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Phase 3A > Psychiatry > Flashcards

Psychiatry Flashcards

1
Q

Name two screening tools for alcohol dependence (2)

A

CAGE

AUDIT

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2
Q

Name some risk factors for alcohol dependence (4)

A 
Chronic illness
Male gender
Family history 
Genetic link
Occupation - Doctor, military
Traumatic life event
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3
Q

Name 6 signs of substance dependance (6)

How many signs must there be and long must they be present for? (3)

A

1) Strong desire/compulsion
2) Preoccupation with substance
3) Withdrawal state if removed
4) Tolerance to substance
5) Persisting use despite harmful effects
6) Impaired ability to control substance use

3 or more and present for more than 1 month

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4
Q

Name physical signs of chronic alcohol consumption (4)

A 
Jaundice
Clubbing
Hepatomegaly
Spider naevi
Ascites
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5
Q

What medical management is there for alcohol dependance? (3)

A

Disulfiram - stops alcohol metabolism - immediate hangover symptoms
Naltrexone - reduce cravings
Acamprosate - reduce cravings

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6
Q

What are the withdrawal symptoms of alcohol? (4)

How many hours after withdrawal is there the peak incidence of seizures? (1)

A

Malaise, tremor, nausea, insomnia, transient hallucinations, autonomic hyperactivity
36 hours

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7
Q

How many hours after withdrawal of alcohol does delirium tremens occur? (1)
What is the management of delirium tremens? (2)

A

72 hours

Chlordiazepoxide + thiamine (Vitamin B + C)

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8
Q

What is the triad for Wernicke’s ecephalopathy? (3)

A

Delirium/confusion, nystagmus, ataxia

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9
Q

What are the signs of Korsakoff’s psychosis? (3)

A

Irreversible short term memory loss
Confabulation
Disorientation to time

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10
Q

What are the three core symptoms of depression? (3)

A

Low mood
Anhedonia
Decreased energy

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11
Q

What SSRI should be prescribed in <18 year olds? (1)

A

Fluoxetine

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12
Q

What are side effects of SSRIs? (4)

A 
Sexual dysfunction
Insomnia
Initial increase in suicidal ideation
HYPONATRAEMIA
Serotonin syndrome
Headache
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13
Q

What are the signs of serotonin syndrome? (3)

A

Autonomic dysfunction - BP, shivering, sweating, hypertension, hyperthermia
Altered mental state - irritation and confusion
Neuromuscular hyperactivity - tremor, increased reflexes

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14
Q

What can be used to manage serotonin syndrome? (4)

A

Stop causative agent
IV fluids
Benzodiazepines
Cyproheptadine (antihistamine antidote if mild-moderate)

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15
Q

What are the side effects of tricyclic antidepressants? (4)

A

Anticholinergic affects - dry eyes, urinary retention, constipation, dry mouth, arrhythmias

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16
Q

What cardiac side effect can citalopram cause? (1)

A

Prolonged QT

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17
Q

Why can’t tricyclics be used in the elderly? (1)

A

Increased risk of stroke

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18
Q

What is the risk of drinking cheese or wine whilst taking monoamine oxidase inhibitors? (1)
What substance causes this? (1)

A

Hypertensive crisis

Tyramine

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19
Q

Give an example of a monoamine oxidase inhibitor (1)

A 
rasagiline 
selegiline 
isocarboxazid 
phenelzine 
tranylcypromine
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20
Q

Name a community screening tool for depression (1)

A

PHQ9

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21
Q

Name of hospital screening tool for depression (1)

A

HAD score

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22
Q

Name first rank symptoms for schizophernia (4)

A

Delusional perception
Thought alienation (thought insertion/withdrawal/broadcast)
Third person auditory hallucinations
Passivity phenomenon

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23
Q

What is needed for a diagnosis of schizophrenia? (3)

A

At least one first rank symptom for at least one month
OR two second rank symptoms for at least one month
Must rule out any organic cause

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24
Q

Name examples of typical antipsychotics (2) and their side effects (4)

A

Haloperidol
Chlorpromazine

Extrapyramidal side effects - Pseudoparkinsonism
Acute dystonia, akathisia, tardive dyskinesia

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25
Q

What is used to manage acute dystonia? (2)

A

Procyclidine and benztropine IV

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26
Q

What is used to manage akathisia? (1)

A

Beta blockers, benzodiazepines

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27
Q

What is used to manage tardive dyskinesia? (1)

A

Tetrabenazine

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28
Q

Which atypical antipsychotic causes the least hyperprolactinaemia? (1)

A

Aripiprazole

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29
Q

What is a serious risk of clozapine? (1)

How is this monitored? (2)

A

Agranulocytosis

Full blood count weekly for 18 weeks

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30
Q

What are the symptoms of neuroleptic malignant syndrome? (5)

A 
Lead pipe rigidity
Onset over days to weeks
Decreased reflexes
Hypertension
Tachycardia
Hyperthermia
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31
Q

How is neuroleptic malignant syndrome managed? (4)

A

Stop causative agent
IV fluids, cooling blankets
Benzodiazepines
Dantrolene (muscle relaxant)

32
Q

Name and describe different types of misidentification delusion (8)

A

Capgras - Belief that a close relative/spouse has been replaced by an imposter
Fregoli - Belief that various people they meet are actually the same person
Intermetamorphosis - Belief that people swap identities with each other whilst maintaining the same appearance
Subjective doubles - Belief that there is a doppelgänger of themselves carrying out independent actions

33
Q

What is Othello syndrome? (1)

A

Delusional jealousy

34
Q

How would thought block present? (1)

A

Sudden interruption of a train of thought leads to the affected person stopping talking suddenly. When they start talking again it is a completely unrelated topic.

