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Psychiatry Flashcards

1
Q

Alcohol withdrawal

  • Mechanism
  • Features
  • Tx
A

Removal of alc mediated inhib of NMDA + enhance of GABA

DT (48-72hr): coarse tremor, confusion, delusions, hallucination, tachycardia

Seizures

1st line: benzodiazepines

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2
Q

Anorexia Nervosa

  • who
  • DSM 5 diagnosis
A

90% are female, predominantly young

1) restricted energy intake giving low Body weight
2) intense fear of gaining weight
3) Body dysmorphia

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3
Q

Anorexia nervosa management & prognosis

A

Anorexia focused Family therapy (1st line in children)

Eating disorder focused CBT

10% die

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4
Q

Anorexia features + physiological abnormalities

A 
Reduced BMI
Bradycardia
hypotension
Enlarged slaivary glands
Lanugo hair
Amenorrhoea

Hypokalaemia
Low FSH, LH, Oestrogens
Raised cortisol

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5
Q

Antipsychotic mech

A

Act on D2 dopamine receptor

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6
Q

What are extra pyramidal SE?

Which antipsychotics have worse?

A

Parkinsonism

Acute dystonia (Muscle tension/ abnormal posture: torticolis, oculogyric crisis)

Akathisia (restlessness)

Tardive dyskinesia (abnormal involuntary movement e.g chewing, pouting jaw)

Typical antipsychotics

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7
Q

SE of antipsychotics

A

Extrapyramidal

Antimuscarinic: dry mouth, blurred vision, urianry retention/constipation

Raised prolactin: glactorrhoea, impaired glucose tolerance

Neuroleptic malignant syndrome

Prolonged QT

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8
Q

Neuroleptic Malignant Syndrome

A

Fever

Altered mental state (Drowsy, coma, delirium, agitated)

Muscle rigidity

Autonomic instability

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9
Q

Antipsychotic monitoring

A

FBC (agranulocytosis risk in Clozapine)
Lipids & weight Fasting glucose
BP
ECG

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10
Q

Atypical antipsychotics

  • when to use
  • Advantage
  • Adverse effects
  • E.Gs
A

1st line in Schizophrenia

Reduced Extrapyramidal SE

Weight gain, Clozapine -Agranulocytosis, In risk stroke/VTE

Clozapine, Olanxzapine, Riperidone, Quetinpine

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11
Q

Effect of Benzodiazepines

A

enhance the effect of GABA by inc GABA Chloride channels

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12
Q

Use of Benzos

A 
Sedation
Hypnotic
Anxiolytic
Anticonvulsant
Muscle relaxant
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13
Q

Problem with Benzos

A

As they work by up regulating channels, quick tolerance and dependance

(only to be used 2-4weeks)

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14
Q

E.G of Benzos

A

The -pams

e.g. Diazepam, Midazolam,
Lorazepam (Status)

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15
Q

Bipolar

  • Def
  • Age of onset
  • Types
A

Mental health disorder with periods of mania/hypomania alongside depression

Typically in late teens

Type I: mania + depression

Type II: Hypomania + depression

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16
Q

What is mania and hypomania

A

Key differentiator is that psychotic symptoms seen in mania (delusions of grandeur, auditory hallucinations)

Mania also lasts longer (7 days Vs 4 in hypo)

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17
Q

Management of Bipolar

A

Lithium is mood stabiliser of choice

For manic episode: stop antidepressants, give antipsychotic (Olanzapine - Atyp, haloperidol- Typical)

For depression: Talking therapies, Fluoxetine is drug of choice

Complications:
COPD, Cardiovasc disease etc from risk taking activities

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18
Q

Section

  • 2
  • 3
  • 4

All need AMHP (Approved mental health practitioner) + Dr input

A

2: Admission for assessment (28dy)
3: Admission for Tx (6mnth)
4: Emergency admission (72hr)

