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Phase 3A > Psychiatry > Flashcards

Psychiatry Flashcards

1
Q

what is an illusion

A

misperception of real stimuli e.g. waking up and mistaking your coat for a person

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2
Q

what is a hallucination

A

perception in the absence of external stimulus

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3
Q

what is an over-valued idea

A

belief sustained beyond reason but held with less rigidity

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4
Q

delusion

A

false belief that is firmly maintained in spite of evidence to the contrary

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5
Q

delusional perception

A

delusional belief resulting from a real perception

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6
Q

thought insertion

A

thoughts have been inserted by an external agency

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7
Q

thought withdrawal

A

thoughts stolen by external agency

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8
Q

thought broadcast

A

thoughts are broadcast so everyone can hear

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9
Q

thought echo

A

auditory hallucination where thoughts are being heard aloud

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10
Q

thought block

A

sudden interruption in train of thoughts, leaving a blank

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11
Q

concrete thinking

A

lack of abstract thinking

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12
Q

loosening of association

A

lack of logical association between thoughts

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13
Q

loosening of association

A

lack of logical association between thoughts = incoherent speech

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14
Q

circumstantiality

A

talking at great length but still returns to topic

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15
Q

perseveration

A

repetition of a word (organic/frontal disorder)

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16
Q

tangential

A

does not return to topic

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17
Q

confabulation

A

giving a false account to fill a memory gap

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18
Q

somatic passivity

A

delusional belief that body sensations are due to an external agency

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19
Q

made acts, feelings and drives

A

experience being carried out by the patient is considered alien/imposed

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20
Q

catatonia

A

significantly excited or inhibited motor activity

waxy flexibility or posturing

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21
Q

stupor

A

loss of activity with no response to stimuli

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22
Q

psychomotor retardation

A

slowing of thoughts and movements

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23
Q

flight of ideas

A

rapidly skipping from one thought to distantly related ideas

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24
Q

neologisms

A

use of novel/made up words

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25
Q

pressure of speech

A

rapid rate of delivery; may be associated with rhymes and puns

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26
Q

poverty of speech

A

reduced amount, range and content of speech

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27
Q

anhedonia

A

inability to derive pleasure from activities previously enjoyed

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28
Q

flattening of affect

A

reduced range of emotional expression

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29
Q

incongruity of affect

A

mismatch between emotional expression and content

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30
Q

obsession

A

unwanted recurrent and intrusive thought

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31
Q

compulsion

A

an irresistible urge to behave in a certain way

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32
Q

compulsion

A

an irresistible urge to behave in a certain way

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33
Q

belle indifference

A

apparent lack of concern at symptoms/disability

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34
Q

depersonalisation

A

thoughts and feelings do not seem to belong to oneself

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35
Q

derealisation

A

feeling as if you are looking at yourself from outside

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36
Q

stereotypy

A

persistent repetition of a behaviour without cause

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37
Q

mannerism

A

habitual gesture of language or behaviour

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38
Q

types of hallucinations

A

command

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39
Q

types of delusion

A

Persecutory: outside agency to cause harm

grandiose

self-referential

Misidentification: Capgras/impostor; Fregoli; intermetamorphosis; subjective doubles

nihilistic: e.g. cotard

religious

hypochondrial

Guilt: responsible for harm

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40
Q

psychosis

A

loss of contact with reality

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41
Q

positive symptoms of psychosis

A

delusions
disordered thought/speech
hallucinations

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42
Q

negative psychotic symptoms

A

flat/blunted affect
poverty of speech
lack of motivation
poor ability to function

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43
Q

negative psychotic symptoms

A

flat/blunted affect
poverty of speech
lack of motivation
poor ability to function

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44
Q

types of schizophrenia

A

Paranoid – Auditory/visual hallucinations and delusions (persecutory and/or grandiose). No thought disorder or flattened affect.

Hebephrenia – or disorganised type. Thought disorder and flat affect present together.