35
Q

Name different types of thought alienation (4)

A

Withdrawal
Insertion
Broadcast
Block

36
Q

What id the definition of a delusion? (3)

A

A false, unshakeable idea or belief that is out of keeping with the patient’s educational, cultural and social background.

37
Q

What are the features of catatonia? (5)

A

Mutism, negativism, echolalia
Echopraxia, waxy flexibility
Withdrawal

38
Q

What is the difference between an obsession and a compulsion? (2)

A

Obsession - Anxiety inducing urges or images that arise persistently, repeatedly and uninvited
Compulsion - Performing repetitive behaviours to provide temporary relief from obsessions

39
Q

What short term and long term effects does alcohol have on neurotransmitters? (4)

A

Short term -
Increased GABA - anxiolytic and sedative
Increased Dopamine - Please and stimulant

Long term -
Down-regulated GABA and up-regulated excitatory glutamate

40
Q

Name some risk factors for alcohol abuse (5)

A 
Male
Young adult
Genetic factors
Antisocial behaviour 
Lack of facial flushing
Life stressors
Single/Separated/Divorced
Family history 
Drug misuse
41
Q

What results are expected on FBC and LFTs in alcohol misuse? (5)

A

Macrocytic anaemia
Raised Gamma glutamyl transpeptidase (GGT)
Raised carbohydrate deficient transferrin (CDT)
ALT and AST - raised if liver damage is present
Blood alcohol - raised if recently been drinking

42
Q

Name some peripheral stigmata of chronic liver disease (6)

A 
Palmar erythema
Spider naevi
Clubbing
Oesophageal varices
Dupytren's contracture
Gynaecomastia
Caput medusa
43
Q

What is the management for opiate overdose? (1)

A

IV Naloxone

44
Q

What personality disorders are in cluster A? Describe them (4)

A

Paranoid disorder - excessive sense of own importance, blames others for mistakes and problems, conspiracy theories, mistrusts others

Schizoid personality disorder - emotionally cold, find little pleasure in any activities, solitary and introspective, indifferent to others expectations

45
Q

What personality disorders are in cluster B? Describe them (8)

A

Borderline personality disorder - Uncertain about personal or sexual identity, forms intense, unstable relationships, rejection issues, recurrent suicidal/self harm threats

Impulsive - impulsive and lack self control, sudden outbursts of anger

Dissocial - Disregard for people’s feelings and social norms, lack of guilt, low threshold for anger and violence

Histrionic - Exaggerated emotions, craves attention, shallow personality, easily influenced by others/circumstance

46
Q

What personality disorders are in cluster C? Describe them (6)

A

Dependent - Feel unable to cope and make decisions on their own, fear of being alone, puts needs of those they are dependent on above their own

Anakastic - Rigid, stubborn, excessively well organised. Perfectionist, insist people do things their way

Anxious/avoidant - Persistent tension/apprehension, low self esteem, avoid situations with criticism or rejection

47
Q

What therapy is best used to treat personality disorders? (1)

A

Dialectal Behavioural Therapy

48
Q

What is Beck’s cognitive triad? (3)

A

Seen in depression -

Pessimistic thoughts about self, the world and the future

49
Q

What features are needs for a diagnosis of Obsessive-Compulsive Disorder? (4)
At what age does it typically manifest? (1)

A

Obsessions and/or compulsions
That are time consuming (>1 hour a day)
Must be present most days over at least two weeks
The symptoms must be distressing and interfere with activities

Typically manifests in adolescence

50
Q

Name three classes of anxiolytics and an example of each (6)

A

Benzodiazepines -Diazepam, lorazepam
Non-benzodiazepine hypnotic - Zopiclone
5HT agonist - Busprione

51
Q

What score is used in adolescents that present with overdose? (1)
Describe the score (5)

A 
PATHOS
Problems for more than a month
Alone at the time of the overdose
Time - planned for more than 3 hours
Hopeless about the future
Sad most of the time before the overdose
52
Q

Name and describe subtypes of schizophrenia (8)

A

Paranoid - Most common with delusions and auditory hallucinations
Catatonic -Psychomotor disturbances, rigidity, posturing echopraxia and echolalia
Hebephrenic - Early onset with poor prognosis. Irresponsible, unpredictable behaviour, mood inappropriate and affect incongruous
Residual - Previously another subtype but currently presenting with negative symptoms and cognitive impairment

53
Q

Name some good prognostic factors for Schizophrenia (6)

