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General Medicine > Psychiatry > Flashcards

Psychiatry Flashcards

0
Q

Why should antipsychotics not be prescribed in lewy body dementia

A

Precipitates severe parkinsonism in 60%

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1
Q

Features of lewy body dementia

A

Day today fluctuating levels of cognitive function
Visual hallucination
Sleep disturbance
Transient loss of consciousness
Recurrent falls
Parkinsonian features (Tremor, hypokinesia, rigidity, postural instability)

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2
Q

Features of vascular dementia

A 
Begins in 60s
Stepwise deterioration cognitive function
Focal neurology
Fits
Nocturnal confusion
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3
Q

Risk factors for vascular dementia

A 
Male
Smoking
Hypertension
DM
Hypercholesterolaemia
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4
Q

Features of frontotemporal dementia

A 
Disinhibition 
inattention 
antisocial behaviour 
personality change 
apathy 
Akinesia 
withdrawal
Memory loss disorientation occur late
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5
Q

Features of normal pressure hydrocephalus

A

Triad of dementia, gait disturbance and urinary incontinence

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6
Q

What is the most common type of dementia

A

Alzheimer’s disease

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7
Q

Features of Alzheimer’s disease

A 
Gradual progressive cognitive decline
Apathy
Labile mood
Altered personality
Paranoia
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8
Q

When may early onset Alzheimer’s occur

A

Down’s syndrome

Inheritance of amyloid precursor or presenillin proteins

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9
Q

Qs in the mini mental state examination

A 
> 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
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10
Q

What is pseudodementia

A

Features of dementia caused by depression

Mood impairment precedes the cognitive symptoms

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11
Q

Within what timeframe do symptoms have to occur following a traumatic event for it to be classed at PTSD

A

6months

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12
Q

What are the 3 main symptoms of PTSD

A

Re-experiencing (Flashbacks and nightmares)
Avoidance
Hyperarousal

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13
Q

Side effects of tri-cyclic antidepressants

A 
Dry mouth 
Postural hypotension
Blurred vision 
Constipation
Urinary retention
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14
Q

Side effects of SSRIs

A

GI upset
Sweating
Erectile dysfunction
Anorgasmia

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15
Q

What foods interact with mono-amine oxidase inhibitors

A

Red wine
Cheese
(Tyramine)

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16
Q

What is the cheese reaction of MAO inhibitors

A

Ingestion of tyramine causes a hypertensive crisis.

Due to release of nor-adrenaline from storage vesicles

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17
Q

Potential risks of ECT

A

Amnesia
Memory loss
Induction of a cardiac arrhythmia
Musculoskeletal injury

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18
Q

What biochemical / haematological abnormalities are found in anorexia nervosa

A

Hypokalaemia
Low WCC
Hypercholesterolaemia
Hypochloraemic alkalosis

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19
Q

Organic causes of anxiety

A 
Hypoglycaemia 
Hyperthyroidism
Paroxysmal SVT
Alcohol withdrawal
Drug withdrawal
Drug intoxication
Phaeochromocytoma (rare)
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20
Q

Features of generalised anxiety disorder

A

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

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21
Q

Management of generalised anxiety disorder

A

Short term - beta blockers
CBT
Counselling / Relationship counselling

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22
Q

Symptoms of panic disorder

A 
Intense anxiety / fear
Palpitations 
Sweating 
Shaking 
SOB
Hyperventilation 
Derealisation
Fear of dying
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23
Q

Management of panic disorder

A

Antidepressants
Relaxation training
CBT
Counselling

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24
Q

What is an obsession

A

Stereotypical and purposeless words / phrases / thoughts that an individual cannot control or out out of their mind

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25
Q

What is a compulsion

A

A repeated ritual

26
Q

Features of obsessive compulsive disorder

A

Unpleasant obsessions and compulsions
Often involving dirt, sex, harm to self or others or religion
The patient realises the thoughts are their own

27
Q

Management of obsessive compulsive disorder

A

SSRIs
CBT
Exposure therapy
Social support

28
Q

Features of PTSD

A 
Follows exposure to serious traumatic event causing harm to self or others 
Reliving - flashbacks / nightmares 
Avoidance
Sleep disturbance 
Reduced concentration
Anxiety
Irritability 
Hyper-vigilance
29
Q

4 criteria of anorexia nervosa

A

BMI<17
Weight loss is self-induced
Distorted body image
Endocrine changes

30
Q

Common symptoms of anorexia nervosa

A 
Constipation
Muscle cramps
Tiredness
Dizzy on standing
Symptoms of anaemia- tiredness and breathlessness
Amenorrhoea
31
Q

What is a section 2 + how long is it for?

Who can request it

A

Admission for assessment
28days
2 drs - 1 section 12 approved

32
Q

What is a section 3 + how long is it for?