Catatonic – either immobile or agitated/purposeless movement. Waxy flexibility. Echolalia /Echopraxia

Simple – insidious and progressive negative symptoms with no history of psychotic symptoms.

Residual – chronic negative symptoms

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45
Q

1st rank symptoms

A

3rd person auditory hallucination
thought alienation
delusional perception
passivity experiences

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46
Q

other types of psychosis

A 
puerperal psychosis 
schizoaffective disorder 
acute transient psychosis 
persistent delusional disorder 
organic psychosis
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47
Q

management of psychosis

A

bio: antipsychotics (clozapine in resistant)
psycho: family therapy, CBT

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48
Q

features of mania

A 
increased energy/libido
decreased need for sleep
increased talking speed/ racing thoughts 
grandiose delusions
psychotic beliefs about ability/identity 
inappropriate elation
irritability 
high risk activities
functional impairment
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49
Q

features of mania

A 
increased energy/libido
decreased need for sleep
increased talking speed/ racing thoughts 
grandiose delusions
psychotic beliefs about ability/identity 
inappropriate elation
irritability 
high risk activities
functional impairment
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50
Q

features of hypomania

A

does not affect functioning

elevation of mood 
talkativeness
overfamiliarity 
increased libido
decreased sleep
irritability
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51
Q

features of bipolar disorder

A

Characterized by at least two episodes in which the patient’s mood and activity levels are significantly disturbed

This disturbance consisting on some occasions of mania/ hypomania and on others depression

Periods of recovery between episodes

Depressive episodes tend to last longer (average 6 months)

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52
Q

management of bipolar disorder

A

bio: mood stabilsers, antidepressants, antipsychotics
psycho: CBT, relapse prevention, psychoeducation

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53
Q

depression: core symptoms, other symptoms and scoring

A

core
- low mood, anhedonia, reduced energy levels

other

  • poor concentration, low self esteem, feeling guilty/worthless, hopelessness about the future
  • disturbed sleep, diminished appetite
  • self-harm/suicide, psychosis

mild: 2 core + 2 others
moderate: 2 core, 3-4 others
severe: 3 core, 4+ others

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54
Q

post natal mood disorders

A

Baby blues
post natal depression
puerperal psychosis

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55
Q

features of baby blues

A

Transient condition that affects up to 75-80% of mothers up to 2 weeks after giving birth
Involves mood lability, tearfulness, mild anxietyand depressive symptoms
Normal

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56
Q

features of postnatal depression

A

Post-natal depression
Depressive disorder in weeks / months post partum
Rx as for depression
Complex multifactorial aetiology

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57
Q

features of puerperal psychosis

A

Puerperal psychosis
Within days or weeks of delivery, risk to mother and baby
Often needs admission (MBU optimal) and high risk of recurrence in subsequent pregnancies
Probable hormonal aetiology in women predisposed to bipolar disorder

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58
Q

management of depression

A 
Bio
Antidepressants
SSRI, TCA, SSRI+TCA ,+adjuvant
Psycho
Talking treatment e.g CBT, CAT
Group work / self help
Psychoeducation
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59
Q

management of depression based on severity

A

mild: watchful waiting, improving access to psychological treatment
moderate: SSRI + IAPT, consider psychiatric referral
severe: consider admission, ECT

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60
Q

hypnotic drugs: subtypes and examples

A

Benzodiazepines
Diazepam, Temazepam, Lorazepam, Chlordiazepoxide (alcohol withdrawal)

Z-drugs
Zopiclone, Zolpidem

Melatonin
Over 55s short term only

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61
Q

contraindication of hypnotics and withdrawal effects

A

not used in GAD

withdrawal effects: sleep disturbance, irritability, seizures, breakthrough anxiety, respiratory depression

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62
Q

anxiolytics

A

(only after talking intervention)

