Psychiatry Flashcards
Why should antipsychotics not be prescribed in lewy body dementia
Precipitates severe parkinsonism in 60%
Features of vascular dementia
Begins in 60s Stepwise deterioration cognitive function Focal neurology Fits Nocturnal confusion
Risk factors for vascular dementia
Male Smoking Hypertension DM Hypercholesterolaemia
Features of frontotemporal dementia
Disinhibition inattention antisocial behaviour personality change apathy Akinesia withdrawal Memory loss disorientation occur late
Features of normal pressure hydrocephalus
Triad of dementia, gait disturbance and urinary incontinence
What is the most common type of dementia
Alzheimer’s disease
Features of Alzheimer’s disease
Gradual progressive cognitive decline Apathy Labile mood Altered personality Paranoia
When may early onset Alzheimer’s occur
Down’s syndrome
Inheritance of amyloid precursor or presenillin proteins
Qs in the mini mental state examination
> year, month, day, date, time > country, county, town, building, floor > Repeat - apple, penny, cup > Calculation - start at 100 and subtract 7 (100, 93,86 ,79, 72) Or spell world backwards - d l r o w > Recall 3 words > name - pencil and watch > repeat 'no ifs ands or buts' > 3 stage command > Read and obey a written command - close your eyes > write a sentence > Copy intersecting pentagons
What is pseudodementia
Features of dementia caused by depression
Mood impairment precedes the cognitive symptoms
Within what timeframe do symptoms have to occur following a traumatic event for it to be classed at PTSD
6months
What are the 3 main symptoms of PTSD
Re-experiencing (Flashbacks and nightmares)
Avoidance
Hyperarousal
Side effects of tri-cyclic antidepressants
Dry mouth Postural hypotension Blurred vision Constipation Urinary retention
Side effects of SSRIs
GI upset
Sweating
Erectile dysfunction
Anorgasmia
What foods interact with mono-amine oxidase inhibitors
Red wine
Cheese
(Tyramine)
What is the cheese reaction of MAO inhibitors
Ingestion of tyramine causes a hypertensive crisis.
Due to release of nor-adrenaline from storage vesicles
Potential risks of ECT
Amnesia
Memory loss
Induction of a cardiac arrhythmia
Musculoskeletal injury
What biochemical / haematological abnormalities are found in anorexia nervosa
Hypokalaemia
Low WCC
Hypercholesterolaemia
Hypochloraemic alkalosis
Organic causes of anxiety
Hypoglycaemia Hyperthyroidism Paroxysmal SVT Alcohol withdrawal Drug withdrawal Drug intoxication Phaeochromocytoma (rare)
Features of generalised anxiety disorder
Excessive worry present more days than its absent
For at least 6m
Occurs with a variety of events
Syx include tension, feeling of impending doom, restlessness, insomnia, fatigue, poor concentration, physical pains
Management of generalised anxiety disorder
Short term - beta blockers
CBT
Counselling / Relationship counselling
Symptoms of panic disorder
Intense anxiety / fear Palpitations Sweating Shaking SOB Hyperventilation Derealisation Fear of dying
Management of panic disorder
Antidepressants
Relaxation training
CBT
Counselling
What is an obsession
Stereotypical and purposeless words / phrases / thoughts that an individual cannot control or out out of their mind
What is a compulsion
A repeated ritual
Features of obsessive compulsive disorder
Unpleasant obsessions and compulsions
Often involving dirt, sex, harm to self or others or religion
The patient realises the thoughts are their own
Management of obsessive compulsive disorder
SSRIs
CBT
Exposure therapy
Social support
Features of PTSD
Follows exposure to serious traumatic event causing harm to self or others Reliving - flashbacks / nightmares Avoidance Sleep disturbance Reduced concentration Anxiety Irritability Hyper-vigilance
4 criteria of anorexia nervosa
BMI<17
Weight loss is self-induced
Distorted body image
Endocrine changes
Common symptoms of anorexia nervosa
Constipation Muscle cramps Tiredness Dizzy on standing Symptoms of anaemia- tiredness and breathlessness Amenorrhoea
What is a section 2 + how long is it for?
Who can request it
Admission for assessment
28days
2 drs - 1 section 12 approved
What is a section 3 + how long is it for?
