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Psychiatry Flashcards

1
Q

List the 10 components of a mental state examination

A 
Appearance
Behaviour
Mood
Speech
Thoughts
Beliefs
Perceptions
Suicide
Cognitive function
Insight
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2
Q

Name 3 mood disorders

A

Depression
Mania
Bipolar affective disorder

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3
Q

What is the classification system used for affective disorders?

A

ICD-10

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4
Q

List 5 broad effects of depression on an individual

A 
Change in mood
Change in thought content
Change in bodily function
Loss of interest
Irritability
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5
Q

List 10 symptoms of depression

A 
Anhedonia
Low mood
Retardation
Fatigue
Loss of appetite
Loss of libido
Loss of interest 
Social withdrawal
Delusions/hallucinations
Loss of confidence
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6
Q

How many general criteria and additional criteria are required for diagnoses of mild, moderate and sever depression?

A 
Mild = 2 general, 2 additional
Moderate = 2 general, 4 additional
Severe = 3 general, 5 additional
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7
Q

List the three ICD-10 general criterion for depression

A

Depressed mood
Loss of interest
Fatigue or reduced energy

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8
Q

List 4 classes of antidepressant

A

SSRIs
TCAs
Monoamine oxidase inhibitors
SNRIs

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9
Q

List 4 treatments for depression

A

Antidepressants
CBT
IPT
ECT

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10
Q

List 6 symptoms of mania

A 
Elevated mood
Increased energy
Disinhibition
Grandiosity
Decreased sleep
Extravagant spending
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11
Q

List 4 treatments for mania

A

Antipsychotics
Mood stabilisers
Lithium
ECT

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12
Q

Name 5 antipsychotics

A 
Olanzapine
Risperidone
Quetiapine
Clozapine
Aripiprazole
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13
Q

Name 3 anticonvulsants

A

Valproic acid
Lamotrigine
Carbamazepine

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14
Q

Can bipolar affective disorder be diagnosed from depression only (without mania)? Can it be diagnosed from mania only (no depression?)

A

Only mania required for diagnosis of bipolar affective disorder. Depressive episode is assumed.

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15
Q

What is CBT?

A

CBT (cognitive behavioural therapy) is a psychological therapy that aims to identify and challenge thinking errors

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16
Q

What is behavioural activation?

A

A psychological therapy which promotes activity scheduling in order to combat harmful behaviours which worsen illness

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17
Q

What is interpersonal therapy?

A

A psychological therapy which aims to identify interpersonal events that may have triggered illness and resolving them as far as possible to relieve illness

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18
Q

What is motivational interviewing?

A

A specialised form of interview where emphasis is focused on understanding individual’s predicament and motivating them to resolve it

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19
Q

What are the 5 stages of change?

A 
Pre-contemplation
Contemplation
Planning
Action
Maintenance
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20
Q

How long can a patient be detained in hospital with:

  • Emergency detention certificate
  • Short-term detention certificate
  • Compulsory treatment order
  • Nurses holding power?
A

EDC - up to 72 hours
STDC - up to 28 days
CTO - up to 6 months
NHP - up to 3 hours

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21
Q

What 5 criteria must be met for a detention order to be granted?

A 
Patient must have a mental disorder
Patient decision-making must be impaired
Necessary for treatment
Significant risk to health
Appropriate
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22
Q

What is a guardianship order?

A

The appointing of someone else to make decisions on behalf of an incapacitated adult

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23
Q

What should be completed before treating a patient without capacity to consent?

A

A certificate of incapacity

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24
Q

What is required to treat a patient with a mental disorder against his will in hospital? Can a certificate of incapacity authorise this?

A

A detention order is required. A certificate of incapacity does not authorise unconsented medical treatment of a mental disorder.

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25
Q

List 5 symptoms of alcohol withdrawal

A 
Tremor
Weakness
Nausea
Vomiting
Seizures
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26
Q

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

A

Wernicke’s encephalopathy

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27
Q

What screening tool is used for assessing alcohol dependence?

