Psychiatry Flashcards
1
Q
What class of drug does mirtazapine belong to?
A
Noradrenergic and serotonergic antidepressants
2
Q
What are some common side effects of mirtazepine?
A
Drowsiness
Increased appetite
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)
4
Q
What are some side effects of clozapine?
A
Low WCC (neutropenia) - agranulocytosis
5
Q
What are indications for ECT?
A
Catatonia
Severe resistant depression
Manic episodes
Moderate depression that responded to previous ECT
6
Q
What effect does smoking have on clozapine?
A
It makes it less effective
7
Q
What is Cotard Syndrome?
A
The delusion that you are already dead
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
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
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
11
Q
What is involve in a mental state examination?
A
ASEPTIC Appearance and behaviour Speech Emotions Perceptions Thoughts Insight Cognition
12
Q
What are the four ‘p’s in the biopsychosocial formulation?
A
Predisposing factors
Precipitating
Perpetuating
Protective
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
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
15
Q
What is the name of alcohol-induced thiamine deficiency?
A
Korsakoff’s Psychosis (thiamine deficiency), Wernicke’s Encephalopathy
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
17
Q
What is the unit limit for woman?
A
14 units (now same as men)
18
Q
What are the features of Wernicke’s encephalopathy?
A
CAN OPEN confusion, ataxia, nystagmus, ophthalmoplegia, peripheral neuropathy
19
Q
What to give someone to prevent alcohol withdrawal symptoms?
A
Chlordiazepoxide
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
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
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)
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
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
25
What is classified as Type C?
Avoidant, Dependent, OCPD
26
Someone who has shallow affect, very ambitious and self-serving is…?
Histrionic
27
Give 5 points on the PCL-R?
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
28
33y teacher has an attack of autonomic symptoms and a sense of impending doom. Name the acute attack.
Panic attack
29
Name 2 endocrine/metabolic causes of anxiety.
Hyperthyroid disease (thyrotoxicosis), ictal anxiety (epilepsy), phaeochromoytoma.
30
What is the name of the cognitive symptom where you feel like she is going to die.
Thanatophobia
31
A patient describes feelings of being removed from her body/the real world. Name these 2 sensations.
Depersonalisation. Derealisation.
32
Name the fear of crowded places.
Agoraphobia
33
What is the term used to describe behaviours in those who take psychoactive substances?
Addictive behaviour
| Dependence
34
What are the three types of personality disorder? What are the key symptoms of the 9 different personality disorders?
Type A - Psychoses (Paranoid, Schizoid, Schizotypal)
Type B - (Antisocial, Histrionic, Narcissistic, Borderline)
Type C - (Avoidant, Obsessive/Anankastic, Dependent)
35
What clusters can personality disorders be divided into?
Withdrawn
Inhibited
Antisocial
Dependent
36
What is another name for obsessive personality disorder?
Anankastic - anxious, doubting, indecisiveness cautious, pedantry, rigidity, perfectionism, preoccupation with order and details, rigid adherence to rules, inflexibility
37
What is the difference between obsessive compulsive personality disorder and OCD? Use the two ‘e’ words.
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
38
What are your differentials for PD?
Schizophrenia, hypomania
Drug and alcohol-induced states
Organic psychosis (Wilson's Disease)
39
What is attachment theory and what are the three types?
Bowlby's theory of the importance of attachment in personal development and the need to form attachment to a caregiver
40
What are the 2 key symptoms groups in OCD?
Obsession
| Compulsion
41
How can you treat OCD?
```
CBT
Self-help exposure therapy
Response prevention therapy
SSRI high dose (NOT FIRST LINE)
Chlomipramine (tricylci antidepressant)
```
42
If insight is not maintained what is the more likely diagnosis?
Obsessive Compulsive Personality Disorder
43
What are the 5 elements required for a PTSD diagnosis?
```
Major trauma experience
Thoughts, nightmares and flashbacks
Emotional blunting
Increased arousal and hypervigilance
Latency period of a few weeks to months
```
44
How is GAD treated?
```
CBT
Counselling
Relaxation techniques
Benzodiazepines
SSRIs
```
45
What is body dysmorphic disorder?
A distressing preoccupation with some imagined or slight defect of appearance in a normal appearing person
46
What are the 3 main types of phobic disorders?