Who can request it
Admission to treat
6 months
2 drs - 1 must be section 12 approved
What is a section 5 (2) + how long is it for?
Who can request it
Holding order for a patient already on the ward
72 hours
1 dr
What is a section 136 + how long is it for?
Who can request it
Police order to remove a person from a public place who is appearing to suffer from a mental disorder, to a place of safety.
72 hrs
Police officer
To have capacity a person must:
Understand the relevant information
Retain the information long enough to decide
Be able to use info / weigh up
Communicate their decision
What mental health sections can a patient appeal
Sections 2 + 3 (in England and Wales)
Physical illnesses commonly associated with depression
Chronic pain Cushing's syndrome Hypothyroidism Stroke Parkinson's MS Hyperparathyroidism
Organic causes of mania
Head injury
MS
Cushing’s syndrome
Normal stages of bereavement
Numbness Pining Depression Recovery Normal up to 6m
What is othello syndrome
Patient believes their partner is cheating despite no evidence.
Accusatory
Stalking
M > F
What is cotards syndrome
Severely depressed patients believe part of their body is dead or decaying
What is capgras syndrome
Patients believe a loved one has been replaced by a double
What is declerambault’s syndrome
Patient believes someone is deeply in love with them.
Usually someone famous
F > M
What is agoraphobia
Phobic anxiety
Fear of being in places where escape may be difficult
Negative symptoms of schizophrenia
Psychomotor retardation
Decreased speech
Social withdrawal
Loss of initiation
Schneiders 1st rank symptoms
Auditory hallucinations
Broadcast of thought / thought withdrawal / insertion
Controlled thoughts / actions = passivity
Delusional perceptions
echo of thoughts
Inappropriate mood
What symptoms dominate in paranoid schizophrenia
Delusions
What symptoms dominate in hebephrenic schizophrenia
Affective symptoms
Irresponsible and unpredictable behaviour
Inappropriate mood
What symptoms dominate in catatonic schizophrenia
Motor symptoms
Abnormal posturing
Repetitive mannerisms
Waxy flexibility
What is simple schizophrenia
Insidious onset
Negative symptoms
No delusions or hallucinations
What is seasonal affective disorder and its symptoms
Onset of depression at a particular season
Symptoms of depression
Plus carbohydrate craving, hypersomnia, weight gain
Symptoms of puerperal psychosis
Commonly 1st week post-partum Mood changes - mania, depression, confusion Irritability Sleeplessness Hallucination
Indications for electroconvulsive therapy
Severe suicidal thoughts Previous response to ECT Psychotic features Catatonic stupor Food refusal Depression refractory to antidepressants
Examples of typical anti-psychotics
Haloperidol
Chlorpromazine
Fluphenazine
Examples of atypical anti-psychotics
Olanzapine Quetiapine Aripriprazole Risperidone Amisulpride Clozapine
What is neuroleptic malignant syndrome
Rare
Potentially fatal
Sympathetic hyperactivity associated with antipsychotics
Symptoms of neuroleptic malignant syndrome
Fever Rigidity Confusion Fluctuating consciousness Sympathetic instability
Raised creatinine kinase
Leucocytosis
Deranged LFTs
Side effects of clozapine
Agranulocytosis Neutropenia Thromboembolism Myocarditis Cardiomyopathy
Side effects of tricyclic antidepressants
Dry mouth Blurred vision Tachycardia / arrhythmia Constipation Urinary retention Drowsiness
Side effects of SSRIs
Nausea Anorexia Dry mouth Diarrhoea Constipation Dyspepsia
Symptoms of serotonin syndrome
Myoclonus Nystagmus Headache Tremor Rigidity Seizure
Symptoms of lithium toxicity
Coarse tremor Diarrhoea Ataxia Twitching Dysarthria Confusion
Complications of vomiting in bulimia nervosa
Cardiac arrhythmia Renal impairment Muscular paralysis Tetany (hypocalcaemia) Swollen salivary glands Dental enamel erosion
Features of lewy body dementia
Day today fluctuating levels of cognitive function
Visual hallucination
Sleep disturbance
Transient loss of consciousness
Recurrent falls
Parkinsonian features (Tremor, hypokinesia, rigidity, postural instability)