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19
Q

Bulimia Nervosa

  • Def
  • DSM 5 diag
A

Eating disorder with episodes of binge eating and purging (e.g. vomit, laxatives, diuretics, exercise)

DSM-5:

  • Recurrent binge eating and lack of control over eating
  • Recurrent compensatory behaviour to prevent weight gain. occur once a week for 3mnth
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20
Q

Bulimia Nervosa Tx

A

Referral to specialist

Bulimia focused self help

Eating disorder focused CBT

Bulimia focused family therapy

Pharma: limited role. Fluoxetine licensed

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21
Q

Charles-Bonnet syndrome

A

Hallucinations (visual or auditory) on the background of viral impair (up to 15% of visually impaired)

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22
Q

Cotard syndrome

A

Belief that part of body is dead/non-exhistent (seen in nihilistic depression )

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23
Q

De Clerambaults syndrome

A

Erotomania

Paranoid delusion
Often single woman believing a famous person/boss is in love with her

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24
Q

Factors suggesting depression rather than dementia

A

Short Hx with rapid onset

Global memory not just short term loss

Reluctant to take tests

PAtient worried about poor memory

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25
Q

Depression Screening Qs

A

2 questions:

  • In last month, have you often been bothered by feeling depressed or hopeless
  • have you often been bothered by having little interest or pleasure in doing things?
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26
Q

Two E.Gs of depression assessment Questionnaires

A

Hospital anxiety and depression scale (HAD)
0-7 normal, 8-10 borderline, 11+ depressed

Patient Health Questionnaire (PHQ-9)

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27
Q

DSM-5 criteria for depression (seen daily or almost daily)

Anything under 5 of the following is sub threshold depression

A

Depressed mood

Diminished interest or pleasure in almost all activities

inc/dec in weight in appetite

insomnia (esp morning waking) or hypersomnia

Psychomotor agitation

Fatigue

Feelings of worthlessness

Diminished concentration

Thoughts of death and suicidal ideation

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28
Q

DSM-5 mild depression

A

Just over 5 symptoms. Minor functional impairment

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29
Q

DSM-5 severe depression

A

Most of the Symptoms are present at impair daily functioning

± psychosis

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30
Q

Non-drug therapy for depression

A 
Guided self help
Computerised CBT
Behavioural activation
interpersonal therapy
Eye movement desensitisation reprocessing
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31
Q

Guided self help

  • For who
  • Desc
A

For depression, anxiety and panic

work through CBT based work book

Therapist helps you understand problems and make +ve changes

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32
Q

counselling

A

One on one. For those who have tried self help

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33
Q

Behavioural activation

A

one on one or group

Motivates you to make small positive changes to life

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34
Q

Interpersonal therapy

A

Addresses problems with poor relationships (family, partners, friends)\

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35
Q

EMDR

  • who
  • what
A

PTSD

helps brain reprocess traumatic events

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36
Q

Switching between antidepressants

A

Usually one with drawn and the next started

fluoxetine - leave a break

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37
Q

ECT

  • when used
  • CI
  • SE
A

Treatment of severe depression refractory to meds or psychotic depression

Increased ICP

Headache,
Nausea,
Short term memory loss
Cardiac arrhythmia

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38
Q

Generalised anxiety disorder Tx

A

SSRI anti-depressants

Beta-blockers

Benzo: diazepam

CBT

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39
Q

General anxiety

  • Central feature
  • Organic Ddx
  • Medication causes
A

Excessive worry about number of events associated with heightened tension

Hyperthyroidism, Cardiac disease

Salbutamol, theophylline, antidepressants, caffeine

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40
Q

Step wise management of GAD

A

1) education about GAD
2) Low intensity psychological (guided self-help or psychoeducational groups)
3) CBT or drug therapy
4) Specialist management