Who can request it

A

Admission to treat
6 months
2 drs - 1 must be section 12 approved

33
Q

What is a section 5 (2) + how long is it for?

Who can request it

A

Holding order for a patient already on the ward
72 hours
1 dr

34
Q

What is a section 136 + how long is it for?

Who can request it

A

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

35
Q

To have capacity a person must:

A

Understand the relevant information
Retain the information long enough to decide
Be able to use info / weigh up
Communicate their decision

36
Q

What mental health sections can a patient appeal

A

Sections 2 + 3 (in England and Wales)

37
Q

Physical illnesses commonly associated with depression

A 
Chronic pain
Cushing's syndrome
Hypothyroidism 
Stroke
Parkinson's
MS
Hyperparathyroidism
38
Q

Organic causes of mania

A

Head injury
MS
Cushing’s syndrome

39
Q

Normal stages of bereavement

A 
Numbness 
Pining
Depression
Recovery
Normal up to 6m
40
Q

What is othello syndrome

A

Patient believes their partner is cheating despite no evidence.
Accusatory
Stalking
M > F

41
Q

What is cotards syndrome

A

Severely depressed patients believe part of their body is dead or decaying

42
Q

What is capgras syndrome

A

Patients believe a loved one has been replaced by a double

43
Q

What is declerambault’s syndrome

A

Patient believes someone is deeply in love with them.
Usually someone famous
F > M

44
Q

What is agoraphobia

A

Phobic anxiety

Fear of being in places where escape may be difficult

45
Q

Negative symptoms of schizophrenia

A

Psychomotor retardation
Decreased speech
Social withdrawal
Loss of initiation

46
Q

Schneiders 1st rank symptoms

A

Auditory hallucinations
Broadcast of thought / thought withdrawal / insertion
Controlled thoughts / actions = passivity
Delusional perceptions
echo of thoughts
Inappropriate mood

47
Q

What symptoms dominate in paranoid schizophrenia

A

Delusions

48
Q

What symptoms dominate in hebephrenic schizophrenia

A

Affective symptoms
Irresponsible and unpredictable behaviour
Inappropriate mood

49
Q

What symptoms dominate in catatonic schizophrenia

A

Motor symptoms
Abnormal posturing
Repetitive mannerisms
Waxy flexibility

50
Q

What is simple schizophrenia

A

Insidious onset
Negative symptoms
No delusions or hallucinations

51
Q

What is seasonal affective disorder and its symptoms

A

Onset of depression at a particular season
Symptoms of depression
Plus carbohydrate craving, hypersomnia, weight gain

52
Q

Symptoms of puerperal psychosis

A 
Commonly 1st week post-partum
Mood changes - mania, depression, 
confusion
Irritability 
Sleeplessness
Hallucination
53
Q

Indications for electroconvulsive therapy

A 
Severe suicidal thoughts 
Previous response to ECT
Psychotic features 
Catatonic stupor
Food refusal 
Depression refractory to antidepressants
54
Q

Examples of typical anti-psychotics

A

Haloperidol
Chlorpromazine
Fluphenazine

55
Q

Examples of atypical anti-psychotics

A 
Olanzapine
Quetiapine
Aripriprazole 
Risperidone 
Amisulpride
Clozapine
56
Q

What is neuroleptic malignant syndrome

A

Rare
Potentially fatal
Sympathetic hyperactivity associated with antipsychotics

57
Q

Symptoms of neuroleptic malignant syndrome

A 
Fever
Rigidity 
Confusion
Fluctuating consciousness 
Sympathetic instability

Raised creatinine kinase
Leucocytosis
Deranged LFTs

58
Q

Side effects of clozapine

A 
Agranulocytosis 
Neutropenia
Thromboembolism
Myocarditis
Cardiomyopathy
59
Q

Side effects of tricyclic antidepressants

A 
Dry mouth
Blurred vision
Tachycardia / arrhythmia 
Constipation 
Urinary retention
Drowsiness
60
Q

Side effects of SSRIs

A 
Nausea
Anorexia
Dry mouth 
Diarrhoea 
Constipation 
Dyspepsia
61
Q

Symptoms of serotonin syndrome

A 
Myoclonus 
Nystagmus 
Headache
Tremor
Rigidity 
Seizure
62
Q

Symptoms of lithium toxicity

A 
Coarse tremor
Diarrhoea 
Ataxia
Twitching
Dysarthria
Confusion
63
Q

Complications of vomiting in bulimia nervosa

A 
Cardiac arrhythmia 
Renal impairment 
Muscular paralysis
Tetany (hypocalcaemia)
Swollen salivary glands
Dental enamel erosion

General Medicine (25 decks)

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