SSRI: sertraline (GAD)
benzodiazepine short term
pregabalin

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63
Q

antidepressant categories and examples

A

selective serotonin reuptake inhibitors: fluoxetine, sertraline, paroxetine, citalopram

serotonin noradrenaline reuptake inhibitors: venlafaxine, duloxetine

tricyclics: Amitriptyline, Lofepramine, Trazodone
tetracyclics: mirtazapine

monoamine oxidase inhibitors: Phenalzine and Moclobemide

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64
Q

side effects of SSRI

A

abdominal, suicidality, sexual dysfunction safe in OD

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65
Q

side effects of TCA

A

sedation, anticholinergic, cardiac arrhythmias

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66
Q

side effects of SNRI

A

suicidality, serotonin syndrome, sexual dysfunction

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67
Q

side effects of tetracyclics

A

sedation, wt gain

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68
Q

side effects of MAOI

A

Hypertesive crises related to tyrosine in cheese, red wine etc

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69
Q

antipsychotic mode of action

A

dopamine blockage

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70
Q

antipsychotic subtypes

A

1st generation – Sulpiride, Haloperidol, Flupentixol, Chlorpromazine (more Extra Pyramidal Side effects)

2nd Generation – “atypical” Olanzapine, Risperidone, Quetiapine, Amisulpride, Aripiprazole (more Metabolic Side Effects)

Clozapine: weight gain, neutropenia

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71
Q

what are extrapyramidal side effects

A

dystonia, dyskinesia, neuroleptic malignancy syndrome

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72
Q

what are metabolic side effects

A

DM, weight gain, lipids, NM

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73
Q

mood stabilising drug options

A

lithium
antipsychotics e.g. olanzapine
anticonvulsants: sodium valproate, carbamazepine, lamotrigine

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74
Q

lithium side effects

A

renal impairment, tremor, confusion, thyroid dysfunction, weight gain

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75
Q

medication for ADHD and their side effects

A

Methylphenidate (ritalin)
SE appetite suppression, psychosis

Atomoxetine
SE liver dysfunction, suicidality

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76
Q

types of psychological interventions

A

primary care:
counselling
psychoeducation
CBT

secondary care:
Dialectic Behavioural Therapy
Psychoanalytic Psychotherapy
Group Therapy
Family therapy
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77
Q

when is exposure and response prevention used

A

CBT based treament for OCD

78
Q

when is Eye movement desensitization and reprocessing used

A

PTSD

79
Q

when is family therapy used

A

young people, anorexia, psychosis

80
Q

when is group psychodynamic therapy used

A

personality

mood

81
Q

when is interpersonal therapy used

A

personality

mood

82
Q

social interventions

A 
Benefits
Care package
Cultural support
Help with meaningful activity
Help with Housing
Safeguarding issues
Anti-discriminatory language (stigma)
Interface with Criminal justice system
MHA / MCA
Self-determination / person centred care
Access/support with Education
Social integration
Building social capital
Weighing up of ethical dilemmas
social prescribing 
health coaching 
substance abuse support group
83
Q

features of emotionally unstable personality disorder

A 
disturbed or uncertain self-image
efforts to avoid abandonment
chronic feelings of emptiness
impulsivity
difficulty in maintaining health relationships
Unhelpful use of substances
self harm
fluctuating mood
84
Q

psychiatric emergencies

A 
Alcohol withdrawal
Delirium tremens
Wernicke’s encephalopathy
Lithium toxicity
Acute dystonic reaction
Neuroleptic malignant syndrome
Seratonin syndrome
Drug overdose
Catatonia
Acute confusional state
85
Q

cluster A personality disorders

A

Cluster A (odd or eccentric disorders)

Paranoid: characterized by a pattern of irrational suspicion and mistrust of others, interpreting motivations as malevolent

Schizoid: lack of interest and detachment from social relationships, apathy, and restricted emotional expression

Schizotypal: a pattern of extreme discomfort interacting socially, and distorted cognitions and perceptions

86
Q

cluster B personality disorders

A

Cluster B (dramatic, emotional or erratic disorders)

Anti-social: a disregard for the rights of others, lack of empathy, increased self-image, manipulative and impulsive behaviour.