Specific phobias
Agoraphobia
Social phobias
47
Define hyperarousal and hypervigilance?
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
48
What are neuroses?
neuroses are understandable symptoms that are quantitatively different from normal such as increased anxiety levels
49
What are risk factors for anxiety?
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
50
Why does Munchausen occur? How can it be diagnosed?
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.
51
What are the three types of somatoform disorders?
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)
52
What are physical findings in anorexia?
```
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
```
53
What is Charles Bonnet syndrome?
Visual hallucinations associated with eye disease
54
Over what period of time should SSRIs be stopped?
4 weeks (except fluoxetin as it has a longer half-life)
55
What is tardive dyskinesia
Chewing, jaw pouting or excessive blinking
| Occurs in patients on anti-psychotics
56
What hormonal effects does anorexia have on the body?
Anorexia nervosa – growth hormone, glucose, salivary glands, cortisol, cholesterol all RAISED, low FSH
57
What treatments are offered in anorexia nervousa? Give some biological, psychological and social treatments
Family therapy (recommended for children), Individual CBT, dietician input regarding refeeding, fluoxetine
58
What is Russel's sign and what does it indicate?
Russel’s sign – calluses over fingers from vomiting
| Bulimia
59
What is anorexia nervosa?
Endocrine disturbance, delayed/arrest puberty, deliberate weight loss, distorted body image, low BMI
60
What is MARSIPAN? How can eating disorders be managed?
Fluoxetine, family therapy
61
What electrolyte disturbances do you see in someone with anorexia?
Electrolyte disturbances – low K, Mg, PO4-
62
What treatment do you use for treatment-resistant schizophrenia?
Clozapine
63
Name 3 negatives symptoms of schizophrenia?
Apathy, poverty of speech, blunted/incongruous affect, loss of motivation, anhedonia
64
What are the four Schneider first rank symptoms?
Delusional perception, Passivity Phenomenon, Auditory Hallucinations, Thought Alienation
65
What are the 5 types of schizophrenia?
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
Give some different differentials for paranoia and delusional thoughts.
Schizophrenia, Substance Abuse
67
What section can police bring patients in under?
136
68
What are poor prognostic indicators for schizophrenia?
Gradual onset, family history, low IG, premorbid history of social withdrawal, lack of obvious precipitant
69
What is the difference between schizoaffective disorder and a mood disorder with psychosis?
The time period in which the symptoms appear and develop over
70
What is a schizotypal disorder?
Odd ideas, fantasy obsession
71
What are erotomanic delusions?
Delusional beliefs that someone is in love with you
72
What is induced delusional disorder and what are the types?
Shared delusional disorder
'folie a deux'
Shared delusion or belief
Folie imposee
Folie simultanee
Folie communique
Folie induite
73
Name 6 symptoms of depression.
Poor sleep, early waking, sexual disinterest, suicidal ideation, low mood, anhedonia
74
Name 3 cognitive symptoms of depression.
Poor concentration, difficulty in focussing, poor memory
75
What test would you use to assess his depression?
PHQ-9, HADs
76
What 3 things could a GP do to manage a patient with depression?
CBT, lifestyle advice regarding exercise and mindfulness, prescribe an antidepressant
77
What are the core symptoms of depression?
Inergia, anhedonia, low mood
78
What are the 9 DSM-IV criteria for depression?
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
What are differentials to a manic episode?
Substance abuse, schizophrenia, hyperthyroid, head injury, ADHD
80
What is the difference between mania and hypomania?
Mania has the inclusion of psychotic symptoms, and is 4+ days, while hypomania has no psychotic symptoms > 1week
81
Give some symptoms seen in either mania or hypomania.
Extreme elation, Pressure of Speech, Flight of ideas, grandiose delusions, increased spending costs, irritable, increased energy, decreased sleep, impaired judgement
82
What are the different types of bipolar disease?
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
What are some RF for depression?
FH of depression, post-partum, low socio-economic status, drug/alcohol abuse, young/elderly, chronic disease, females, dementia
84
What occurs in severe depression – what is needed for a diagnosis?
Catatonia, >6 weeks interfering with normal function
85
What does SAD stand for?
Seasonal Affective Disorder, mood affected by the season
86
What are some differentials to depression including biological differentials?
