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3rd year > Psychiatry > Flashcards

Psychiatry Flashcards

1
Q

What are the symptoms of lithium toxicity?

A

GI - nausea and diarrhoeaCNS - weakness, drowsiness, ataxia, tremor, fasciculation

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2
Q

Hypomanic episode criteria

A

A - Mood elevated or irritable to abnormal degree for at least 4 daysANDB - at least 3 of: increased activity, restlessness, talkativeness, difficulty concentrating, distractibility, less need for sleep, inc. sexual energy, mild spending sprees.

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3
Q

Manic episode criteria

A

A - mood abnormally elevated/expansive/irritable for at least 1 week
B - at least three of: inc. activity, restless, inc. talkativeness, flight of ideas, loss of inhibitions, dec. need for sleep, inflated self-esteem, distractability, reckless behaviour, marked sexual energy

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4
Q

When is onset of bipolar most common?

A

Late teens - early 20s

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5
Q

Heritability of bipolar

A

59%

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6
Q

Heritability of schizophrenia

A

64%

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7
Q

Which type of bipolar is most common?

A

Bipolar II

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8
Q

Which type of bipolar is more depressive?

A

II

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9
Q

What is the product of inactivation of serotonin by MAO?

A

5-HIAA

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10
Q

How is tyrosine converted into NA?

A

Tyrosine -> DOPA via tyrosine hydroxylase
DOPA -> DA via L-AA decarboxylase
DA -> NA by DA B-hydroxylase

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11
Q

Reverse MAOI

A

Moclobemide

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12
Q

Irreversible MAOI

A

Phenelzine

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13
Q

Side effects of MAOIs

A 
Hypertensive crisis from dietary tyramine
Insomnia (stimulant)
Postural hypotension
Peripheral oedema
Decreased metabolism of barbiturates
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14
Q

Name four tricyclic antidepressants

A

Imipramine, lofepramine, amitriptyline, dosulepin

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15
Q

How do tricyclic antidepressants work?

A

Prevent reuptake of monoamines into the presynaptic terminal, thus preventing breakdown by MAO inside the cell

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16
Q

Side effects of tricyclic antidepressants

A

Anticholinergic effects (blurred vision, dry mouth, constipation, urinary retention), sedation, weight gain, cardiovascular effects (postural hypotension, tachycardia, arrhythmias, cardiotoxic in overdose)

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17
Q

Examples of SSRIs

A

Citalopram, fluoxetine, sertraline, paroxetine

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18
Q

Side effects of SSRIs

A

Nausea, headache, sweating, vivid dreams, worsened anxiety, sexual dysfunction, hyponatraemia, increase in self harm in under 25s

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19
Q

What class is venlafaxine?

A

SNRI

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20
Q

What class is duloxetine?

A

SNRI

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21
Q

What class is mirtazapine?

A

Atypical antidepressants/NASSA

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22
Q

What class is dosulepin?

A

Tricyclic antidepressant

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23
Q

Actions of mirtazapine

A

Blocks a2, 5-HT2, 5-HT3 receptors

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24
Q

Mirtazapine side effects

A

Weight gain

Sedation(SSRIs can help with serotonergic side effects so sometimes given together)

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25
Q

How does lithium work as a mood stabiliser?

A

Maybe by blocking phosphatidylinositol pathway or by inhibiting glycogen synthase kinase 3B

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26
Q

When should blood lithium levels first be monitored after initiation?

A

12 hours after first dose

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27
Q

Side effects of lithium

A

Dry mouth, polydipsia, polyuria, tremor, hypothyroidism, reduced renal function, nephrogenic diabetes insipidus, weight gain.Toxic effects - vomiting, diarrhoea, ataxia, drowsiness, convulsions, coma

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28
Q

What % of women experience baby blues in the first 2 weeks?

A

75%

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29
Q

How common is puerperal psychosis?

A

1 in 500 births

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30
Q

Recurrence risk of puerperal psychosis

A

1 in 3

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31
Q

Risk of depression after childbirth

A

10% MDD within 3-6 months

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32
Q

Changes to HPA axis in depression

A

Increased ACTH and cortisol secretion

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33
Q

Changes to HPT axis in depression

A

(20-30%) Increased TRH, blunted TSH response to TRH

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34
Q

Brain changes in bipolar

A

Reduced grey matter in anterior cingulate
Increased metabolism in amygdala
Reduced metabolism in olfactory cortex and medial ventral prefrontal cortex

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35
Q

Which antidepressant is particularly useful in patients with sleep and appetite issues?

A

Mirtazapine

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36
Q

First line antipsychotics in acute mania

A

Olanzapine, quietiapine, risperidone

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37
Q

Absolute contraindications for ECT

A

Recent (<3m) MI, recent CVA, intracranial mass, phaeochromocytoma

38
Q

Relative contraindications for ECT

A

Angina, congestive heart failure, severe pulmonary disease, severe osteoporosis, pregnancy

39
Q

Side effects of ECT

A

Headache, memory problems, muscle ache, cognitive problems

40
Q

ICD criteria for dependence

A 
Strong desire to take the substance
Difficulties in controlling substance use
Physiological withdrawal state
Tolerance
Neglect of alternative pleasures
Persistence despite evidence of harm
41
Q

Which area of the brain has increased blood flow when winning at gambling?

A

Striatum

42
Q

Which area of the brain is activated in addicts by drug cues, triggering cravings?