Borderline: mood swings, instability in relationships, self-image/identity, behaviour and affect, often leading to self-harm and impulsivity.

Histronic: attention seekingbehaviour and excessive emotions.

Narcissistic: grandiosity, need for admiration and a perceived lack of empathy.

87
Q

Cluster C personality disorders

A

Cluster C (anxious or fearful disorders)

Avoidant: social inhibition and inadequacy, extreme sensitivity to negative evaluation.

Dependent: a pervasive psychological need to be cared for by other people.

Obsessive-compulsive: rigid conformity to rules, perfectionism, and control to the point of satisfaction and exclusion of leisurely activities and friendship

88
Q

5 key principles of the mental capacity act

A

You must be treated as if you have capacity unless it is proven you do not

You must be supported to make your own decisions including being given information in different ways.

You have a right to make unwise decisions as long as you have capacity

Anything done for you must be in your best interests

Anything done for you must be the least restrictive option available

89
Q

what is section 2 of the mental health act

A

Detention in hospital for assessment of your mental health and potentially get treatment
Lasts up to 28 days

90
Q

what is section 3 of the mental health act

A

Detention in hospital for treatment, which might be necessary your health, safety or for the protection of other people
Lasts up to 6 months

91
Q

what is section 5 of the MHA

A

Section 5(2)
Doctor’s holding power to allow an assessment under the MHA
Lasts up to 72 hours

Section 5(iv)
Nurses holding power
6 hours
Needs to be followed by MHA

92
Q

what is section 135 of the MHA

A

Police removal from home to designated place of safety for MHA assessment

93
Q

what is section 136 of MHA

A

Police removal from public place to designated place of safety for MHA assessment

94
Q

who do you need for an assessment under the MHA

A

2 FY2+ Drs (one is section 12 approved)

Approved mental health professional

95
Q

what conditions must be met for someone to be sectioned

A

mental health disorder

severe enough nature to warrant hospital detention

risk to self, others or health

96
Q

who could release a patient from the section

A

RMO (responsible medical officer?)

consultant psychiatrist

nearest relative

mental health tribunal

97
Q

what is needed for a diagnosis of schizophrenia

A 
at least 1 first rank symptom AND
 2 or more secondary symptoms:
- delusions
-2nd person auditory hallucinations 
- any other hallucination
- thought disorder
- catatonic behaviour
- negative symptoms
98
Q

what is needed for a diagnosis of generalised anxiety

A

Excessive anxiety across different situations
>6 months
Tiredness
Poor concentration
Irritability
Muscle tension
Disturbed sleep (usually initial insomnia rather than EMW)

99
Q

what are the symptoms of panic disorder

A

physical: palpitations, chest pain, choking, tachypnoea, dry mouth, urgency or micturition, dizziness, blurred vision, parasthesiae
psychological: feeling of impending doom, fear of dying, fear of losing control, depersonalisation and derealisation

100
Q

what is OCD

A

obsessive thoughts + compulsive acts

obsessive thoughts are repetitive, intrusive, irrational and unwanted

101
Q

what is conversion

A

Unconscious mechanism of symptom formation, which operates in conversion hysteria, is the transposition of a psychological conflict into somatic symptoms which may be of a motor or sensory nature

102
Q

dissociation

A

An experience where a person may feel disconnected from himself and/or his surroundings

103
Q

akathisis

A

a condition marked by motor restlessness, ranging from anxiety to inability to lie or sit quietly or to sleep

104
Q

Projection

A

A mechanism in which what is emotionally unacceptable in the self is unconsciously rejected and attributed (projected) to others. For example, mother may project their anxiety on their children claiming that they are anxious instead

