
- Beta-blockers
- Social support e.g. finance, housing and family support
39
Mr E present to you following an argument with his next-door neighbours. He says the argument started when he went round as he could hear them talking about him when when he was in his house. He says they are always talking about him and they say nasty things. He also believes that they are trying to make him go to prison and that they have somehow managed to find a way of controlling him and making him steal things in order to get him into prison. He knows this is the case because the electrician has been hanging around their house yesterday and therefore he must have installed a controlling device. What is the most likely diagnosis?
Schizophrenia
40
What are the First Rank symptoms of Schizophrenia?
- Auditory hallucinations (typically 3rd person)
- Passivity or delusions of control
- Somatic hallucinations
- Thought disorder
- Delusional perception
41
What are positive symptoms in relation to Schizophrenia?
These are symptoms that involve changes in behaviour or thoughts e.g. hallucinations
42
What is meant by negative symptoms in relation to Schizophrenia?
These are symptoms that involve withdrawal or lack of function e.g. being emotionless, being socially isolated and reclusive
43
What treatments can be carried out for Schizophrenia?
- Antipsychotics
| - Psychological therapies - CBT, Family therapy, arts therapy
44
What is psychosis?
A mental health condition that causes people to perceive or interpret things differently from those around them
45
List some causes of psychosis
- Schizophrenia
- Bipolar
- Severe Depression
- Severe stress
- Severe anxiety
- Significant lack of sleep
- Medical conditions such as Alzheimer's, hypoglycaemia, brain tumour etc
- Post-natal
- Drugs and alcohol
46
Give some examples of First generation (typical) antipsychotics
- Haloperidol
- Chlorpromazine
- Fluphenazine
47
Give some examples of Second generation (atypical) antipsychotics
- Olazapine
- Quitepine
- Rispiradone
- Aripiprazole
- Clozapine
48
What is the mechanism of action for first generation (typical) antipsychotics?
Blocks predominantly dopamine D2 receptors
49
What is the mechanism of action for second generation (atypical) antipsychotics?
Blocks additional receptors to dopamine including serotonin, muscarinic and histamine
50
What are the significant side-effects of antipsychotic medication?
- Extrapyramidal symptoms
- Raised prolactin
- Prolonged QT
- Sedation and sexual dysfunction
- Metabolic - insulin resistance, weight gain, hyperglycaemia
51
What are the extrapyramidal symptoms seen in antipsychotic use?
- Tremor
- Acute dystonia
- Parkinsonism
- Akathisia
- Tardive dyskinesia
52
How can raised prolactin affect men and women?
Men - gynaecomastia
| Women - breast tenderness and lactation
53
Extrapyramidal side effects can occur in all antipsychotics - are they more common in first generation (typical) or second generation (atypical) antipsychotics?
First generation (typical)
54
Metabolic side effects can occur in antipsychotic medication use - are they more common in first generation (typical) or second generation (atypical) antipsychotics?
Second generation (atypical)
55
What are the side effects of Clozapine?
- Agranulocytosis
- Venous thromboembolism
- Myocarditis
- Cardiomyopathy
- Constipation
56
What is the biggest killer in patients on Clozapine?
Constipation
57
To start a patient on Clozapine what must have been tried first?
Two other antipsychotics - one of which must have been atypical
58
Name an anxiolytic
Benzodiazepines e.g. diazepam
59
Name a hypnotic (inducing sleep)
Zopiclone
60
How do benzodiazepines work?
They potentiate the inhibitory effects of GABA
61
What are the side effects of benzodiazepines?
- Drowsiness
- Ataxia
- Amnesia
- Dependence
- Disinhibition
62
What are the withdrawal symptoms of benzodiazepines?
- Anxiety
- Shaking
- Abdominal cramps
- Perceptual disturbances
- Persecutory delusions
- Seizures
63
What type of drug is Lithium?
Mood stabiliser
64
What conditions is lithium used in?
- Bipolar disorder
- Acute treatment of mania
- Schizoaffective disorder etc
65
Why do patients on lithium have to be monitored closely?
- Lithium has a narrow therapeutic range
| - It can affect thyroid and renal function
66
What are the side-effects of lithium?
Nausea, fine tremor, weight gain, oedema, polydipsia, polyuria, hypothyroidism
67
What are the symptoms and signs of lithium toxicity?
- Vomiting
- Diarrhoea
- Coarse tremor
- Weakness
- Slurred speech
- Ataxia
- Visual disturbance
- Abnormal reflexes
- Confusion
- Arrhythmias
- Convulsions
68
Other than lithium what else can be used as mood stabilisers?
- Anti-epileptic medication e.g. sodium valproate, lamotrigdine, carbamazepine
- Anti-psychotics e.g. Haloperidol, olazapine. qutiepine, risperidone
69
What is the difference between Bipolar type 1 and Bipolar type 2?
Bipolar type 1 - Both mania and depression
| Bipolar type 2 - More depression with hypomania
70
What are the symptoms of hypomania?
- Elevated mood
- Increased energy
- Increased talkativeness
- Decreased need for sleep
- Poor concentration
- Mild recklessness
- Increased sociability
71
What are the symptoms of mania?
- Extreme elation
- Overactivity
- Impaired judgement
- Extreme risk taking
- Social disinhibition
- Inflated self-esteem/grandiosity
- Psychotic symptoms
72
What is the management for Bipolar disorder?
- Mood stabilisers e.g. lithium carbonate, anticonvulsants or antipsychotics
- Psychological treatment - CBT, psychoeducation and family therapy
73
Personality Disorder: If a patient has excessive doubt, preoccupation with details and rules, has perfectionism that interferes with the completion of tasks and excessively adheres to social norms what is the likely diagnosis?