A

CAGE

  • Cut down?
  • Felt annoyed by criticism?
  • Guilt
  • Eye-opener
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28
Q

Name 3 medications used in the treatment of alcohol withdrawal

A

Thiamine (to prevent Wernicke’s)
Benzodiazepine (chlordiazepoxide)
Disulfaram (deterrent - adversely reacts to alcohol consumption)

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29
Q

What cardiac risk do TCAs carry?

A

Can cause QT lengthening

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30
Q

List 4 side effects of TCAs

A

Weight gain
Dry mouth
Dry eyes
Loss of libido

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31
Q

Name 3 TCAs

A

Amitriptyline
Nortriptyline
Doxepin

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32
Q

List 5 side effects of monoamine oxidase inhibitors

A

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)

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33
Q

List 3 side effects of SSRIs

A

GI upset
Loss of libido
Insomnia

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34
Q

List 4 SSRIs

A

Paroxetine
Sertraline
Fluoxetine
Citalopram

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35
Q

List 2 SNRIs

A

Venlafaxine

Duloxetine

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36
Q

List 2 novel antidepressants

A

Mirtazapine

Buproprion

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37
Q

List a common side effect of mirtazapine

A

Raises cholesterol

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38
Q

Can lithium be prescribed to pregnant women?

A

No

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39
Q

List 5 side effects of lithium

A 
GI upset
Thyroid problems
Polyuria
Cognitive slowing
Hair loss
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40
Q

What is the aim blood level of lithium?

A

Between 0.6 and 1.2

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41
Q

List 4 side effects of valproic acid

A

Thrombocytopenia
Nausea
Weight gain
Sedation

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42
Q

What is the first line agent for mania?

A

Carbamazepine (anticonvulsant)

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43
Q

Before prescribing anticonvulsants, what four tests should be performed?

A

LFTs
FBC
Pregnancy test
ECG

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44
Q

List 5 side effects of carbamazepine

A 
Rash
Nausea
Sedation
Diarrhoea
AV conduction delays
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45
Q

List 4 side effects of lamotrigine

A

Nausea
Sedation
Dizziness
Stevens Johnson’s Syndrome (skin falls off)

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46
Q

What 3 tests must be done before lithium prescription?

A

TSH
Creatinine
Pregnancy test

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47
Q

What are the 4 dopaminergic pathways?

A

Mesocortical
Mesolimbic
Nigrostriatal
Tuberoinfundibular

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48
Q

Are typical antipsychotics or atypical antipsychotics more favourable? Why?

A

Atypical favoured due to lack of extrapyramidal side effects

49
Q

List 2 side effects of risperidone

A

Weight gain Sedation

50
Q

List 4 side effects of olanzapine

A

Weight gain
Hypercholesterolemia
Hyperglycaemia
Hypertriglycerideaemia

51
Q

What is the main dangerous side effect of clozapine? How is this monitored?

A

Agranulocytosis (destruction of WBC).

Monitored weekly for first 6 months, then 2-weekly for second 6 months)

52
Q

What is the first line antipsychotic used?

A

Risperidone
Then aripiprazole
Then clozapine

53
Q

What 3 blood tests must be undertaken before prescription of an antipsychotic?

A

Fasting BM
Fasting lipid profile
LFTs

54
Q 
What is akathisia?
What class of drugs cause this side effect? How is it treated?
A

Akathisia - inner restlessness.
Caused by antipsychotics.
Treat with propranolol or anticholinergic.

55
Q

Define tolerance

A

Reduced responsiveness to a drug caused by previous administration

56
Q

Name 2 mechanisms of tolerance and a brief description of each

A

Dispositional tolerance - less drug reaches active site

Pharmacodynamic tolerance - drug has less effect on receptors

57
Q

What are 2 common complications of tolerance?

A

Withdrawal

+ consequent dependence (to avoid withdrawal effect)

58
Q

What causes psychological craving?

A

Reward centres being activated by drugs

59
Q

What are the main forms of drug dependence?

A 
Physical dependence (result of tolerance)
Psychological craving (result of reward pathway stimulation)
60
Q

What are the 3 components of the reward pathway?