105
Q

transference

A

the redirection to a substitute, usually a therapist, of emotions that were originally felt in childhood

106
Q

what are the 4 Ps of a formulation

A

predisposing
precipitating
perpetuating/prolonging
protective

107
Q

when is dialectic behavioural therapy used

A

(borderline) personal therapy

108
Q

what is dialectic behaviour therapy

A

Goal is to help patients learn to manage difficult emotions by letting them experience, recognise and accept them

‘Dialectics’ means trying to balance seemingly contradictory positions

109
Q

what is cognitive analytic therapy

A

mixture of psychoanalytical and cognitive therapy

110
Q

mode of action of monoamine oxidase inhibitors

A

prevent degradation of serotonin by blocking the enzyme

111
Q

how do tricylclics work

A

block 5HT and NA transporters and prevent the re-uptake of serotonin

112
Q

what is serotonin syndrome and how is it treated

A

neuromuscular abnormalitiies, altered mental state, autonomic dysfunction

treatment: cyproheptadine

113
Q

what is the attachment timeline

A

0 - 3 months: indiscriminate attachment

3 - 6 months: preference for main caregiver

6 - 12 months: attached to main caregiver

12 months +: increasingly able to separate from main caregiver

114
Q

what is the mode of action of chlorpromazine

A

Dopaminergic blockade in the mesolimbic system

115
Q

features of the mental state exam

A 
appearance/behaviour
speech
mood and affect
thoughts 
cognition
insight 
risk
116
Q

second and third line treatment for bipolar

A

sodium valproate

carbamazepine

117
Q

how many months does it take for lithium to work

A

18

118
Q

therapeutic range for lithium

A

0.4 - 1 mmol/L

119
Q

Important tests to carry on patients with lithium

A 
renal function (U+E, creatinine)
TFT (hypothyroidism)
120
Q

side effects of lithium

A 
Leukocytosis
Insipidus diabetes 
tremors 
hypothyroidism 
increased urine 
mums beware (teratrogenic)
121
Q

what is lithium toxicity

A

lithium levels above 2.5

Blurred vision
COARSE tremor (fine tremor= early s/e)
Muscle weakness
Ataxia
N and V
Hyper-reflexia
Circulatory failure
Oliguria
Seizures 
Coma
122
Q

side effect of venlafaxine and contraindication

A

Venlafaxine can raise BP and is CI in heart disease.

123
Q

risk factors for suicide

A 
Alcohol or substance misuse
Bipolar, personality disorder
Previous suicide attempts
Physical or sexual abuse
Possession of firearms
Incarceration
Chronic pain
124
Q

warning signs for suicide

A

Obsessive thinking about death
Feelings of hopelessness, worthlessness, helplessness
Behahaviours suggestive of absolute death wish:
Putting financial affairs in order
Visiting people to say goodbye

125
Q

management of suicidal ideation

A

High risk of imminent suicide attempt: consider inpatient treatment

Medium risk: consider home crisis plan & provide details of crisis team

126
Q

criteria for a delusion

A

certainty

incorrigibility

impossibility

127
Q

4 things necessary for a diagnosis of GAD

A

6 months history of tension worry or anxiety

4 of the following

  • autonomic
  • chest/abdomen
  • brain/mind
  • tension
  • general

does not fulfil criteria for other anxiety disorders

physical/medical conditions not responsible

128
Q

treatment of GAD

A

mild: active monitoring
moderate: self-help
severe: CBT or SSRI

referral for specialist care

129
Q

symptoms of PTSD

A

emotional numbing

avoidance

inability to recall

re-experiencing

hyper - arousal

130
Q

how long should symptoms have occured for:

GAD
PTSD
OCD
depression
bulimia
A 
GAD: 6 months
PTSD: 1 month
OCD: 2 weeks 
Depression: 2 weeks 
bulimia: 3 weeks
131
Q

