Psychiatry Flashcards
Tardive dyskinesia
Involuntary muscle movements - usually tongue, lips, trunk and extremities. May be described as choreoathetoid.
Medication likely to cause tardive dyskinesia
Long-term anti-dopamine meds such as antipsychotics (particularly typical), metoclopramide, prochlorperazine, carbamezapine and phenytoin
Serotonin syndrome symptoms
3 or more of the following: ataxia, diarrhoea, hyper-reflexia, agitation, tremor, clonus or changes in mental status
Complications of serotonin syndrome
Seizures, renal failure, resp failure, rhabdomyolysis or arrythmias.
Treatment of serotonin syndrome
Usually supportive - resolves
What is akathisia?
Restlessness - inability of the patient to remain motionless. Usually caused by anti-psychotics
Acute dystonia
Intermittent or sustained contractions affecting any muscles (usually caused by neuroleptic medication)
Neuroleptic malignant syndrome
Associated with the use of antipsychotics. Hypethermia (>38), muscle rigidity, change in consciousness and autonomic instability.
Neuroleptic malignant syndrome treatment
Remove causative medication. Cooling the patient or using dantrolene/bromocriptine is necessary. Resolves 1-2 weeks but can be life-threatening.
Key symptoms of depression (ICD-10)
2 of: Persistent low mood, loss of interest/pleasure and fatigue/low energy
Other symptoms of depression (ICD-10)
Disturbed sleep, poor concentration/indecisiveness, low self confidence, changed appetite, suicidal thoughts/acts, agitation/slowing of movement, guilt/self blame
Negative symptoms of schizophrenia
Blunted affect, social withdrawal, apathy and anhedonia, speech reduced and slowness in thought and movement
Effect of prominent Negative symptoms on schizophrenia prognosis
Unfavourable
Delusions of passivity
Person feels that their actions, feelings or impulses are being controlled by an external force
Main management for OCD
CBT including exposure response therapy and/or SSRI
Best therapy for bereavement related depression
Interpersonal therapy - CBT is less useful if their is a key trigger
Dangerous dosulepin side effect
Cardiac conduction defects and arrythmias
Criteria for substance dependence
3 or more of the following:
Strong desire or sense of compulsion to take substance
Difficulty controlling substance taking behaviours in onset, termination or level of use
Physiological withdrawal state without substance
Increased tolerance
Progressive neglect of alternate pleasures/interests - increase time devoted to substance
Persisting with substance use despite evidence of it causing harm
Traits of avoidant personality disorder
Socially inhibited, sensitive to rejection and timid with overwhelming fears of inadequacy
Traits of dependent personality disorder
Low self-confidence, submissive, clingy and excessive need for nurture
Traits of schizotypal personality disorder
Odd thought patterns, interpersonal awkwardness and odd appearance
Traits of schizoid personality disorder
Voluntary social exclusion and limited emotional expression
Minimum symptom length for PTSD
1 month
Symptoms of acute stress disorder
Persistently heightened awareness, difficulty sleeping, flashbacks, and interference of thoughts with activities of daily living
Adjustment disorder criteria
An identifiable stressor, a maladaptive response to this which interferes with ADLs, symptoms started within 3 months of stressor and must not meet the criteria for any other psych disorder
Panic disorder symptoms
SOB, chest pain, diaphoresis, nausea, choking, abdo distress and feelings of impending doom
Treatment of acute dystonia (post-anti-psychotics)
Anti-cholinergics
Most appropriate sleep medication in learning difficulties
Melatonin - they often have chronic sleep/wake cycle disturbances
What is social learning?
Where patterns of behaviour are acquired by watching other people and assimilating their actions into the behaviour repetoire. Often when people repeat behaviours seen by their parents as a child.
Schneider’s first rank symptoms
Delusional perception
Auditory hallucinations
Delusions of thought interference
Passivity phenomenon or delusions of control
Tourette’s syndrome
Multiple motor tics plus one or more vocal tics (throat clearing and grunting count). Motor tics usually develop first and is more common in men
Conduct disorder
Mental disorder causing persistent and repetitive pattern of behaviour which violates either the basic rights of others or goes against the age-developmental norms. Can develop into dissocial personality disorder at 18
Neologisms
New words made up by patient
What is splitting in borderline personality disorder?
