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Psychiatry Flashcards

1
Q

Staying still in an unusual position

A

Catatonia

-can have catatonic schizophrenia

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2
Q

Drug which reduces the seizure threshold

A

Clozapine

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3
Q

Antidepressant which elongates QT interval

A

Citalopram (also escitalopram)

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4
Q

Atypical antipsychotic with best side effect profile (esp for hyperprolactin)

A

Aripiprazole

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5
Q

Antidepressant used after MI

A

Sertraline

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6
Q

How do benzos work?

A

Enhance GABA by increasing frequency of chloride channels

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7
Q

Treatment of tardive dyskinesia

A

Tetrabenazine

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8
Q

Lifestyle factor which increases clozapine levels

A

Smoking

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9
Q

Antipsychotics in elderly- what about?

A

Stroke and VTE

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10
Q

Antidepressant mechanism: Inhibit a2 and serotonin receptors, enhancing both transmission in brain

A

Noradrenergic and Specific Serotonin Antidepressant (NaSSA)

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11
Q

Antidepressant mechanism: Inhibit serotonin and noradrenaline reuptake at presynaptic membrane

A 
Tricyclic Antidepressants (TCAs)
Serotonin and Noradrenaline Reuptake Inhibitors (SNRIs)
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12
Q

Antidepressant mechanism: Inhibit serotonin reuptake at presynaptic membrane

A

Selective Serotonin Reuptake Inhibitors (SSRIs)

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13
Q

Antidepressant mechanism: Inhibit metabolism of monoamines

A

Monoamine Oxidase Inhibitors (MAOIs)

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14
Q

Mechanism behind extrapyramidal side effects of typical antipsychotics

A

Blockade of the dopamine receptor promotes hypersensitivity of the D2 receptor in the nigrostriatal pathway

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15
Q

Wernicke’s Triad

A

Confusion
Ataxia
Ophthalmoplegia (lateral recti)

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16
Q

Korsakoff’s Triad

A

Retrograde amnesia
Anterograde amnesia
Confabulation

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17
Q

Mechanism of methylphenidate

A

Noradrenaline-dopamine reuptake inhibitor

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18
Q

Alternative to chlordiazepoxide in liver failure

A

Lorazepam (avoids increased risk of sedation)

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19
Q

Who is involved in Section 135 and 136?

A

Police + AMHP + 2 docs remove the patient

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20
Q

Who is involved in Mental Health Act Assessment?

A
  1. Patient
  2. Approve Mental Health Professional (AMHP)
  3. S12 Approved doctor (consultant psychiatrist)
  4. Doctor (patient’s GP ideally)
  5. Nearest relative (long-term partner, eldest parent)

Just need doc and AMHP for Section 4

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21
Q

Rapid tranquilisation drugs

A

IM lorazepam and IM haloperidol

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22
Q

Antidote for benzo-induced respiratory distress

A

Flumazenil

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23
Q

Max alcohol consumption per week (in Units)

A

14 Units/week

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24
Q

Definition of binge (in Units)

A

6 Units in a session

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25
Q

Baby with small eye openings, flat philtrum and thin upper lip

A

Foetal Alcohol Syndrome

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26
Q

Antidepressants causing GI bleeding

A

SSRI (need to give PPI if also on NSAID)

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27
Q

Antidepressant which must not be combined with other antidepressants

A

Phenelzine (Monoamine Oxidase Inhibitor)

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28
Q

Antidepressant that causes Neonatal Adaptation Syndrome (agitated, insomnia, poor feeding)

A

Paroxetine

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29
Q

Type 1 vs Type 2 Bipolar

A

Type 1: manic and depressive

Type 2: depressive with hypomanic

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30
Q

Definition of toxic level of lithium

A

> 1.2

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31
Q

Lithium side-effects

A

Decreased memory
Tremor
Hypothyroidism

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32
Q

Schneider’s First-rank symptoms

A

Auditory hallucinations
Delusional perception
Passivity
Thought interference

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33
Q

3 types of auditory hallucinations in Schneider’s

A

Talk about patient
Running commentary
Thought echo

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34
Q

Mechanism of antipsychotics

A

Block post-synaptic D2 receptors

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35
Q

4 defining features of Anorexia Nervosa

A
  1. BMI < 17.5
  2. Deliberate weight loss
  3. Distorted body image
  4. Endocrine dysfunction= HPG axis messed up
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36
Q

How much weight gain should anorexia aim for?

