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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
Depression Screening Qs
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?
26
Two E.Gs of depression assessment Questionnaires
Hospital anxiety and depression scale (HAD) 0-7 normal, 8-10 borderline, 11+ depressed Patient Health Questionnaire (PHQ-9)
27
DSM-5 criteria for depression (seen daily or almost daily) Anything under 5 of the following is sub threshold depression
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
28
DSM-5 mild depression
Just over 5 symptoms. Minor functional impairment
29
DSM-5 severe depression
Most of the Symptoms are present at impair daily functioning ± psychosis
30
Non-drug therapy for depression
``` Guided self help Computerised CBT Behavioural activation interpersonal therapy Eye movement desensitisation reprocessing ```
31
Guided self help - For who - Desc
For depression, anxiety and panic work through CBT based work book Therapist helps you understand problems and make +ve changes
32
counselling
One on one. For those who have tried self help
33
Behavioural activation
one on one or group Motivates you to make small positive changes to life
34
Interpersonal therapy
Addresses problems with poor relationships (family, partners, friends)\
35
EMDR - who - what
PTSD | helps brain reprocess traumatic events
36
Switching between antidepressants
Usually one with drawn and the next started fluoxetine - leave a break
37
ECT - when used - CI - SE
Treatment of severe depression refractory to meds or psychotic depression Increased ICP Headache, Nausea, Short term memory loss Cardiac arrhythmia
38
Generalised anxiety disorder Tx
SSRI anti-depressants Beta-blockers Benzo: diazepam CBT
39
General anxiety - Central feature - Organic Ddx - Medication causes
Excessive worry about number of events associated with heightened tension Hyperthyroidism, Cardiac disease Salbutamol, theophylline, antidepressants, caffeine
40
Step wise management of GAD
1) education about GAD 2) Low intensity psychological (guided self-help or psychoeducational groups) 3) CBT or drug therapy 4) Specialist management
41
Drug therapy in GAD
SSRI 1st line | under 30 warn of suicidal ideation - weekly follow up 1st month
42
Panic disorder Tx
1) Recognition and self help (self guided therapy) | 2) CBT or drug (SSRI)
43
5 stages of grief:
Denial (may include pseudo hallucinations) Anger (often against medical professionals, fam members) Bargaining Depression Acceptance ** not all go through all stages
44
Features of atypical greif
Delayed Grief (2 week + delay) Prolonged Grief (Normal may take up to 12 months)
45
Insomnia Def
Difficulty initiating sleep or early morning waking. Leads to impaired daytime functioning
46
Lithium - Problem - Adverse effects
Narrow therapeutic index N&V, Tremor, Nephrotoxic (nephorgenic diabete insipidus = poyuria) ECG: Twave inversion Weight gain
47
Circumstantiality
Answer question with excessive unecessary details
48
Tangentiality
Wandering from a topic without returning
49
Neoligism
new word formation, may be made up of two words
50
Knights move thinking seen in what?
severe loosening of associations. Unexpected illogical leaps from one idea to anther (seen in schizophrenia)
51
Flight of ideas. Feature of?
Leaps from one topic to another without link Seen in mania
52
Echolalia
Repeating someones speech, including questions just asked
53
Monoamine oxidase inhibitors: - Mech - Use - Adverse effects/interactions
Block MAO presynaptic metabolism of serotonin and noradrenaline Antidepressant Hypertensive reaction with tyraminefoods (cheese, bovril, marmite, broad beans)
54
OCD diagnosis
Obsession Repetitive behaviours in response to obsession. Compulsion prevent distress Take up time (e.g. over 1 hour a day
55
OCD associated diseases
Depressio Schizophrenia Tourettes Anorexia
56
Othello's syndrome
Pathological jealousy Convinced of cheating without proof. Socially unacceptable behaviour in response
57
Panic disorder - diagnosis - who - tx
Symptoms for 1mnth+ Women (15-24, 45-54) SSRIs. CBT
58
RF panic disorder
Living alone Parental loss Hx of abuse Low socioeconomic group
59
Antisocial behaviour disorder
``` 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
Avoidant Personality Disorder
Avoids activities with interpersonal contact, Fear criticism and rejection (preoccupied that they are being) View of self inferior to others Social isolation
61
Borderline Personality Disorder
Unstable interpersonal relationships (alternate between idealised and devalued) Ustable self image Impulsive (e.g. spending, sex, substance abuse) suicidal behaviour Self destructive
62
Dependant
Difficulty making decisions without excessive reassurance Need others to assume responsibility Unrealistic feelings they cant care for themselves
63
Histrionic Personality Disorder
Inapprop sexual seductiveness Need centre of attention
64
Narcissistic Personality Disorder
Grandiose self importance Taking advantage of others for own needs Arrogant Chronic envy
65
Paranoid Personality Disorder
Hypersensitive and unforgiving Questions loyalty of friends Reluctant to confide in others Preoccupied with conspirational beliefs
66
Schizoid Personality Disorder
Lack of desire for sex and companionship Few interest/friends Flat affect
67
Shizotypal Personality Disorder
ideas of reference Paranoid ideation/suspiciousness Lack of close friends Odd speech
68
Post concussion syndrome
Headache Fatigue Anxiety Dizziness
69
PTSD | - Features and diagnosis
Over a month of - Flashbacks, nightmare - Avoidance of associated people/circumstances - Hyperarousal: sleep probs, hyper vigilance, irritability - emotional numbing
70
Complication of PTSD
Depression | Alcohol/Drug misuse
71
Management PTSD