Patient distinguishes between 2 groups of people - ones they like and trust and one they do not
Are morning erections maintained in psychological causes of ED?
Yes, difficulty is just during sexual encounters. Loss of morning erections implies organic cause
SSRI side effects
Restlessness, insomnia, generalised agitation (akathisia), GI upset, increased risk of fracture and sexual dysfunction
SSRI with lowest rate of antimuscarinic side effects
Fluoxetine
What are postpartum blues?
Fatigue/tearfulness/depressed affect that develops 2-3 days post birth and resolves without treatment within 10-14 days. Occurs in 50% of women
Usual age of onset for schizophrenia
Late teens/early 20s in men and late 20s/early 30s in women
Schizophrenia prodrome
Social withdrawal, unusual beliefs and deterioration in hygiene/social/occupational functioning
Difference between hallucinations and illusions
Hallucinations are perceptions of stimuli that aren’t there whereas illusions are incorrect perceptions of stimuli that are there
Symptoms of mania
Must have elevated mood for 1 week + 3 or more of: Increased activity/physical restlessness Increased talkativeness Flight of ideas/racing thoughts Loss of social inhibiton Decreased sleep requirement Inflated self esteem/grandiosity Distractibility/changing activity or plans Reckless/risky behavious Marked sexual energy With/without delusions/hallucinations
Deficiency of which vitamin causes Korsakoff’s?
Vitamin B1 - thiamine. Results in bilateral loss of the mammilary bodies in the brain.
What is Korsakoff’s?
Severe deficiency of vit B1 resulting in bilateral loss of the mammillary bodies. Often due to chronic alcoholism. Causes anterograde amnesia and confabulations.
Effects of thiamine deficiency
Korsakoff’s dementia, beriberi, polyneuritis, symmetrical muscle wasting and dilated cardio-myopathy
Indications for ECT
Major depression with high risk of suicide, psychotic features, catatonic stupor, food refusal/severe weight loss/dehydration, refractory to antidepressants or previous response to ECT.
Treatment for delirium
Treat underlying cause, reorientate, reassure and optimise environment
What is a section 4?
Used in emergencies when only one doctor available and section 2, 3 or 5(2) would cause delay. Lasts 72 hours.
Learning disability classification IQ ranges
Mild 50-69
Moderate 35-49
Severe 20-34
Profound is less than 20
Length of time to class as psychosis
4 weeks
Length of time to class as depression
2 weeks
Length of time to class as mania
1 week
Length of time to class as hypomania
4 days
Cluster A personality disorders
Odd/eccentric: Schizoid, schizotypal and paranoid
Cluster B personality disorders
Dramatic/eratic/emotional: Antisocial, EUPD, Histrionic, Narcissistic
Cluster C personality disorders
Anxious: Avoidant, Dependent and Obsessive-compulsive
Traits of histrionic personality disorder
Dramatic, attention-seeking and manipulative
What is dissociation?
An immature ego defence where one’s personal identity is temporarily and drastically modified to avoid the distress of a given situation,
Most common type of hallucination in schizophrenia
Auditory - normally malevolent voices
Positive symptoms in schizophrenia (THREAD)
T Thinking may become disturbed, neologism usage
H Hallucinations may occur, usually auditory
R Reduced contact with reality, the natural barrier between subjective and objective deteriorates
E Emotional control may be disturbed with inappropriate laughter or anger (incongruous affect)
A Arousal may lead to worsening of symptoms
D Delusions may occur
Discontinuation symptoms
Rebound anxiety, depressive symptoms, flu-like symptoms, dizziness, nausea or sleep-disturbance
Early side effects of SSRI treatment
worsening of anxiety, agitation and sleep problems
First line drug for OCD
Sertraline
Which symptom differentiates delirium from dementia
Reduced level of consciousness
Core features of ADHD
Inattenion, hyperactivity abd impulsiveness
First line treatment in mild-moderate depression
Low intensity psychological intervention or CBT such as computerised CBT
Indications for ECT
Severe depression, catatonia and prolonged/severe mania
