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Medical Finals 2020 > Psychiatry > Flashcards

Psychiatry Flashcards

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USMLE® Step 1 flashcards
1
Q

What class of drug does mirtazapine belong to?

A

Noradrenergic and serotonergic antidepressants

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2
Q

What are some common side effects of mirtazepine?

A

Drowsiness

Increased appetite

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3
Q

What are some side effects of tricyclic antidepressants?

A 
Drowsiness
Urinary retention (can cause overflow incontinence)
Lengthening QT
Blurred vision
Constipation
(Anticholinergic symptoms)
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4
Q

What are some side effects of clozapine?

A

Low WCC (neutropenia) - agranulocytosis

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5
Q

What are indications for ECT?

A

Catatonia
Severe resistant depression
Manic episodes
Moderate depression that responded to previous ECT

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6
Q

What effect does smoking have on clozapine?

A

It makes it less effective

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7
Q

What is Cotard Syndrome?

A

The delusion that you are already dead

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8
Q

What is a common symptom occurring around 36-hours post cessation of drinking?

A

Withdrawal seizures - alcohol enhances GABA mediated inhibition, withdrawal means there is decreased GABA and increased NMDA glutamate transmission
Give benzodiazepine post-cessation for seizures

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9
Q

What is the difference between positive and negative symptoms?

A

Positive symptoms are an increase of normal function

Negative symptoms are a decrease or loss of normal function

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10
Q

What questions need to be asked in a psych screening review?

A

Schizophrenia - hallucinations, delusions, delusional perception
Depression - mood, sleep, energy, appetite, future, suicidal thoughts, relationships
Other - memory loss, anxiety, insight

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11
Q

What is involve in a mental state examination?

A 
ASEPTIC
Appearance and behaviour
Speech
Emotions
Perceptions
Thoughts
Insight
Cognition
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12
Q

What are the four ‘p’s in the biopsychosocial formulation?

A

Predisposing factors
Precipitating
Perpetuating
Protective

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13
Q

How is capacity decided?

A

Assume patient to have capacity unless proven otherwise
A patient must be able to understand the information presented to them, weigh up the pros and cons, retain the information and be able to communicate their decision back
The Mental Capacity Act

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14
Q

What is a section 3?

A

6 month inpatient stay
Done by a S12, doctor, AMHP
Can force treatment in first 3 months

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15
Q

What is the name of alcohol-induced thiamine deficiency?

A

Korsakoff’s Psychosis (thiamine deficiency), Wernicke’s Encephalopathy

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16
Q

What is a section 4 and who can use it?

A

72 hours holding, can be done by one doctor and an AMHP, used when waiting for a second doctor would result in undesirable results

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17
Q

What is the unit limit for woman?

A

14 units (now same as men)

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18
Q

What are the features of Wernicke’s encephalopathy?

A

CAN OPEN confusion, ataxia, nystagmus, ophthalmoplegia, peripheral neuropathy

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19
Q

What to give someone to prevent alcohol withdrawal symptoms?

A

Chlordiazepoxide

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20
Q

What physical health problems do alcohol cause?

A 
Alcoholic cirrhosis and hepatitis
GI: nausea and vomiting, gastritis, peptic ulcers, Mallory-Weiss tears, pancreatitis
AF
Acute intoxication
Foetal alcohol syndrome
Subdural haemorrhage
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21
Q

What can occur in alcohol withdrawal?

A

Seizures (grand mal)
Delirium tremens
Coarse tremors, sweating, insomnia, tachycardia (pulse >100), hallucinations, n+v
Alcohol hallucinosis

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22
Q

What is Delirium Tremens? How is it treated?

A

Tremor, agitation, dilated pupils, visual hallucinations, seizures – DT occurs in acute alcohol withdrawal, treat with benzodiazepines (lorazepam)

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23
Q

Name 3 features of dependency.