A 
Female
Good social support
In a relationship
No negatie symptoms
Intelligence/high level of education
Low stress
Paranoid subtype
Late onset
Acute onset 
No substance misuse
54
Q

What are the three subtypes of Bipolar Affective Disorder (6)

A

Bipolar I - One or more manic or mixed episode and one or more major depressive episode
Bipolar II - Recurrent major depressive episodes and hypomanic episodes
Cyclothymic disorder - Chronic mood fluctuation over at least two years with episodes of depression and hypomania, Insufficient severity for other subtypes

55
Q

What is the gold standard medical prophylaxis for bipolar affective disorder? (1)

A

Litium

56
Q

What must be tested before initiating Lithium treatment? (2)

When must they be tested during treatment? (2)

A

Thyroid and renal function

Every 3 months in the first year then every 6 months

57
Q

Name some common adverse effects of Lithium treatment (5)

A

Leukocytosis
Insipidus diabetes
Tremor/Teratogenic (Ebstein’s anomaly)
Hypothyroidism

58
Q

What is the mechanism of Sodium Valproate? (2)

A

Inhibits GABA transaminase to increase levels of GABA

59
Q

What are the adverse effects of Sodium Valproate? (8)

A 
Vomiting
Alopecia
Liver toxicity
Pancreatitis/Pancytopenia
Retention of fat
Oedema
Appetite increase
Tremor/teratogenicity
Enzyme inducer
60
Q

What birth defects can Sodium Valproate cause? (2)

A

Minor - small fingers and toes

Major - Cleft palate, spina bifida

61
Q

Name the dopaminergic pathways antipsychotics work on and what affect they have on each (8)

A

Mesolimbic - Positive symptoms
Mesocortical - Negative symptoms
Nigrostriatal - Extrapyramidal symptoms
Tuberoinfundibular - Hyperprolactinaemia

62
Q

What factors would indicate hospitalisation is required in anorexia nervosa? (3)

A

Significant physical abnormalities
Suicide risk
BMI <13.5

63
Q

What is the management of anorexia nervosa? (2)

A

Structured eating plan

Psychotherapy

64
Q

Name some signs of anorexia nervosa (5)

A 
Low subcutaneous fat
Low energy levels, poor concentration
Orthostatic hypotension
Bradycardia
Lanugo - fine body hair
Dry skin and nails
Longterm - osteoporosis
65
Q

What is increased in anorexia nervosa (3Cs and 3Gs)? (6)

A 
Carotinaemia
Hypercholesterolaemia
Excess salivary gland excretion
Growth hormone
Glucose
66
Q

What are the key this that Deprivation of Liberty Safeguards are designed to ensure? (3)

A

A patient, who has their liberty deprived, has an independent representative to act upon
their behalf
That the deprivation of their liberty is reviewed on a regular basis
That the patient – or their representative has a legal basis on which to challenge the deprivation of liberty through the court of protection

67
Q

How long does an emergency DOLS last? (1)

A

7 days

68
Q

What is the maximum amount of time a DOLS can be in place before it is reviewed? (1)

A

1 year

69
Q

Under which act can a lasting power of attorney and advanced directives be put in place? (1)

A

The Mental Capacity Act

70
Q

Describe Section 2 of the Mental Health Act (4)

A

An Assessment Order–
Allows a patient to be sectioned for up to 28 days.
Must be signed by 2 doctors and an ASW.
One of the doctors has to have previously known the patient.
It allows patients to be treated against their will as it is considered to be part of the assessment.

71
Q

Describe Section 3 of the Mental Health Act (4)

A

Treatment orders – Last for 6 months.
The ASW must seek the consent of the nearest relative, and the patient cannot be detained if this relative objects.
The doctor has to state the category of mental illness the patient is thought to be suffering from.
Treatment can be given – but after 3 months, either:
The patient has to consent to treatment or third doctor has to review the patient and give their consent for treatment to be given

72
Q

Describe Section 4 of the Mental Health Act (4)

A

Emergency order– admission for emergency treatment. Lasts up to 72 hours.
Must be signed by a doctor and ASW.
Cannot treat against the patient’s will with this order – just used for assessment.

73
Q

Describe Section 5 of the Mental Health Act (3)

A

Compulsory detention of patient who has come to hospital voluntarily.
5(2) is performed by a doctor and lasts up to 72 hours
5(4) is performed by a nurse and lasts up to 6 hours

74
Q

Describe Section 135 of the Mental Health Act (3)

A

A police officer may enter the patient’s premises and remove a person to a ‘place of safety’ for up to 72 hours. Can only be used if a social worker has obtained a warrant.
Cannot treat against the patient’s will.

75
Q

Describe Section 136 of the Mental Health Act (3)

A

A policer officer may remove a patient from a public space to a ‘place of safety’ for up to 72 hours.
It does not require a warrant.

76
Q

What are the principles of de-escalation? (5)

A 
Active listening
Empathy
Rapport
Influence
Change
77
Q

What therapy is best for PTSD? (1)

A

Eye movement desensitisation and reprocessing

Phase 3A (6 decks)

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