Obsessive-compulsive/Aanankastic Personality Disorder
74
What differs between an obsessive-compulsive personality disorder and obsessive-compulsive disorder?
In OCD the person shows resistance to obsessions whereas in OCPD the person does not show resistance
75
Personality Disorder: If a patient is socially withdrawn, is restricted in emotional expression, is indifferent to praise and criticism and is insensitive to social norms what is the likely diagnosis?
Schizoid Personality Disorder
76
Personality Disorder: If a patient is suspicious, preoccupied with mistrust, bares grudges and is reluctant to confide and takes remarks negatively what is the likely diagnosis?
Paranoid Personality Disorder
77
Personality Disorder: If a patient has frequent intense relationships, often becomes paranoid, is scared of abandonment and has recurrent suicidal thoughts or self-harm what is the likely diagnosis?
Emotionally unstable/Borderline Personality Disorder
78
Personality Disorder: If a patient has difficulty maintaining relationships, often gets aggressive, does not express guilt, has disregard for the safety of them and others, is impulsive and often blames others what is the likely diagnosis?
Dissocial/Antisocial Personality Disorder
79
Personality Disorder: If a patient has persistent feelings of tension and inadequacy, has social inhibitions, is unwilling to get involved with people particularly if not certain being liked what is the most likely diagnosis?
Avoidant/Anxious Personality Disorder
80
Personality Disorder: If a patient has an excessive need to be taken care of, fears separation, often need advice on daily decisions, needs others to assume responsibility, constantly needs close relationships and complies unduly with others wishes what is the likely diagnosis?
Dependent Personality Disorder
81
Personality Disorder: If a patient is attention-seeking, shows inappropriate sexual seductiveness with immaturity, narcissism, grandiosity and is emotionally shallow what is the likely diagnosis?
Histrionic Personality Disorder
82
Ms W is concern about her husbands memory, she has noticed that his memory has become significantly worse over the last year. When asked how quickly this has happened she says it got worse a few months ago and has stayed the same since. What diagnosis would fit with this?
Vascular dementia
83
Mr P is is concerned about his partners memory. He says that his partner has been having having episodes of confusion and has been saying that they often see rabbits in the house. In addition to these episodes he also reports that his partner seems to be getting declining in mobility and starting to shuffle a lot and has fallen over a few times. What diagnosis would fit with this?
Lewy-body dementia - often fluctuating onset and progression with visual hallucinations of small children, animals and complex scenes. They can also exhibit parkinsonian signs and have frequent falls.
84
Mrs J has come to see you as she is concerned about her forgetfulness. She says over the past year she has become increasingly forgetful and she has missed numerous appointments, often forgets where she left items and often enters a room and has no idea why she is there. What diagnosis would you be concern about in this case?
Alzheimer's Disease - Insidious onset of amnesia with additional symptoms such as apraxia, agnosia, and aphasia as the disease develops
85
Mrs G is concern about her husband. She reports that he is just not himself and hasn't been for a while. She at first thought he was up to no good but is now worried because he has become often emotionless, is reluctant to socialise with friends he always used to see regularly and has started doing things that are out of character for him. What diagnosis would you be concerned about in this situation?
Fronto-temporal dementia
86
Donepezil, rivastigmine and galantine are examples of what and what are they used for?
Acetyl-cholinesterase inhibitors which increase Acetylcholine and therefore used to improve cognition in Alzheimer's
87
Memantine is an example of what medication and in what condition is it used?
It is an NMDA antagonist which leads to the increase in glutamate and it is used in Alzheimer's disease to improve cognition
88
A patient suffering with dementia may suffer from anxiety, depression, agitation, psychosis or disinhibition. These are collectively known as what?
Behavioural and Psychological Symptoms of Dementia (BPSD)
89
What can cause BPSD's in dementia patients?
- Pain
- Infection
- Nutrition
- Constipation
- Dehydration
- Medications
- The environment they are in
90
A patient comes into A&E with reduced level of consciousness, reduced breathing and has small pupils and has track marks on his arm- what is likely to be the cause?
Heroin/opiate overdose
91
A patient comes into A&E who is drowsy, is weak with slurred speech and has lack of coordination. The patient is a known to have severe anxiety and his family are concerned he has taken too much medication. What medications likely to have caused this?
Benzodiazepines
92
What is the most common inherited cause of learning disability?
Fragile X Syndrome
93
What are the features of someone with Fragile X Syndrome?
Large protruding ears, long face, high arched palate, flat feet, large testicles, hypotonia and reduced IQ, memory difficulties, autism, transient fluctuation of mood
94
A patient is suspected of having depression. Give a list of differential diagnosis.
- Depression
- Anxiety
- Bipolar disorder
- Hypothyroidism
- Alcohol-induced mood disorder
- Emotionally unstable personality disorder
95
A patient is suspected of having Bipolar disorder - what other diagnoses should be considered?
- ADHD
- Substance-induced disorder
- Major depressive disorder
- Psychotic disorder
- Personality Disorder
96
A patient is suspected of having Schizophrenia - what other diagnoses should be considered?
- Substance-induced psychotic disorder
- Depression with psychosis
- Bipolar with psychosis
- Factitious disorder
- Delusional disorder
- Hyperthyroidism
97
A patient is suspected of having OCD - what other diagnoses should be considered?
- Obsessive-compulsive personality disorder
- Delusional disorder
- Panic disorder
- Autism Spectrum Disorder
98
A patient is suspected of having PTSD - what other diagnoses should be considered?
- Anxiety disorder
- Phobias
- Obsessive-compulsive disorder
- Substance-induced