A

Habits in obtaining and using your dependent substance, use of dependant substance to avoid a withdrawal, increased tolerance, continued use despite negatives, pattern use

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24
Q

Give 8 signs of dependence:

A

Compulsion to drink, Aware of harms but persists, Neglecting other activities, Tolerance of alcohol, Stopping = withdrawal, Stereotypes problems, Time preoccupied by alcohol, Out of control, Persistent desire to cut down

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25
Q

What is classified as Type C?

A

Avoidant, Dependent, OCPD

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26
Q

Someone who has shallow affect, very ambitious and self-serving is…?

A

Histrionic

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27
Q

Give 5 points on the PCL-R?

A

Short term marital relations, parasitic lifestyle, poor impulse control, low threshold for discharge of aggression, ego-centralism, lack of remorse, superficial charm, lack of realistic long-term goals, difficulty in accepting responsibility

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28
Q

33y teacher has an attack of autonomic symptoms and a sense of impending doom. Name the acute attack.

A

Panic attack

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29
Q

Name 2 endocrine/metabolic causes of anxiety.

A

Hyperthyroid disease (thyrotoxicosis), ictal anxiety (epilepsy), phaeochromoytoma.

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30
Q

What is the name of the cognitive symptom where you feel like she is going to die.

A

Thanatophobia

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31
Q

A patient describes feelings of being removed from her body/the real world. Name these 2 sensations.

A

Depersonalisation. Derealisation.

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32
Q

Name the fear of crowded places.

A

Agoraphobia

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33
Q

What is the term used to describe behaviours in those who take psychoactive substances?

A

Addictive behaviour

Dependence

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34
Q

What are the three types of personality disorder? What are the key symptoms of the 9 different personality disorders?

A

Type A - Psychoses (Paranoid, Schizoid, Schizotypal)
Type B - (Antisocial, Histrionic, Narcissistic, Borderline)
Type C - (Avoidant, Obsessive/Anankastic, Dependent)

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35
Q

What clusters can personality disorders be divided into?

A

Withdrawn
Inhibited
Antisocial
Dependent

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36
Q

What is another name for obsessive personality disorder?

A

Anankastic - anxious, doubting, indecisiveness cautious, pedantry, rigidity, perfectionism, preoccupation with order and details, rigid adherence to rules, inflexibility

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37
Q

What is the difference between obsessive compulsive personality disorder and OCD? Use the two ‘e’ words.

A

Egodystonic - thoughts and behaviours are in conflict with a person’s ideal self-image
Egoyntonic - the patient doesn’t see anything wrong with what they are doing, behaviours are in line with their needs

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38
Q

What are your differentials for PD?

A

Schizophrenia, hypomania
Drug and alcohol-induced states
Organic psychosis (Wilson’s Disease)

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39
Q

What is attachment theory and what are the three types?

A

Bowlby’s theory of the importance of attachment in personal development and the need to form attachment to a caregiver

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40
Q

What are the 2 key symptoms groups in OCD?

A

Obsession

Compulsion

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41
Q

How can you treat OCD?

A 
CBT
Self-help exposure therapy
Response prevention therapy
SSRI high dose (NOT FIRST LINE)
Chlomipramine (tricylci antidepressant)
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42
Q

If insight is not maintained what is the more likely diagnosis?

A

Obsessive Compulsive Personality Disorder

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43
Q

What are the 5 elements required for a PTSD diagnosis?

A 
Major trauma experience
Thoughts, nightmares and flashbacks
Emotional blunting
Increased arousal and hypervigilance
Latency period of a few weeks to months
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44
Q

How is GAD treated?

A 
CBT
Counselling
Relaxation techniques
Benzodiazepines
SSRIs
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45
Q

What is body dysmorphic disorder?

A

A distressing preoccupation with some imagined or slight defect of appearance in a normal appearing person

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46
Q

What are the 3 main types of phobic disorders?

A

Specific phobias
Agoraphobia
Social phobias

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47
Q

Define hyperarousal and hypervigilance?

A

Hypervigilance - too much sensitivity to threats that are not worth worrying about
Hyperarousal - the inability to relax during times when you are meant to relax

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48
Q

What are neuroses?