First line therapy for PTSD

A

Trauma focussed CBT

eye movement desensitisation and reprocessing

132
Q

second line therapy for PTSD

A

venlafaxine or an SSRI

133
Q

features of anorexia nervosa

A 
Dieting
Denial
Dread of gaining weight
Disturbed beliefs about weight
Doesn’t want help
Dual effect– dieting + over-exercise/diuretics, laxatives and self-induced vomiting
Disinterested/socially withdrawn
Decline in weight = rapid

Weight below 85% of predicted (adults <17.5)
Refusal to maintain a normal body weight for age and height

134
Q

physical signs of anorexia

A 
Dry skin
Hypercarotenemia
Lanugo body hair
Acrocyanosis
Breast atrophy
Swelling of the parotid and submandibular glands
Thinning hair
135
Q

blood results for anorexia

A

increased: Cs and GH
cortisol, beta-carotene, cholesterol and growth hormone

decreased: potassium, T3, glucose, oestrogen, testosterone, FSH, LH and phosphate

136
Q

other medical tests for someone with anorexia

A

DXA

ECG: bradycardia, prolonged QT, T wave changes (hypokalaemia)

137
Q

risk assessment in anorexia

A

management of really sick patients with anorexia nervosa

138
Q

treatment for anorexia

A

child

  1. anorexia based family therapy
  2. CBT

adult
individual eating disorder focused CBT

Maudsley anorexia nervosa treatment for adults

specialist supportive clinical management

139
Q

what is bulimia nervosa

A

Binge eating followed by intentional vomiting or other purgative behaviours such as the use of laxatives or diuretics or exercising

140
Q

investigative results on someone with bulimia nervosa

A

metabolic alkalosis

ECG hypokalaemia: first degree heart block, tall p-waves, flattened t waves

141
Q

features of bulimia nervosa

A

recurrent binge eating
lack of control during episode
recurrent compensatory behaviour (vomiting, misuse of laxatives, diuretics, fasting, excessive exercise)
once a week for 3 months
self-evaluation is unduly influenced by body shape and weight

142
Q

OCD categories and management

A

mild: still able to function
= 1. CBT + ERP or group CBT; 2. SSRI

moderate: less able to function
= high intensity CBT + ERP +/- SSRI

severe: unable to function
= high intensity CBT + ERP + SSRI

143
Q

opiate overdose

A

acute: drowsiness, respiratory depression, hypotension, pin point pupils
chronic: constipation

144
Q

opiate overdose management

A

ABCDE
IV naloxone
oral activated charcoal

145
Q

neuroleptic malignant syndrome

A

usually within 10 days of antipsychotic treatment

autonomic dysfunction, altered mental state, neuromuscular dysfunction

lab results: raised WBC and CPK

146
Q

complications of NMS

A

pneumonia, cardiovascular collapse, thromboembolism, renal failure

147
Q

management of NMS

A
  1. stop drug
  2. maintain fluid balance
  3. diazepam for muscle rigidity
  4. dantrolene for malignant hyperthermia
  5. bromocriptine to stop dopamine blockade
148
Q

section 4 of MHA

A

emergency; like section 5.2 but patient not already admitted

149
Q

what are social determinants of health

A

conditions in which people are born, grow, live, work and age that affect health e.g. poverty, migration, social isolation, homelessness, education, trauma and abuse

150
Q

what can be done to improve social determinants of health

A 
Help with meaningful activity
Social prescribing
Health coaching
Benefits support
Care packages
Housing support
Support with social integration
151
Q

what is tardive dyskinesia

A

side effect of antipsychotic medication

jerky or slow uncontrollable movements

152
Q

what is acute dystonia and how is it managed

A

face grimasing, involuntary upward eye movement, muscle spasms in tongue, face, neck and back (arching forward)