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41
Q

Drug therapy in GAD

A

SSRI 1st line

under 30 warn of suicidal ideation - weekly follow up 1st month

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42
Q

Panic disorder Tx

A

1) Recognition and self help (self guided therapy)

2) CBT or drug (SSRI)

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43
Q

5 stages of grief:

A

Denial (may include pseudo hallucinations)

Anger (often against medical professionals, fam members)

Bargaining

Depression

Acceptance

** not all go through all stages

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44
Q

Features of atypical greif

A

Delayed Grief (2 week + delay)

Prolonged Grief (Normal may take up to 12 months)

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45
Q

Insomnia Def

A

Difficulty initiating sleep or early morning waking. Leads to impaired daytime functioning

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46
Q

Lithium

  • Problem
  • Adverse effects
A

Narrow therapeutic index

N&V, Tremor, Nephrotoxic (nephorgenic diabete insipidus = poyuria)
ECG: Twave inversion
Weight gain

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47
Q

Circumstantiality

A

Answer question with excessive unecessary details

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48
Q

Tangentiality

A

Wandering from a topic without returning

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49
Q

Neoligism

A

new word formation, may be made up of two words

50
Q

Knights move thinking

seen in what?

A

severe loosening of associations. Unexpected illogical leaps from one idea to anther (seen in schizophrenia)

51
Q

Flight of ideas.

Feature of?

A

Leaps from one topic to another without link

Seen in mania

52
Q

Echolalia

A

Repeating someones speech, including questions just asked

53
Q

Monoamine oxidase inhibitors:

  • Mech
  • Use
  • Adverse effects/interactions
A

Block MAO presynaptic metabolism of serotonin and noradrenaline

Antidepressant

Hypertensive reaction with tyraminefoods (cheese, bovril, marmite, broad beans)

54
Q

OCD diagnosis

A

Obsession

Repetitive behaviours in response to obsession. Compulsion prevent distress

Take up time (e.g. over 1 hour a day

55
Q

OCD associated diseases

A

Depressio
Schizophrenia
Tourettes
Anorexia

56
Q

Othello’s syndrome

A

Pathological jealousy
Convinced of cheating without proof.
Socially unacceptable behaviour in response

57
Q

Panic disorder

  • diagnosis
  • who
  • tx
A

Symptoms for 1mnth+

Women (15-24, 45-54)

SSRIs. CBT

58
Q

RF panic disorder

A

Living alone
Parental loss
Hx of abuse
Low socioeconomic group

59
Q

Antisocial behaviour disorder

A 
Disrespect for law
Repeated lying and conning of others
Impulsive
Irritable/Aggressive
Reckless disregard for safety
Lack of remorse to others following harm/mistreat/stealing
60
Q

Avoidant Personality Disorder

A

Avoids activities with interpersonal contact,
Fear criticism and rejection (preoccupied that they are being)
View of self inferior to others
Social isolation

61
Q

Borderline Personality Disorder

A

Unstable interpersonal relationships (alternate between idealised and devalued)

Ustable self image

Impulsive (e.g. spending, sex, substance abuse)

suicidal behaviour

Self destructive

62
Q

Dependant

A

Difficulty making decisions without excessive reassurance

Need others to assume responsibility

Unrealistic feelings they cant care for themselves

63
Q

Histrionic Personality Disorder

A

Inapprop sexual seductiveness

Need centre of attention

64
Q

Narcissistic Personality Disorder

A

Grandiose self importance

Taking advantage of others for own needs

Arrogant

Chronic envy

65
Q

Paranoid Personality Disorder

A

Hypersensitive and unforgiving

Questions loyalty of friends

Reluctant to confide in others

Preoccupied with conspirational beliefs

66
Q

Schizoid Personality Disorder

A

Lack of desire for sex and companionship
Few interest/friends
Flat affect

67
Q

Shizotypal Personality Disorder

A

ideas of reference

Paranoid ideation/suspiciousness

Lack of close friends

Odd speech

68
Q

Post concussion syndrome

A

Headache
Fatigue
Anxiety
Dizziness

69
Q

PTSD

- Features and diagnosis

A

Over a month of

  • Flashbacks, nightmare
  • Avoidance of associated people/circumstances
  • Hyperarousal: sleep probs, hyper vigilance, irritability
  • emotional numbing
70
Q