A

0.5kg a week

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37
Q

2 forms of psychotherapy for adults with anorexia

A

Eating Disorder-Focused CBT: addresses low self-esteem, perfectionism and the urge to have control of things

Maudsley Anorexia Nervosa Treatment for Adults (MANTRA): overcome personality traits and thinking styles that foster anorexia

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38
Q

First-line psychotherapy for kids with anorexia/bulimia

A

Family Therapy: 20 sessions over a year –> shows role of family in helping kid recover

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39
Q

ADHD has to onset before this age

A

<7yrs

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40
Q

3 defining components of ADHD

A
  1. Inattention
  2. Hyperactivity
  3. Impulsivity
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41
Q

Questionnaire used in ADHD

A

Conner’s Rating Scales

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42
Q

Complication of ADHD, which is another psych disorder

A

Oppositional Defiant Disorder (60% ADHD)

43
Q

Genetic disorder that causes autism

44
Q

3 defining components of autism

A
  1. Reciprocal social interaction issues (don’t pick cues)
  2. Communication issues
  3. Repetitive/restrictive behaviour
45
Q

Questionnaire for autism

A

Autism Diagnostic Inventory- Revised (ADI-R)

46
Q

Length of time needed for GAD to be diagnosed

47
Q

Questionnaire for anxiety

A

Beck Anxiety Inventory

48
Q

Beta-blockers contraindicated in these conditions (3)

A

Asthma
AV Block
Diabetes (masks tachy due to hypo)

49
Q

How do you reduce the dose of benzo?

A

Reduce by 1/8 every 2 weeks

50
Q

Psychotherapy used in phobia and OCD

A

Exposure and Relapse Prevention

51
Q

Questionnaire for OCD

A

Yale-Brown OCD Scale

52
Q

4 components of PTSD

A
  1. Intrusions (inc flashbacks)
  2. Avoidance
  3. Decreased mood
  4. Hyperarousal
53
Q

Specific therapy for PTSD

A

Eye Movement Desensitisation and Reprocessing (EMDR): patient recounts trauma in as much detail as possible – while also watching therapist’s finger moving from side to side!!

54
Q

Psychotherapy for childhood anxiety

A

School-based CBT prevention strategies

55
Q

4 A’s in dementia

A

Amnesia: recent memories lost first (appointments, car keys…)
Aphasia: can’t find right words
Agnosia: can’t recognise things (faces…)
Apraxia: can’t do skilled tasks (dressing)

56
Q

Lewy-Body Dementia diagnostic criteria

A

Need 2 of the 3:
Fluctuating cognition
Visual hallucinations (people, animals)
New Parkinsonian signs –> ask about falls!

57
Q

Questionnaire for dementia

58
Q

Dementia with disinhibition and antisocial behaviour –> progresses to apathy and akinesia

A

Pick’s Disease (frontotemporal dementia)

59
Q

Diagnostic criteria for Learning Disability (3)

A
  1. IQ < 70 (normal = 100)
  2. Impact on daily living
  3. Present before age 18
60
Q

Definitions of Mild, Moderate, Severe and Profound LD

A 
Mild = IQ 50-69
Moderate = IQ 35-49
Severe = IQ 20-34
Profound = IQ <20
61
Q

If patient needs to be sectioned under Mental Health Act, Advance Decisions are not legally binding (even if make AD when competent) - true or false?

62
Q

Dementia which day-to-day fluctuations in cognition

A

Lewy-Body Dementia

63
Q

Psychotherapy used in EUPD

A

Dialectical Behavioural Therapy (DBT)

64
Q

What is the name of cytoplasmic inclusion bodies (made of tau protein), found in the substantia nigra?

A

Pick’s bodies

65
Q

Triad of:

  1. Dementia
  2. Gait disturbance
  3. Urinary incontinence
A

Normal-Pressure Hydrocephalus = increased CSF, but minor increase in pressure (as ventricles dilate to compensate)

66
Q

Patient feels that aliens are pinching and poking him - what symptom is this?