procyclidine

153
Q

community psychiatric teams

A

early intervention team: 1st episode of psychosis

assertive outreach team: complex mental health needs

crisis team: mental health crisis

154
Q

long term complications of alcohol dependence

A
  • Hepatic: alcoholic liver disease
  • GI: chronic pancreatitis, chronic diarrhoea, Barrett’s oesophagus, gastritis, Mallory Weiss tears, peptic ulceration
  • Cancer: hepatocellular, oesophagus, stomach, mouth, tongue, pharynx
  • Cardiovascular: hypertension, arrythmias, dilated cardiomyopathy
  • Neurological: WK syndrome, peripheral neuropathy
  • Other: foetal alcohol syndrome, gout, osteoporosis, malnutrition, accidents, violent crime, diminished compliance
155
Q

withdrawal

A

symptoms that occur after abstinence from a drug due to previous dependence

156
Q

what are features of dependence syndrome

A

primary drug seeking behaviour

narrowing of repertoire

increased tolerance

loss of control consumption

signs of withdrawal when abstinent + using drugs to avoid withdrawal symptoms

continued drug use despite negative symptoms

157
Q

tolerance

A

more of drug is needed to achieve the same effect

158
Q

risk factors for alcohol misuse

A

male
low socioeconomic group/ educational attainment
young
jobs: drinks industry, travelling salesmen, doctors
first degree relative with alcohol problem

159
Q

alcohol screening tools

A

CAGE
AUDIT (alcohol use disorders identification test)
Fast alcohol screening test

160
Q

management of alcohol misuse

A

motivational interviewing + planning interventions

161
Q

alcohol withdrawal syndromes

A

uncomplicated alcohol withdrawal: begins 4 - 12 hrs; coarse tremor, sweating, insomnia, tachycardia, nausea, vomiting, generalised anxiety, hallucinations or illusions

alcohol withdrawal with seizures: 6 - 48 hrs after last drink

Delirium tremens: peak incidence 48hrs after last drink

162
Q

indications of prescribing a reducing regime

A

symptoms of withdrawal
history of alcohol dependence syndrome
>10 units a day for 10 days

163
Q

preferred drug for reducing regime

A

benzodiazepam: chlordiazepoxide

164
Q

biopsychological management of alcohol misuse

A

psychological: individual counselling, group support/therapy
biological: disulfram, acamprosate, naltrexone

165
Q

name an aversive alcohol misuse drug, its mode of action and side effects

A

disulfram

inhibition of ALDH causing build up of acetaldehyde in bloodstream and unpleasant effects of headache, flushing, N+V and tachycardia

headache and halitosis

166
Q

name an anti-craving alcohol misuse drug, its mode of action and side effects

A

acamprosate

enhances GABA transmission

GI upset, itch, rash, altered libido

167
Q

what is wernicke-korsakoff syndrome

A

thiamine deficiency

wernicke encephalopathy: confusion, ataxia, nystagmus

korsakoff psychosis: inability to lay down new memories, retrograde amnesia

168
Q

management of smoking addiction

A

nicotine replacement therapy

buproprion

varenicline

169
Q

indication for hospital detox admission

A

o Past history of complicated withdrawals (seizures or delirium)
o Current symptoms of confusion or delirium
o Comorbid mental/physical illness, polydrug misuse or suicide risk
o Symptoms of Wernicke – Korsakoff syndrome
o Severe nausea/vomiting; severe malnutrition
o Lack of stable home environment

170
Q

short and long term use of IVDU

A
  • Short term: overdose – respiratory depression, damage to blood vessels, infection (embolism?), risky behaviour
  • Long term: HIV, endocarditis, chronic venous insufficiency, thrombosis, MSK infections, addiction, psychosis, malnutrition, chronic hepatitis
171
Q

paracetamol overdose medication

A

N-acetylcysteine

172
Q

learning disability vs. learning difficulty

A 
•	Learning disability: global, 
o	Mild 50 – 69
o	Moderate 35 – 49 
o	Severe 20 – 34 
o	Profound <20

