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Medical School Finals > Psychiatry > Flashcards

Psychiatry Flashcards

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USMLE® Step 1 flashcards
1
Q

Patient - elderly man, inpatient in hospital becomes acutely confused following UTI, hallucinating, w/ sleep wake reversal

A

Delirium

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2
Q

Delirium Aetiology

A
  • Infection
  • Drugs - BZ, opiates, L-Dopa, Digoxin
  • Hypoglycaemia
  • Dehydration and electrolyte imbalance
  • Decreased O2
  • Alcohol withdrawal
  • Surgery

RF’s

  • Age
  • Dementia or brain injury
  • New environment
  • Sleep deprivation
  • Immobilization
  • Visual or hearing impairment
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3
Q

Delirium Presentation

A
  • Sleep/wake reversal
  • Incoherent thought and speech
  • Visual hallucinations
  • Persecutory delusions
  • Hyperactive = agitated and upset
  • Hypoactive = Drowsy and withdrawn.
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4
Q

Delirium Ix

A

1) Hx and Exam to identify underlying cause.

2. Septic screen

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5
Q

Delirium Rx

A
  1. Nurse in a quiet and safe area.
  2. Re-orientate
  3. Avoid psychoactive drugs (can use haloperidol if severe)
  4. Treat cause
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6
Q

Patient - Young male, cannabis user, auditory hallucinations, thought echo, though withdrawal and passivity.

A

SCH

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7
Q

SCH Aetiology

A
  • UK
  • Genetics - FHx
  • Dopamine excess (only explains positive Sx)
  • Daily cannabis use is a RF.
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8
Q

SCH Presentation

A

First rank Sx; 3rd person auditory hallucinations + thought echo + thought interference + delusional perception + passivity phenomenon.

  • Sx must be present for 6 months.
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9
Q

SCH: Paranoid

A
  • Common, hallucinations and delusions are persecutory
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10
Q

SCH: Hebephrenic

A
  • Disorganised SCH w/ fleeting affect, hallucinations and delusions.
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11
Q

SCH: Catatonic

A
  • Stupor, posturing and negativism (withdrawal, self-neglect, blunted affect)
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12
Q

SCH Ix

A

1) Clinical

2) Rule out brain pathology such as FTD or LBD. Brain scan for mass lesions.

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13
Q

SCH Rx

A

1) Antipsychotic (neuroleptic drugs)
- Block D1 and D2 receptors.
- Manage acute +’ve Sx.
- Extra-pyramidal SE; parkinsonism due to Dopamine blockade.
- Common SE = Akathisia, parkinsonism, tardive dyskinesia, hypotension, dry mouth, weight gain, urinary retention.

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14
Q

Antipsychotics

A

1st gen = Chlorpromazine, haloperidol

2nd gen = risperidone, olanzapine, clozapine

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15
Q

Patient - 5 days after first dose of haloperidol, becomes hyperthermic, rigid, w/ increased HR and pallor.

A

Neuroleptic malignant syndrome

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16
Q

NMS Aetiology

A
  • Due to dopamine blockade, triggers massive glutamate release, neurotoxic and muscle damage.
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17
Q

NMS Presentation

A
  • Pyrexia
  • Muscle rigidity
  • Antonomic lability, HTN, high HR, high RR.
  • Agitated delirium and confusion
  • LOC
18
Q

NMS Ix

A

1) Clinical w/ Hx of Antipsychotics or levodopa (when stopped)
2) Bloods; CK and FBC (leucocytosis)

19
Q

NMS Rx

A

1) Stop offending drug.
2) ITU for nursing
3) Dantrolene to decrease muscle tone
4) Bromocriptine (dopamine agonist) enhances dopaminergic activity.

20
Q

Patient - Periods of depression and low mood punctuated with periods of elation and psychotic behaviour

A

Bipolar disorder.