Trauma focused CBT | Eye movement desensitisation and reprocessing
72
Pseudohallucinations
False sensory perception in the absence of external stimuli Insight retained: aware they are hallucinating
73
Hypnogogic halluciantion
Often auditory pseudo hallucination when falling to sleep
74
Psychosis
Hallucinations or Delusions
75
Schizophrenia - Strongest RF - Other RF
``` Family Hx (50% if monozygotic) Black Caribbean Migration Urban env Cannabis use ```
76
Schizophrenia | - Schneiders 1st rank symptom categories
Auditory hallucinations Thought disorders Passivity Phenomena Delusional perceptions
77
Auditory hallucination types
Two voices discussing patient in third person Thought Echo Voices commenting on behaviour
78
Thought disorder types
Insertion Withdrawal Broadcasting
79
Passivity phenomena
External influence controlling body Action/feelings imposed on individual by others
80
Delusional perceptions
Delusional insight to an objects/events meaning for the patient (e.g. traffic light is green therefore I am king)
81
Features of schizophrenia (other than 1st rank)
Impaired insight Incongruous/blunted affect (inappropriateness emotions for circumstances) Decreased speech Neologisms Catatonia
82
Negative symptoms Schizophrenia
Blunt affect Anhedonia (inability to derive pleasure Poor speech Lack of motivation
83
Schizophrenia management
Oral atypical antipsychotics (Olanzapine Quetiapine) CBT If 2+ atypical not controlling then consider Clozapine (Risk agranulocytosis)
84
Poor prognostic indicators in Schizoprenia
Strong FH Gradual onset Low IQ Premorbid social withdrawal
85
Section - 5(2) - 5(4)
Inpatient detainment or 6hrs by Dr 5(4) same but nurse
86
Section - 135 - 136
court order to break into house to remove Police can take someone from public place
87
SSRIs - Preferred 1st line - Post MI - In children
Citalopram and Fluoxetine Sertraline post MI Fluoxetine
88
SSRI adverse effect
GI most common Inc anxiety and agitation (counsel patients on this)
89
Citalopram Advers effect + CI
Prolonged QT (dose dependant) Congenital long QT, Other drugs increasing QT
90
SSRIs interactions
NSAIDs/Aspirin (give PPI to prevent GI bleeding Warfarin/Heparin Triptans
91
How to prescribe SSRIS
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
Sleep paralysis features
Paralysis - occurs after waking Hallucinations - images or auditory
93
Suicide RFs
``` Male sex Hx of self harm Alcohol/drug misuse Mental illness (depression, Schizophrenia Chronic disease Advancing age Unemployed Lives alone Unmarried/Divorced/Widowwed ```
94
In suicide attempts, inc risk of completion
Efforts to avoid discovery Planning Written note Final acts e.g. sorting finances Violent method (hence why males)
95
Suicide Protective factors
Family support Children at home Religion
96
Tricyclic antidepressants - Use - SE - Drugs
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
Unexplained symptoms:
Somatisation: - Multiple physical symptoms for 2 years - refusal to accept reassurance Conversion disorder: - Loss of motor/sensory functions - No feigning symptoms or malingering
98
Munchausen's syndrome
Factitious disorder Intentional production of physical or psychological symptoms Can go as far as getting surgery
99
Malingering
Fraudulent simulation or exaggeration of symptoms with intention of financial or other gain
100
Major and minor symptoms of depression
Low mood Anhedonia Fatigue Sleep disturbance, appetite change, poor conc, low self esteem, guilt, suicidal thoughts, pessimistic of future
101
Neurodevelopmental model for schizophrenia
Genetic predisposition Childhood/adolescent stressors Psychoactive drugs Schizophrenia in early childhood
102
Depression pathophys
Low BDNF Decreased neural acitivty and survival (inc apoptosis and atrophy) this reduce monoamine Its
103
Mini mental state examination mnemonic
ASEPTIC Appearance and behaviour Speech Emotion Perceptions Thoughts Insights Cognition
104
Schizophrenia diagnosis:
1 clear 1st rank or at least 2 other symptoms for over 1 month
105
Features of paranoid schizophrenia
Delusions of persecution/reference Threatening hallucinatory voices
106
Catatonic Schizophrenia additional prodominating feature
marked decrease in reactivity to the environment and in spontaneous movements and activity
107
How is Clozapine monitored
Weekly for 18 weeks Fortnightly for 1 year Monthly
108
Neuroleptic malignant syndrome | Cause & Tx
neuroleptic drug use causing imbalance of dopaminergic NTs Bromocriptine
109
Bloods of Neuroleptic malignant syndrome
``` High K+ (Rhabdomyolysis) Leukocytosis High LFTs (Liver fail) High Cr (Renal fail) Low pH (acidosis) ```
110
SAD PERSONS | suicide
Sex (male Age (under 19, over 45 Depression ``` Previous attempt Ethanol Rational (lost) Social support (none) Organised plan No spouse Sickness ```
111
Types of anxiety
GAD Panic disorder Phobias
112
GAD def
6 months of prominent tension about everyday events 4 out of: Trembling, Palpitations, Sweating, Dry mouth, SOB, Chest pain, nausea, dixxi etc
113
3 types of phobia
Agoraphobia (crowded places) Acrophobia (heights)
114
GAD Questionairred
Ask about feelings of anxiety/nervousness over the past 2 weeks
115
What is used in primary care for monitoring depression
PHQ-9
116
How to manage first psychotic episode
ORal antipsychotic AND Psychological interventions
117
When can MHA be applied
Risk f harm to self or others Nature of illness warrants detention Informal detention Drug/alcohol dependance
118
Serotonin syndrome triad
1) Cognitive impairment 2) Autonomic dysfunction 3) Neuromuscular dysfunction
119
Lithium excretion
Renally Half in first 12 hours Rest over 2 weeks
120
When is Lithium dangerous
Dehydration Sodium depletion Thiazide diuretic Renal disease

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