• Learning difficulty: one specific aspect of learning, IQ is normally fine

173
Q

risk factors for schizophrenia

A
  • Genetics: MHC locus, DRD2, DISC1
  • Complications of pregnancy, delivery and the neonatal period
  • Delayed walking and neurodevelopmental difficulties
  • Early social service contact and disturbed childhood behaviour
  • Severe maternal malnutrition
  • Maternal influenza in pregnancy + winter births
  • Degree of urbanisation at birth
  • Use of cannabis especially during adolescence
174
Q

3 features of ADHD

A

Attention-deficit/ hyperactivity disorder

inattention
hyperactivity
impulsiveness

175
Q

management of ADHD

A

bio: ritalin (methylphenidate), atomexitin
psycho: family therapy (+/- parent management therapy), psychoeducation
social: school liaison

176
Q

features of autism spectrum disorder

A

difficulty with social relationships

problems in communication

restrictive and repetitive behaviour, activities or interests

sensory sensitivity

177
Q

subtypes of delusional disorder

A 
erotomatic 
grandiose
jealous 
persecutory 
somatic
178
Q

management of delusional disorder

A

CBT

olanzapine, SSRI

179
Q

risk factors for GAD

A

Aged 35- 54
Being divorced or separated
Living alone
Being a lone parent

180
Q

Mimimum time for SSRI

A

continue for at least 6 months

181
Q

preffered SSRI in CAMHS

A

fluoxetine

182
Q

non blood investigation for antipsychotics

A

ECG: QT
BP + pulse
weight gain + abdominal girth

183
Q

annual investigations for patients on antipsychotics

A 
weight BMI/weight/ abdominal girth
fasting lipids
blood glucose 
liver function 
ECG
U+E
FBC
TFT
Prolactin
BP and pulse
184
Q

annual investigations for patients on clozapine

A 
weight BMI abdominal girth
fasting lipids 
blood glucose 
liver function
ECG 
U+E
FBC
Prolactin
BP + Pulse
185
Q

tardive dyskinesia medication

A

tetrabenazine

186
Q

what receptors do antipsychotics work on

A

D2 receptors

187
Q

treatment of akathisia

A

propanalol

188
Q

investigations for overdose

A 
toxicology 
LFT
U+E
ABG
clotting screen
189
Q

panic attack

panic disorder

A

panic attack: period of intense fear characterised by a constellation of symptoms e.g. feeling of impending doom

panic disorder: recurrent panic disorders

190
Q

types of OCD

A

Washers are afraid of contamination. They usually have cleaning or hand-washing compulsions.

Checkers repeatedly check things (oven turned off, door locked, etc.) that they associate with harm or danger.

Doubters and sinners are afraid that if everything isn’t perfect or done just right something terrible will happen, or they will be punished.

Counters and arrangers are obsessed with order and symmetry. They may have superstitions about certain numbers, colors, or arrangements.

Hoarders fear that something bad will happen if they throw anything away. They compulsively hoard things that they don’t need or use. They may also suffer from other disorders, such as depression, PTSD, compulsive buying, kleptomania, ADHD, skin picking, or tic disorders.

191
Q

common obsessions in OCD

A

Fear of being contaminated by germs or dirt or contaminating others
Fear of losing control and harming yourself or others
Intrusive sexually explicit or violent thoughts and images
Excessive focus on religious or moral ideas
Fear of losing or not having things you might need
Order and symmetry: the idea that everything must line up “just right”
Superstitions; excessive attention to something considered lucky or unlucky

192
Q

common compulsions in OCD

A

Excessive double-checking of things, such as locks, appliances, and switches
Repeatedly checking in on loved ones to make sure they’re safe
Counting, tapping, repeating certain words, or doing other senseless things to reduce anxiety
Spending a lot of time washing or cleaning
Ordering or arranging things “just so”
Praying excessively or engaging in rituals triggered by religious fear
Accumulating “junk” such as old newspapers or empty food containers

Phase 3A (9 decks)

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