A

VTA (ventral tegmental area)
Nucleus accumbens
Prefrontal cortex

61
Q

List 3 ‘good’ and 3 ‘bad’ effects of cocaine

A

Euphoria
Increased energy
Increased confidence

Damage to URT
Hypertension
Arrhythmias

62
Q

List 4 opiates

A

Morphine
Heroin
Codeine
Methadone

63
Q

List 4 effects of heroin

A

Analgesia
Drowsiness
Euphoria
Respiratory depression

64
Q

List 4 symptoms of opiate withdrawal syndrome

A

Craving
Insomnia
Muscle pain
Dilated pupils

65
Q

List 4 side effects of ecstasy

A

Nausea
Increased BP
Dry mouth
Dehydration

66
Q

Define psychosis

A

Psychosis represents an inability to distinguish between symptoms of hallucination, delusion and disordered thinking from reality.

67
Q

List 3 conditions that may present with psychosis

A

Schizophrenia
Delirium
Severe affective disorder

68
Q

List 3 positive and 3 negative symptoms of schizophrenia

A

Positive:
Delusions
Hallucinations
Disordered thinking

Negative:
Lack of interest
Lack of emotions
Apathy

69
Q

What are the ICD-10 criteria for a diagnosis of schizophrenia?

A

One of:
Thought alienation
Delusions
Hallucinatory voices

And two of:
Persistent hallucinations
Breaks of thought
Catatonic behaviour
Negative symptoms
70
Q

List 5 factors which may predispose someone to schizophrenia

A 
Substance misuse
Family history
Social isolation
Obstetric complications
Dramatic family
71
Q

What is a Cluster A personality disorder? List 3.

A

Prominent problems are with the perceived safety of interpersonal relationships.
Paranoid personality disorder
Schizoid personality disorder
Schizotypal personality disorder

72
Q

What is paranoid personality disorder?

A

A distrust and suspiciousness of others with motives being interpreted as harmful

73
Q

What is schizoid personality disorder?

A

A detachment from social relationships and restricted range of interpersonal emotions

74
Q

What is schizotypal personality disorder?

A

A discomfort with close relationships accompanied by cognitive or perceptual distortions

75
Q

What is a Cluster

B personality disorder? List 4.

A 
Prominent problems are with keeping feelings tolerable without acting.
Antisocial personality disorder
Borderline personality disorder
Narcissistic personality disorder
Histrionic personality disorder
76
Q

What is antisocial personality disorder?

A

Disregard for and violation of the rights of others

77
Q

What is borderline personality disorder?

A

Instability of interpersonal relationships, self-image, mood and a marked impulsivity

78
Q

What is narcissistic personality disorder?

A

Grandiosity, need for admiration and lack of empathy

79
Q

What is histrionic personality disorder?

A

Excessive emotionality and attention seeking

80
Q

What is a Cluster C personality disorder? List 3.

A

Prominent problems relate to anxiety and how it is managed.
Obsessive-compulsive disorder
Dependence personality disorder
Avoidant personality disorder

81
Q

What is obsessive-compulsive disorder?

A

Pre-occupation with orderliness, perfectionism and control

82
Q

What is dependent personality disorder?

A

Excessive need to be cared for that leads to submissive and clinging behaviour

83
Q

What is avoidant personality disorder?

A

Social inhibition, feelings of inadequacy and hypersensitivity to negative evaluation

84
Q

What is stigma?

A

A social construction that devalues people due to a distinguishing characteristic or mark

85
Q

What are the 2 forms of coping?

A

Problem focussed

Emotion focussed

86
Q

List 5 symptoms of anxiety

A 
Psychological arousal
Autonomic arousal
Muscle tension
Hyperventilation
Sleep disturbance
87
Q

List 2 forms of anxiety disorder

A

Phobic anxiety disorder

Generalised anxiety disorder

88
Q

List 3 forms of phobia

A

Agoraphobia
Social phobia
Specific phobia

89
Q

List 2 drug classes suitable for treatment of generalised anxiety disorder

A

Antidepressants (SSRI/TCA)

Sedatives

90
Q

List 4 treatments for generalised anxiety disorder

A

Medication
CBT
Counselling
Relaxation training

91
Q

List 2 treatments for OCD

92
Q

What are the 3 key elements of a PTSD reaction?