A

neuroses are understandable symptoms that are quantitatively different from normal such as increased anxiety levels

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49
Q

What are risk factors for anxiety?

A

Environmental factors such as familiar background, there may be a genetic inherited predisposition to neurosis, premorbid anxious avoidant personality, a link to early childhood separation

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50
Q

Why does Munchausen occur? How can it be diagnosed?

A

This is a disorder in which a person deliberately acts as if they have a mental or physical illness when they are not sick. It is associated with severe emotional difficulty. The pathological lying may be to the extreme that they present to different hospitals under different names.

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51
Q

What are the three types of somatoform disorders?

A

Somatization disorder - chronic physical symptoms persisting for several years with no adequate medical explanation
Hypochondriac - unrealistic alarm by symptoms assuming it is the cause of a serious illness
Persistent Pain Disorder - severe and distressing pain that cannot be explained by physiological or physical disorder (emotion link)

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52
Q

What are physical findings in anorexia?

A 
Laguno hair - fine downy hair growth in response to loss of body fat
Failure of secondary sex characteristics
Bradycardia
Cold intolerance
yellow-tinge on skin
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53
Q

What is Charles Bonnet syndrome?

A

Visual hallucinations associated with eye disease

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54
Q

Over what period of time should SSRIs be stopped?

A

4 weeks (except fluoxetin as it has a longer half-life)

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55
Q

What is tardive dyskinesia

A

Chewing, jaw pouting or excessive blinking

Occurs in patients on anti-psychotics

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56
Q

What hormonal effects does anorexia have on the body?

A

Anorexia nervosa – growth hormone, glucose, salivary glands, cortisol, cholesterol all RAISED, low FSH

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57
Q

What treatments are offered in anorexia nervousa? Give some biological, psychological and social treatments

A

Family therapy (recommended for children), Individual CBT, dietician input regarding refeeding, fluoxetine

58
Q

What is Russel’s sign and what does it indicate?

A

Russel’s sign – calluses over fingers from vomiting

Bulimia

59
Q

What is anorexia nervosa?

A

Endocrine disturbance, delayed/arrest puberty, deliberate weight loss, distorted body image, low BMI

60
Q

What is MARSIPAN? How can eating disorders be managed?

A

Fluoxetine, family therapy

61
Q

What electrolyte disturbances do you see in someone with anorexia?

A

Electrolyte disturbances – low K, Mg, PO4-

62
Q

What treatment do you use for treatment-resistant schizophrenia?

A

Clozapine

63
Q

Name 3 negatives symptoms of schizophrenia?

A

Apathy, poverty of speech, blunted/incongruous affect, loss of motivation, anhedonia

64
Q

What are the four Schneider first rank symptoms?

A

Delusional perception, Passivity Phenomenon, Auditory Hallucinations, Thought Alienation

65
Q

What are the 5 types of schizophrenia?

A

Paranoid (auditory/visual hallucinations and delusions, no thought disorder), Hebephrenic (disorganised, thought disorder and flat affect), Catatonic (waxy flexibility, immobile or agitated, echolalia), Simple (insidious and progressive negative symptoms), residual (chronic negative symptoms)

66
Q

Give some different differentials for paranoia and delusional thoughts.

A

Schizophrenia, Substance Abuse

67
Q

What section can police bring patients in under?

A

136

68
Q

What are poor prognostic indicators for schizophrenia?

A

Gradual onset, family history, low IG, premorbid history of social withdrawal, lack of obvious precipitant

69
Q

What is the difference between schizoaffective disorder and a mood disorder with psychosis?

A

The time period in which the symptoms appear and develop over

70
Q

What is a schizotypal disorder?

A

Odd ideas, fantasy obsession

71
Q

What are erotomanic delusions?

A

Delusional beliefs that someone is in love with you

72
Q

What is induced delusional disorder and what are the types?

A

Shared delusional disorder
‘folie a deux’
Shared delusion or belief

Folie imposee
Folie simultanee
Folie communique
Folie induite

73
Q

Name 6 symptoms of depression.