Complication of PTSD

A

Depression

Alcohol/Drug misuse

71
Q

Management PTSD

A

Trauma focused CBT

Eye movement desensitisation and reprocessing

72
Q

Pseudohallucinations

A

False sensory perception in the absence of external stimuli

Insight retained: aware they are hallucinating

73
Q

Hypnogogic halluciantion

A

Often auditory pseudo hallucination when falling to sleep

74
Q

Psychosis

A

Hallucinations or Delusions

75
Q

Schizophrenia

  • Strongest RF
  • Other RF
A 
Family Hx (50% if monozygotic)
Black Caribbean
Migration
Urban env
Cannabis use
76
Q

Schizophrenia

- Schneiders 1st rank symptom categories

A

Auditory hallucinations

Thought disorders

Passivity Phenomena

Delusional perceptions

77
Q

Auditory hallucination types

A

Two voices discussing patient in third person

Thought Echo

Voices commenting on behaviour

78
Q

Thought disorder types

A

Insertion
Withdrawal
Broadcasting

79
Q

Passivity phenomena

A

External influence controlling body

Action/feelings imposed on individual by others

80
Q

Delusional perceptions

A

Delusional insight to an objects/events meaning for the patient (e.g. traffic light is green therefore I am king)

81
Q

Features of schizophrenia (other than 1st rank)

A

Impaired insight

Incongruous/blunted affect (inappropriateness emotions for circumstances)
Decreased speech
Neologisms
Catatonia

82
Q

Negative symptoms Schizophrenia

A

Blunt affect
Anhedonia (inability to derive pleasure
Poor speech
Lack of motivation

83
Q

Schizophrenia management

A

Oral atypical antipsychotics
(Olanzapine Quetiapine)

CBT

If 2+ atypical not controlling then consider Clozapine (Risk agranulocytosis)

84
Q

Poor prognostic indicators in Schizoprenia

A

Strong FH
Gradual onset
Low IQ
Premorbid social withdrawal

85
Q

Section

  • 5(2)
  • 5(4)
A

Inpatient detainment or 6hrs by Dr

5(4) same but nurse

86
Q

Section

  • 135
  • 136
A

court order to break into house to remove

Police can take someone from public place

87
Q

SSRIs

  • Preferred 1st line
  • Post MI
  • In children
A

Citalopram and Fluoxetine

Sertraline post MI

Fluoxetine

88
Q

SSRI adverse effect

A

GI most common

Inc anxiety and agitation (counsel patients on this)

89
Q

Citalopram Advers effect + CI

A

Prolonged QT (dose dependant)

Congenital long QT, Other drugs increasing QT

90
Q

SSRIs interactions

A

NSAIDs/Aspirin (give PPI to prevent GI bleeding

Warfarin/Heparin

Triptans

91
Q

How to prescribe SSRIS

A

Review in two weeks (check anxiety, suicidal ideation, compliance)

Should take for 6mnths after remission to reduce risk of relapse

When stopping gradually reduce over 4 weeks

92
Q

Sleep paralysis features

A

Paralysis - occurs after waking

Hallucinations - images or auditory

93
Q

Suicide RFs

A 
Male sex
Hx of self harm
Alcohol/drug misuse
Mental illness (depression, Schizophrenia
Chronic disease
Advancing age
Unemployed
Lives alone
Unmarried/Divorced/Widowwed
94
Q

In suicide attempts, inc risk of completion

A

Efforts to avoid discovery

Planning

Written note

Final acts e.g. sorting finances

Violent method (hence why males)