A

Hyperarousal
Re-experiencing phenomena
Avoidance of reminders

93
Q

List 5 factors which may predispose children to psychiatric conditions

A 
Parental attachment
Abuse
Maternal health
Co-morbidities
Head injury
94
Q

What are conduct disorders?

A

Repetitive patterns of antisocial, aggressive or defiant behaviours

95
Q

List 3 management options for childhood conduct disorders

A

Parent training programme
Family therapy
Behavioural support

96
Q

What is ADHD?

A

Hyperkinetic disorder characterised by abnormal inattention, hyperactivity and impulsivity

97
Q

List 3 treatments for ADHD

A

Psychoeducation
Stimulant medication - methylphenidate
Parent training

98
Q

Anxiety disorders in adolescents is associated with suppressed activity of which neurological structure?

99
Q

List 2 treatments for adolescent anxiety disorders

A

SSRIs

Behavioural (CBT)

100
Q

List 2 classes of synaptic proteins that may be implicated in autism spectrum disorder

A

GABA

Glutaminergic

101
Q

List 4 distinctive features of autism

A

Non-verbal communication
Repetitive behaviour
Obsessions
Low IQ

102
Q

What is oppositional defiant disorder?

A

A childhood psychiatric condition characterised by high temper and refusal to obey adult request

103
Q

What is the main drug treatment for dementia?

A

Acetylcholinesterase inhibitors

104
Q

What screening tool is used to assess likelihood of an eating disorder?

A

SCOFF questionnaire

105
Q

What is anorexia nervosa? What is the considered BMI?

A

Eating disorder characterised by limited food intake and fear of weight gain.
Causes amenorrhoea.
BMI <17.5

106
Q

List 4 symptoms of anorexia

A

Amenorrhoea
Weakness
Hypotension
Cold intolerance

107
Q

What is bulimia nervosa?

A

Eating disorder characterised by episodes of binge eating with a sense of loss of control. Followed by self-induced vomiting, laxative abuse or diuretic abuse. Obsession about body shape and weight.

108
Q

List 4 symptoms of bulimia nervosa

A

Heartburn
Pharyngeal trauma
Dental issues
Weakness

109
Q

What is binge eating disorder?

A

Eating disorder characterised by episodes of binge eating without any compensatory mechanism (self-induced vomiting etc)

110
Q

List 4 complications of eating disorders

A

Fertility problems
Increased likelihood of depression
Anaemia
Reduced immunity

111
Q

List 3 risk factors of developing anorexia nervosa

A

Stressful life events
Genetics
Puberty

112
Q

List 5 treatments for anorexia nervosa

A 
Re-feeding
CBT
IPT
Family therapy
Medication (SSRI or Olanzapine)
113
Q

List 4 common features of organic mental disorders

A

Cognitive impairment
Behavioural abnormality
Mood changes
Psychosis

114
Q

Name 1 acute and 1 chronic organic mental disorder

A

Acute - delirium

Chronic - dementia

115
Q

List 5 presenting symptoms of delirium

A 
Impaired attention
Disorientation
Mood changes
Disordered thinking
Hallucinations/illusions
116
Q

What is a learning disability?

A

A condition of incomplete development of the mind

117
Q

List 3 criteria for a diagnosis of learning disability

A 
Intellectual impairment (IQ<70)
Social dysfunction
Early onset (during developmental period)
118
Q

What IQ range depicts mild, moderate, severe and profound learning disability?

A 
Mild = 50-69
Moderate = 35-49
Severe = 20-34
Profound = <20
119
Q

List 4 causes of learning disability

A

Genetic
Infection (meningitis, rubella)
Fetal alcohol syndrome
Trauma (head injury)

Psychiatry (14 decks)

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