A

Somatic passivity = first-rank symptom!

67
Q

Russel’s Sign in bulimia

A

Thick skin on dorsum of hands, after repeated gagging

68
Q

Echolalia

A

Repeat what someone else says

69
Q

Coprolalia

A

Swear lots, like Tourette’s

70
Q

“Over-the-counter preparation for depression”, on top of SSRI – what is the consequence?

A

Serotonin Syndrome (crazy HTN, tachy, hyper-reflexia)

71
Q

Antidepressant helpful for sleeping difficulties

A

Amitriptyline

72
Q

Fine, downy hair on face, arms and trunk

A

Lanugo hair in anorexia nervosa

73
Q

Antipsychotics act on which pathway to improve psychotic symptoms, and which pathway to cause side effects

A

Mesolimbic pathway = improve symptoms

Mesocortical pathway = side effects

74
Q

Puerperal psychosis defined as how soon after birth?

A

Within 6 weeks

75
Q

Minimum time needed for GAD diagnosis

76
Q

Suicide incidence in UK

A

1 in 10,000

77
Q

Risk of suicide in the next year after one act of self-harm

A

1% = 100x increased risk!

78
Q

Memory loss with increased aggression and antisocial behaviour

A

Frontotemporal Dementia = Pick’s Disease

79
Q

Why do benzos have increased duration of action in old people?

A

Old people have increased body fat –> benzos are fat-soluble… –> falls, resp depression

80
Q

Rapid onset of symptoms in schizo = good or bad?

81
Q

How often should lithium be monitored?

A

Weekly until stable –> then 3-monthly, with TFTs and U&Es

82
Q

Why are Down Syndrome increased risk of Alzheimer’s?

A

Extra copy of APP gene on trisomy 21

83
Q

Atrophy in Alzheimer’s affects which part of brain?

A

Hippocampus = required for new learning and visuospatial skills

84
Q

Beta-amyloid plaques made of what?

A

Tau protein

85
Q

Aphasia vs agnosia vs apraxia

A

Aphasia: can’t find right words
Agnosia: can’t recognise things (faces…)
Apraxia: can’t do skilled tasks (dressing)

86
Q

What do Lewy Bodies contain?

A

Alpha-synuclein and ubiquitin

87
Q

Where do Lewy Bodies distribute?

A

Cyngulate gyrus and cerebral cortex

88
Q

2 things you must always do in dementia PACES

A 
Risk assess (impact on ADLs)
Check if patient has insight
89
Q

Which 2 Personality Disorders are more common in women?

A

EUPD (Borderline) and Histrionic

90
Q

IQ cut-offs

A 
70 = normal
50-70 = mild
35-50 = moderate
20-35 = severe
91
Q

Hypoactivity of prefrontal lobes, enlarged cerebral ventricles

A

Schizophrenia

92
Q

Hyperactivity of prefrontal lobes

93
Q

How long can urgent DoLS be used in care home?

94
Q

Schizophrenia risk if one parent has it

95
Q

Blockage of this pathway causes galactorrhoea after antipsychotic use

A

Tuberoinfundibular pathway (dopamine inhibits prolactin)

96
Q

Blockage of this pathway causes extrapyramidal symptoms after antipsychotic use

A

Nigrostriatal pathway

97
Q

Dementia severity (according to MMSE)

A

Mild: 21-26
Moderate: 10-20
Severe: <10

98
Q

Axis overactivated in GAD

A

Hypothalamic-pituitary-adrenal (adrenaline/noradrenaline)

99
Q

Max time that Adjustment Disorder lasts

100
Q

How to switch from fluoxetine to sertraline

A

Gradually reduce fluoxetine over 2 weeks

  • ->wait 7 days (long half-life so needs flushing out period)
  • -> start sertraline
101
Q

Antidepressant causing thrombocytopaenia (and dry mouth/blurry vision)

A

Amitriptyline (TCA)

102
Q

Antipsychotic causing “torsade de pointes”

A

Haloperiodol (prolonged QT)

103
Q

1st line antidepressant in kids

A

Fluoxetine

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