95
Q

Suicide Protective factors

A

Family support

Children at home

Religion

96
Q

Tricyclic antidepressants

  • Use
  • SE
  • Drugs
A

Used more widely in neuropathic pain (lower dose). Blocks monoamine uptake. also affects muscarinic (parasympathetic block)

Drowsiness, dry mouth, blurred vision, constipaiton, urinary retention

Low dose Amitriptyline common in pain and prophylaxis of tension headache/migrain

97
Q

Unexplained symptoms:

A

Somatisation:

  • Multiple physical symptoms for 2 years
  • refusal to accept reassurance

Conversion disorder:

  • Loss of motor/sensory functions
  • No feigning symptoms or malingering
98
Q

Munchausen’s syndrome

A

Factitious disorder

Intentional production of physical or psychological symptoms

Can go as far as getting surgery

99
Q

Malingering

A

Fraudulent simulation or exaggeration of symptoms with intention of financial or other gain

100
Q

Major and minor symptoms of depression

A

Low mood
Anhedonia
Fatigue

Sleep disturbance, appetite change, poor conc, low self esteem, guilt, suicidal thoughts, pessimistic of future

101
Q

Neurodevelopmental model for schizophrenia

A

Genetic predisposition

Childhood/adolescent stressors

Psychoactive drugs

Schizophrenia in early childhood

102
Q

Depression pathophys

A

Low BDNF

Decreased neural acitivty and survival (inc apoptosis and atrophy) this reduce monoamine Its

103
Q

Mini mental state examination mnemonic

A

ASEPTIC Appearance and behaviour Speech Emotion Perceptions Thoughts Insights Cognition

104
Q

Schizophrenia diagnosis:

A

1 clear 1st rank or at least 2 other symptoms for over 1 month

105
Q

Features of paranoid schizophrenia

A

Delusions of persecution/reference

Threatening hallucinatory voices

106
Q

Catatonic Schizophrenia additional prodominating feature

A

marked decrease in reactivity to the environment and in spontaneous movements and activity

107
Q

How is Clozapine monitored

A

Weekly for 18 weeks

Fortnightly for 1 year

Monthly

108
Q

Neuroleptic malignant syndrome

Cause & Tx

A

neuroleptic drug use causing imbalance of dopaminergic NTs

Bromocriptine

109
Q

Bloods of Neuroleptic malignant syndrome

A 
High K+ (Rhabdomyolysis)
Leukocytosis
High LFTs (Liver fail)
High Cr (Renal fail)
Low pH (acidosis)
110
Q

SAD PERSONS

suicide

A

Sex (male
Age (under 19, over 45
Depression

Previous attempt
Ethanol
Rational (lost)
Social support (none)
Organised plan
No spouse
Sickness
111
Q

Types of anxiety

A

GAD

Panic disorder

Phobias

112
Q

GAD def

A

6 months of prominent tension about everyday events

4 out of:
Trembling, Palpitations, Sweating, Dry mouth, SOB, Chest pain, nausea, dixxi etc

113
Q

3 types of phobia

A

Agoraphobia (crowded places)

Acrophobia (heights)

114
Q

GAD Questionairred

A

Ask about feelings of anxiety/nervousness over the past 2 weeks

115
Q

What is used in primary care for monitoring depression

A

PHQ-9

116
Q

How to manage first psychotic episode

A

ORal antipsychotic

AND

Psychological interventions

117
Q

When can MHA be applied

A

Risk f harm to self or others
Nature of illness warrants detention

Informal detention

Drug/alcohol dependance

118
Q

Serotonin syndrome triad

A

1) Cognitive impairment
2) Autonomic dysfunction
3) Neuromuscular dysfunction

119
Q

Lithium excretion

A

Renally
Half in first 12 hours
Rest over 2 weeks

120
Q

When is Lithium dangerous

A

Dehydration
Sodium depletion
Thiazide diuretic
Renal disease

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