Psychiatry Flashcards
List the 10 components of a mental state examination
Appearance Behaviour Mood Speech Thoughts Beliefs Perceptions Suicide Cognitive function Insight
Name 3 mood disorders
Depression
Mania
Bipolar affective disorder
What is the classification system used for affective disorders?
ICD-10
List 5 broad effects of depression on an individual
Change in mood Change in thought content Change in bodily function Loss of interest Irritability
List 10 symptoms of depression
Anhedonia Low mood Retardation Fatigue Loss of appetite Loss of libido Loss of interest Social withdrawal Delusions/hallucinations Loss of confidence
How many general criteria and additional criteria are required for diagnoses of mild, moderate and sever depression?
Mild = 2 general, 2 additional Moderate = 2 general, 4 additional Severe = 3 general, 5 additional
List the three ICD-10 general criterion for depression
Depressed mood
Loss of interest
Fatigue or reduced energy
List 4 classes of antidepressant
SSRIs
TCAs
Monoamine oxidase inhibitors
SNRIs
List 4 treatments for depression
Antidepressants
CBT
IPT
ECT
List 6 symptoms of mania
Elevated mood Increased energy Disinhibition Grandiosity Decreased sleep Extravagant spending
List 4 treatments for mania
Antipsychotics
Mood stabilisers
Lithium
ECT
Name 5 antipsychotics
Olanzapine Risperidone Quetiapine Clozapine Aripiprazole
Name 3 anticonvulsants
Valproic acid
Lamotrigine
Carbamazepine
Can bipolar affective disorder be diagnosed from depression only (without mania)? Can it be diagnosed from mania only (no depression?)
Only mania required for diagnosis of bipolar affective disorder. Depressive episode is assumed.
What is CBT?
CBT (cognitive behavioural therapy) is a psychological therapy that aims to identify and challenge thinking errors
What is behavioural activation?
A psychological therapy which promotes activity scheduling in order to combat harmful behaviours which worsen illness
What is interpersonal therapy?
A psychological therapy which aims to identify interpersonal events that may have triggered illness and resolving them as far as possible to relieve illness
What is motivational interviewing?
A specialised form of interview where emphasis is focused on understanding individual’s predicament and motivating them to resolve it
What are the 5 stages of change?
Pre-contemplation Contemplation Planning Action Maintenance
How long can a patient be detained in hospital with:
- Emergency detention certificate
- Short-term detention certificate
- Compulsory treatment order
- Nurses holding power?
EDC - up to 72 hours
STDC - up to 28 days
CTO - up to 6 months
NHP - up to 3 hours
What 5 criteria must be met for a detention order to be granted?
Patient must have a mental disorder Patient decision-making must be impaired Necessary for treatment Significant risk to health Appropriate
What is a guardianship order?
The appointing of someone else to make decisions on behalf of an incapacitated adult
What should be completed before treating a patient without capacity to consent?
A certificate of incapacity
What is required to treat a patient with a mental disorder against his will in hospital? Can a certificate of incapacity authorise this?
A detention order is required. A certificate of incapacity does not authorise unconsented medical treatment of a mental disorder.
List 5 symptoms of alcohol withdrawal
Tremor Weakness Nausea Vomiting Seizures
What condition presents normally with confusion and is a result of excessive alcohol consumption? Hint: pathophysiology is a thiamine deficiency secondary to excessive alcohol intake
Wernicke’s encephalopathy
What screening tool is used for assessing alcohol dependence?
CAGE
- Cut down?
- Felt annoyed by criticism?
- Guilt
- Eye-opener
Name 3 medications used in the treatment of alcohol withdrawal
Thiamine (to prevent Wernicke’s)
Benzodiazepine (chlordiazepoxide)
Disulfaram (deterrent - adversely reacts to alcohol consumption)
What cardiac risk do TCAs carry?
Can cause QT lengthening
List 4 side effects of TCAs
Weight gain
Dry mouth
Dry eyes
Loss of libido
Name 3 TCAs
Amitriptyline
Nortriptyline
Doxepin
List 5 side effects of monoamine oxidase inhibitors
Dry mouth
Weight gain
Loss of libido
Hypertensive crisis if taken with cheese!!
Serotonin syndrome (must wait 2 weeks before switching from SSRI to MAOI)
List 3 side effects of SSRIs
GI upset
Loss of libido
Insomnia
List 4 SSRIs
Paroxetine
Sertraline
Fluoxetine
Citalopram
List 2 SNRIs
Venlafaxine
Duloxetine
List 2 novel antidepressants
Mirtazapine
Buproprion
List a common side effect of mirtazapine
Raises cholesterol
Can lithium be prescribed to pregnant women?
No
List 5 side effects of lithium
GI upset Thyroid problems Polyuria Cognitive slowing Hair loss
What is the aim blood level of lithium?
Between 0.6 and 1.2
List 4 side effects of valproic acid
Thrombocytopenia
Nausea
Weight gain
Sedation
What is the first line agent for mania?
Carbamazepine (anticonvulsant)
Before prescribing anticonvulsants, what four tests should be performed?
LFTs
FBC
Pregnancy test
ECG
List 5 side effects of carbamazepine
Rash Nausea Sedation Diarrhoea AV conduction delays
List 4 side effects of lamotrigine
Nausea
Sedation
Dizziness
Stevens Johnson’s Syndrome (skin falls off)
What 3 tests must be done before lithium prescription?
TSH
Creatinine
Pregnancy test
What are the 4 dopaminergic pathways?
Mesocortical
Mesolimbic
Nigrostriatal
Tuberoinfundibular