A

Poor sleep, early waking, sexual disinterest, suicidal ideation, low mood, anhedonia

74
Q

Name 3 cognitive symptoms of depression.

A

Poor concentration, difficulty in focussing, poor memory

75
Q

What test would you use to assess his depression?

A

PHQ-9, HADs

76
Q

What 3 things could a GP do to manage a patient with depression?

A

CBT, lifestyle advice regarding exercise and mindfulness, prescribe an antidepressant

77
Q

What are the core symptoms of depression?

A

Inergia, anhedonia, low mood

78
Q

What are the 9 DSM-IV criteria for depression?

A

DEAD SWAMP – depressed mood, energy loss or fatigue, anhedonia, death thoughts, sleep disturbances, worthlessness or guilt, appetite or weight changes, mentation (concentration decrease), psychomotor agitation or retardation

79
Q

What are differentials to a manic episode?

A

Substance abuse, schizophrenia, hyperthyroid, head injury, ADHD

80
Q

What is the difference between mania and hypomania?

A

Mania has the inclusion of psychotic symptoms, and is 4+ days, while hypomania has no psychotic symptoms > 1week

81
Q

Give some symptoms seen in either mania or hypomania.

A

Extreme elation, Pressure of Speech, Flight of ideas, grandiose delusions, increased spending costs, irritable, increased energy, decreased sleep, impaired judgement

82
Q

What are the different types of bipolar disease?

A

Type 1 – severe depression and mania, Type 2 – predominantly depression, mild hypomania, Rapid cycling >4 in 12 months, Cyclothymia – persistent instability of mood, Mixed – simultaneous symptoms

83
Q

What are some RF for depression?

A

FH of depression, post-partum, low socio-economic status, drug/alcohol abuse, young/elderly, chronic disease, females, dementia

84
Q

What occurs in severe depression – what is needed for a diagnosis?

A

Catatonia, >6 weeks interfering with normal function

85
Q

What does SAD stand for?

A

Seasonal Affective Disorder, mood affected by the season

86
Q

What are some differentials to depression including biological differentials?

A

Hypothyroidism, dementia, bipolar

87
Q

What are the three psychiatric disorders that can occur following pregnancy and how are they treated?

A

Baby blues (resolves normally), post-partum depression (sertraline), post-partum psychosis (olanzapine)

88
Q

Give five potential causes of toxic psychosis.

A

Endocrine, metabolic, autoimmune, infection, narcolepsy, epilepsy, space occupying lesions, stroke, head injury, dementia

89
Q

What is serotonin syndrome?

A

Altered mental state due to SSRIs, causes tremors, sweating and fever. Do an FBC, check Ca, Mg, give fluids, benzos, cooling, stop SSRI. [Neuromuscular abnormality, autonomic hyperactivity, mental state changes]

90
Q

What are the two most important tests we need to carry out in patients on Lithium?

A

U&E, CrCl for renal function and TFT for hypothyroidism

91
Q

What are some signs of lithium toxicity?

A

Blurred vision, fine tremor, coarse tremor later, muscle weakness, fatigue, dry mouth, n+v, ataxia, hyperreflexia, circulatory failure, oliguria, seizures, coma

92
Q

What are four extrapyramidal side effects of antipsychotics and how are they managed?

A

Parkinsonism, tardive dyskinesia, akathisia, acute dystonia – procyclidine

93
Q

What is neuroleptic malignant syndrome?

A

This is a complication that follows the commencement of starting antipsychotics or increasing the dose. Symptoms include fever, stiffness, seizures and coma. On ABG there is metabolic acidosis, increased CK, leucocytosis and prolonged QT on ECG. Treatment includes supportive hydration, benzos, dantrolene (muscle relaxants), bromicriptine (dopamine agonist).

94
Q

What do you expect to see on investigations for neuroleptic malignant syndrome?