21
Q

BPD Aetiology

A
  • UK
  • Genetics
  • Biochemical - increased serotonin
22
Q

BPD Presentation

A
  • Develops in late teens.
  • Type 1 = mania and depression
  • Type 2 = Hypomania and depression.
23
Q

Mania

A
  • Abnormal elevated mood or irritability
  • In mania there is severe functional impairment or psychosis for 7 days or more.
  • Hypomania is less severe or less prolonged.
  • Delusions of grandeur, pressure of speech, flight of ideas etc, sexual promiscuity.
24
Q

BPD Rx

A

1) Lithium is the drug of choice. Alternative = valproate.
2) Mania management = stop antidepressant and start antipsychotic therapy - olanzapine or haloperidol.
3) Manage depression w/ talking or fluoxetine.

Lithium;

  • TFT, parathyroid and U&E prior to starting.
  • Toxicity can occur
  • Interacts w/ NSAID’s and diuretics.
  • Monitoring week following first dose and 12hrs following last dose. + every 3 months when stable.
  • TFT and U&E every 6 months
25
Q

Lithium toxicity

A
  • Therapeutic range = 0.4-1.0mmol/L
  • Toxicity occurs >1.5mmol/L
  • May be precipitated by; dehydration, renal failure, NSAID, diuretics and metronidazole.
  • Coarse tremor
  • Hyperreflexia
  • Acute confusion
  • Seizure
  • Come

Rx

  • Mild to mod = volume resus w/ saline
  • Dialysis
26
Q

Patient - No joy, low mood and little energy for 2 weeks or more.

A

Ya depressed mate

27
Q

Depression Aetiology

A
  • Genetics; FHx
  • Biochemical - Monoamines
  • Biopscyhosocial - yeh we don’t fucking know.
28
Q

Depression Presentation

A
  • Anhedonia
  • Low mood
  • Anenergia
  • All for atleast 2 weeks.
    Others include;
    Biological - insomnia, decreased libido and appetite
    Psychological - decreased motivation, guilt, decreased confidence, worthlessness and hopelessness.
    Psychosis.
29
Q

Depression Ix

A

1) PHQ9
2) HAD
3) Beck’s depression inventory
4) Bloods (TFT, steroids) to rule out organic illness.

30
Q

Depression Rx

A

1) Talking therapies (CBT, IPT) mindfulness.
2) Lifestyle changes (reduce alcohol and drugs)
3) Medications if severe.

31
Q

Patient - Gave birth to a beautiful baby boy 2 months ago, feels low, feels guilty and like a bad mother. To the point she cant leave the house or function :(

A

Post-natal depression.

32
Q

PND Aetiology

A
  • UK
  • Related to the removal of pregnancy hormones and the surges etc.
  • Any depressive illness occurring in the first post-natal yr. Can be de novo or following a hx of depression.
33
Q

PND Risks

A
  • Previous mental health issues
  • Poor support
  • poor partner relationship
  • major life events
  • baby blues
  • not breast feeding
  • unemployment
  • substance misuse.
34
Q

PND Presentation

A
  • Same as normal depression
35
Q

PND Ix

A
  • Assess for Hx
  • Alcohol and drug screen
  • The pregnancy experience
  • Mother baby relationship
  • DV at home
36
Q

PND Rx

A

1) Reassure - ‘you’re a great mother - gurl you got dis’
2) Mild to mod - CBT
3) Severe - consider CBT + drugs.

37
Q

SSRI side effects

A
  • GI upset
  • Hyponatraemia
  • Long QT
38
Q

SSRI in pregnancy

A
  • Risk Vs benefit
  • used in 1st trimester = small risk of heart defects
  • Used in 3rd trimester can causes persistent pulmonary hypertension of the newborn.
39
Q

Antipsychotic side effects

A
  • Parkinsonism
  • Acute dystonia (torticollis, oculogyric crisis)
  • Akathisia
  • Tardive dyskinesia
  • NMS
40
Q

ECT

  1. indication
  2. SE
A
  1. Severe depression + catatonia
  2. Headache
    - Nausea
    - short-term memory loss
    - Anterograde amnesia
    - arrhythmia
41
Q

Anorexia presentation

A
  • All things low

- G’s and C’s are raised; Cortisol, growth hormone, glucose, salivary glands, cholesterol.

42
Q

GAD Rx

A
  1. Education
  2. Low intensity CBT
  3. high intensity CBT and/or drug (SSRI)

Medical School Finals (24 decks)

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