A

Orbito-frontal cortex

43
Q

Symptoms of opiate withdrawal

A

Dysphoria, cravings, agitation, tachycardia, hypertension, piloerection, diarrhoea, N+V, dilated pupils, joint pains, yawning rhinorrhoea, lacrimation

44
Q

Which partial opioid agonist is used in opiate substitution?

A

Buprenorphine

45
Q

Which full opioid agonist is used in opiate substitution?

A

Methadone

46
Q

Diagnostic criteria for GAD

A

Anxiety most days for >6 months, not controllable, causing significant distress or impairment in function

47
Q

Which area of the brain shows increased metabolism in panic attack?

A

Anterior pole of the temporal lobe

48
Q

OCD diagnostic criteria

A

Obsessional symptoms or compulsive acts presents most days for at least 2 weeksand a source of distress.Obsessions must be individual’s own thoughts

49
Q

How do benzos work?

A

Enhance effect of GABA via allosteric modulation on GABA-A receptor.

50
Q

Side effects of benzodiazepines

A

Sedation, psychomotor impairment, withdrawal problems, dependency and abuse, interaction with alcohol, worsening of depression

51
Q

What is Type 1 trauma?

A

A single, unexpected traumatic event

52
Q

What is Type 2 trauma?

A

Includes repetitive trauma, ongoing abuse, betrayal of trust, developmental trauma

53
Q

Which type of trauma carries a higher risk of PTSD?

A

Type 2

54
Q

What proportion of bipolar patients have a history of childhood deprivation or abuse?

A

50%

55
Q

Which areas in the brain do anxiety and fear originate from?

A

PAG, ventral tegmental area

56
Q

Features of tonic immobility

A

Decreased vocalisation, intermittent eye contact, rigidity and paralysis, muscle tremors, chills, unresponsiveness to pain

57
Q

PTSD diagnostic criteria

A

Traumatic event(s)
1 or more intrusive symptoms
1 or more avoidancesymptoms
1 or more negative alterations in cognitionand mood
2 or more signs of increased arousal
Duration >1 monthDistress and impairment in functioning

58
Q

What is complex PTSD?

A

PTSD symptoms + cognitive disturbance, identity disturbance, interpersonal difficulties, dissociation, somatisation, tension reduction activities

59
Q

Which hormone is found in unusually low levels in PTSD patients?

A

Cortisol

60
Q

Main neurological findings in PTSD

A

Hippocampal atrophy
Increased amygdala activity
Deactivation of Broca’s area when accessing traumatic memories
Right-hemispheric lateralisation

61
Q

First line treatment for mania in pregnancy

A

Olanzapine

62
Q

Which drug should be trialled in treatment resistant schizophrenia?

A

Clozapine

63
Q

Which type of antipsychotic is associated with metabolic syndrome?

A

Atypicals e.g. olanzapine

64
Q

How long can patients be held under a compulsory treatment order?

A

6 months

65
Q

Which investigation should be performed before starting lithium?

A

U and Es - it can cause renal impairment

66
Q

What proportion of people develop PTSD after an MI?

A

15%

67
Q

What % of patients in neurology outpatient clinics have functional symptoms?

A

30%

68
Q

What proportion of mental disorders begin before age 14?

A

Half

69
Q

What is the lifetime prevelance of major depression?

A

14-18%

70
Q

What is dysthymia?

A

A mild, chronic depressive state also known as persistent depressive disorder

71
Q

How long must symptoms last to meet criteria for diagnosis of depression?

A

At least 2 weeks

72
Q

Which three core features of depression must have two present for diagnosis?

A 
Depressed mood (at least 2 weeks)
Anhedonia
Decreased energy
73
Q

When is oppositional defiant disorder diagnosed?

A

Before age 12

74
Q

When is conduct disorder diagnosed?

A

After age 12

75
Q

What proportion of adults with depression experience symptoms before age 20?

A

Half

76
Q

What proportion of over 65s have a mental illness?

A

25%

77
Q

Which season do suicide rates peak?

A

Spring

78
Q

What proportion of suicides have a history of deliberate self-harm?

A

40%

79
Q

What is the strongest risk factor for suicide

A

Deliberate self harm

80
Q

Concordance of suicide for MZ twins

A

13%

81
Q

Which type of auditory hallucination is suggestive of schizophrenia?

A

3rd person

82
Q

Which form of schizophrenia is associated with early onset?

A

Hebephrenic

83
Q

What is heritability?

A

The proportion of observable differences in a trait between individuals in a population that is due to genetic differences.

84
Q

Macroscopic brain changes in schizophrenia with poor prognosis

A

Reduced frontal lobe volume and grey matter

Enlarged lateral ventricles

85
Q

Action of D1 and D5 dopamine receptors

A

Stimulate cAMP

86
Q

Action of D2, D3, D4 dopamine receptors

A

Inhibit adenyl cyclase
Inhibit voltage gated Ca channels
Open K channels

87
Q

Atypical antipsychotics

A

Olanzapine, risperidone, quetiapine, clozapine, aripiprazole, amisulpride

88
Q

Difference between typical and atypical antipsychotics

A

Atypical are newer, less likely to induce extrapyramidal side effect, and have more 5-HT2A activity

89
Q

Treatment of acute dystonia

A

Ach antagonists - prochloperazine, procyclidine, orhphenadrine

90
Q

Antidote in tricyclic overdose

A

Sodium bicarbonate

91
Q

ECG changes in tricyclic overdose

A

sinus tachycardia
widening of QRS
prolongation of QT interval

3rd year (6 decks)

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