A

Raised WCC, raised CKK, metabolic acidosis

95
Q

Give five differences between serotonin syndrome and NMS?

A

SS - abrupt, rapid, myoclonic and tremor, increased reflexes, mydriasis
NMS - gradual, prolonged course, diffuse rigidity, decreased reflectes, normal pupil

96
Q

Give 5 side effects for SSRI?

A

Sleep disturbance, suicidal thoughts, stress, stomach upset, size (weight gain), sexual dysfunction, serotonin syndrome

97
Q

Give 5 SE for Tricyclics.

A

Anticholinergic, arrythmia, heart block, dizziness, sleep problems, confusion
Overdose: seizures, hypotensive, sinus tachy, wide QRS. Do ABCDE, sodium bicarb for cardiac issues and diazepam for seizures

98
Q

What extrapyramidal SE occur with anti-psychotic medications?

A

Parkinsonism (tremor resting), acute dystonia (torticollis, oculogyric crisis), akathisia (restlessness), tardive dyskinesia (involuntary movements, chewing and pouting of the jaw, lip smacking)

99
Q

What are some metabolic side effects of antipsychotics?

A

Hypercholesteraemia, hyperlipidaemia, hyperglycaemia (reduced insulin sensitivity), hyperprolactinaemia (as dopamine is a prolactin antagonist), increased risk of stroke and VTE

100
Q

What tests need to be done before commending someone on clozapine and why?

A

WCC (it causes a decreased WCC)

101
Q

How do benzodiazepines work?

A

Increases GABA, dopamine, decreases glutamate

102
Q

What biopsychosocial treatments exist for depression?

A

CBT, interpersonal therapy, psychoeducation

103
Q

What biopsychosocial treatments exist for schizophrenia?

A

CBT, family therapy, arts therapy

104
Q

What is ECT and what are indications for it? Under what circumstances should ECT NOT be performed?

A

Catatonia, prolonged or severe mania, severe depression that is life threatening. Potential adverse effects include headache, nausea, short term memory impairment, nausea, cardiac arrythmia

105
Q

What effect do SSRIs have during pregnancy?

A

During third trimester can risk persistant pulmonary hypertension of the newborn, first trimester increased risk of congenital heart defects

106
Q

Why is smoking an important factor for those on clozapine?

A

Smoking decreases the effectiveness of clozapine so a higher dose is required

107
Q

What is a major SE of antipsychotics?

A 
Dystonia - spasms
Akathisia
Weight gain
Dizziness, dry mouth, constipation
EPSE
Tardive dyskinesia
108
Q

Name 4 atypical antipsychotics.

A

Olanzapine
Risperidone
Quetiapine
Clozapine

109
Q

What is procyclidine and what is it used for?

A

Used for EPSE of antipsychotics

Anti-muscarinic

110
Q

When is lithium used and why is it monitored? What do you monitor?

A

Bipolar prophylaxis
Mania/Hypomania
Monitor TFTs, plasma lithium levels, U&Es

111
Q

Why are benzodiazepines only indicated for short term?

A

High levels of addiction

112
Q

What are some metabolic side effects of antipsychotics?

A

Hypercholesteraemia, hyperlipidaemia, hyperglycaemia (reduced insulin sensitivity), hyperprolactinaemia (as dopamine is a prolactin antagonist), increased risk of stroke and VTE

113
Q

What is the difference between sub-clinical, mild, moderate and severe depression?

A

Mild <5 symptoms
Moderate
Severe - symptoms interfere with normal function

114
Q

What are management options for depression? Give one psychological, one social and one biological treatment option.

A

SSRI - sertraline
CBT - self-guided health
Support group

115
Q

What psychoses commonly occur in psychotic depression?

A

Nihilistic delusions - Cotard delusion (belief that they are already dead)
Financial delusions
Somatic delusions

116
Q

What are the different types of schizophrenia?

A 
Paranoid
Hebephrenic
Catatonic
Simple
Undifferentiated
117
Q

What is hebephrenic schizophrenia?

A

Irresponsible and unpredictable behaviour
Rambling
Incoherent speech and affect changes
Incongruous affect, poorly organised delusions and fragmented hallucinations

118
Q

What allows for a diagnosis of delusional disorder over schizophrenia?

A

A lack of thought disorder, mood disorder, hallucination or flattening of affect

119
Q

What are some risk factors towards delusions?

A

Advanced age, social isolation, low socioeconomic status, premorbid personality

120
Q

What are the 6 main types of delusion?

A 
Grandiose
Erotomanic
Jealous (Othello)
Persecutory
Somatic
Cotard's
Mixed
121
Q

What time period do delusions need to occur over for a diagnosis to be main?

A

> 3 month history

122
Q

How are delusions managed?

A

Separation from focus of delusion
Antipsychotics
SSRIs
Individual therapy

123
Q

Name some common misidentified delusional symptoms?

A

Capgras - replacement of a person they know by an imposter
Fregoli - an unknown individual is someone they know in disguise

Usually symptoms of an underlying disorder

124
Q

What are some organic differentials of schizophrenia?

A

Substance misuse
Psychotic disorder - epilepsy, tumour, head injury
Delirium, dementia

125
Q

What are the first rank symptoms of schizophrenia?

A

Thought alienation
Passivity phenomena
Hallucinations
Delusional perception

126
Q

What is the first line treatment of schizophrenia?

A

Antipsychotic medications - olanzapine

127
Q

What’s the difference between a delusion and an overvalued idea?

A

A thought held with rigidity that someone can be argued out of

128
Q

What are the different kinds of thought alienation?

A 
Insertion
Withdrawal
Broadcast
Echo
Block
129
Q

What is passivity?

A

The state of feeling that someone else in controlling part of your body.
Somatic passivity - bodily sensations caused by unreasonable external agency
Made acts - external agency causing alien feelings, drives

130
Q

What is circumstantiality?

A

Takes a patient a long time to get to a point but they will eventually get there

131
Q

What is concrete thinking?

A

Loss of abstract thinking

132
Q

What is anhedonia and what illness is it common in?

A

Lack of care, loss of enjoyment in activities previously found enjoyable - Depression

133
Q

What symptoms and signs may suggest someone has an eating disorder? What habits may they have?

A

Exercise patterns, fluid loading, laxative abuse, binge eating, food beliefs, purging

Individual may eat in seclusion, diminutive range in food eaten, may take a particular interest in the presentation of food
May still be obese and have an eating problem
May wear baggy clothes to hide weight loss
May initially appear more cheerful, work harder
Seeking control, past bully? Enmeshment (relationships with family)

134
Q

Suggest some causes and precipitating factors of an eating disorder?

A

Increased risk if a first degree relative
Family over-protectiveness, rigidity, attitudes
Poor self-esteem, body shape, occupation, peer pressure
Perfectionist, anxiety, control

135
Q

Give 6 physical health problems that occur in people with eating disorders

A 
Anaemia
Dehydrations
Gastric problems - low secretions, oesophageal tears, delayed emptying
Growth problems
Cardiovascular - arrythmias, bradycardia, hypotension
Visual - subconjuctival pallor
Poor peripheral circulation
Weight loss
136
Q

When should someone with anorexia be treated as an inpatient?

A

If rapid weight loss
BMI <13
Suicide risk
Evidence of dangerous physical problems

137
Q

What advice should you give someone wanting to stop an SSRI after only 8 weeks if they are feeling better?

A

To continue for at least 6 months as relapse of symptoms if you stop before is high in this period?

138
Q

What are you most likely to see in blood tests for neuroepileptic malignant syndrome?

A

Raised WCC, Raised CK, Raised K+, Low Ca2-

139
Q

Under what laws can you treat someone against their will?

A

Mental Health Act – Section 2 28 day admission, or section 3 6 month detection
Section 4 – emergency treatment for <72 hours

140
Q

What is your management of a tricyclic overdose?

A

Sodium bicarbonate

Medical Finals 2020 (25 decks)

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