Hypothyroidism, dementia, bipolar
87
What are the three psychiatric disorders that can occur following pregnancy and how are they treated?
Baby blues (resolves normally), post-partum depression (sertraline), post-partum psychosis (olanzapine)
88
Give five potential causes of toxic psychosis.
Endocrine, metabolic, autoimmune, infection, narcolepsy, epilepsy, space occupying lesions, stroke, head injury, dementia
89
What is serotonin syndrome?
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
What are the two most important tests we need to carry out in patients on Lithium?
U&E, CrCl for renal function and TFT for hypothyroidism
91
What are some signs of lithium toxicity?
Blurred vision, fine tremor, coarse tremor later, muscle weakness, fatigue, dry mouth, n+v, ataxia, hyperreflexia, circulatory failure, oliguria, seizures, coma
92
What are four extrapyramidal side effects of antipsychotics and how are they managed?
Parkinsonism, tardive dyskinesia, akathisia, acute dystonia – procyclidine
93
What is neuroleptic malignant syndrome?
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
What do you expect to see on investigations for neuroleptic malignant syndrome?
Raised WCC, raised CKK, metabolic acidosis
95
Give five differences between serotonin syndrome and NMS?
SS - abrupt, rapid, myoclonic and tremor, increased reflexes, mydriasis
NMS - gradual, prolonged course, diffuse rigidity, decreased reflectes, normal pupil
96
Give 5 side effects for SSRI?
Sleep disturbance, suicidal thoughts, stress, stomach upset, size (weight gain), sexual dysfunction, serotonin syndrome
97
Give 5 SE for Tricyclics.
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
What extrapyramidal SE occur with anti-psychotic medications?
Parkinsonism (tremor resting), acute dystonia (torticollis, oculogyric crisis), akathisia (restlessness), tardive dyskinesia (involuntary movements, chewing and pouting of the jaw, lip smacking)
99
What are some metabolic side effects of antipsychotics?
Hypercholesteraemia, hyperlipidaemia, hyperglycaemia (reduced insulin sensitivity), hyperprolactinaemia (as dopamine is a prolactin antagonist), increased risk of stroke and VTE
100
What tests need to be done before commending someone on clozapine and why?
WCC (it causes a decreased WCC)
101
How do benzodiazepines work?
Increases GABA, dopamine, decreases glutamate
102
What biopsychosocial treatments exist for depression?
CBT, interpersonal therapy, psychoeducation
103
What biopsychosocial treatments exist for schizophrenia?
CBT, family therapy, arts therapy
104
What is ECT and what are indications for it? Under what circumstances should ECT NOT be performed?
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
What effect do SSRIs have during pregnancy?
During third trimester can risk persistant pulmonary hypertension of the newborn, first trimester increased risk of congenital heart defects
106
Why is smoking an important factor for those on clozapine?
Smoking decreases the effectiveness of clozapine so a higher dose is required
107
What is a major SE of antipsychotics?
```
Dystonia - spasms
Akathisia
Weight gain
Dizziness, dry mouth, constipation
EPSE
Tardive dyskinesia
```
108
Name 4 atypical antipsychotics.
Olanzapine
Risperidone
Quetiapine
Clozapine
109
What is procyclidine and what is it used for?
Used for EPSE of antipsychotics
| Anti-muscarinic
110
When is lithium used and why is it monitored? What do you monitor?
Bipolar prophylaxis
Mania/Hypomania
Monitor TFTs, plasma lithium levels, U&Es
111
Why are benzodiazepines only indicated for short term?
High levels of addiction
112
What are some metabolic side effects of antipsychotics?
Hypercholesteraemia, hyperlipidaemia, hyperglycaemia (reduced insulin sensitivity), hyperprolactinaemia (as dopamine is a prolactin antagonist), increased risk of stroke and VTE
113
What is the difference between sub-clinical, mild, moderate and severe depression?
Mild <5 symptoms
Moderate
Severe - symptoms interfere with normal function
114
What are management options for depression? Give one psychological, one social and one biological treatment option.
SSRI - sertraline
CBT - self-guided health
Support group
115
What psychoses commonly occur in psychotic depression?
Nihilistic delusions - Cotard delusion (belief that they are already dead)
Financial delusions
Somatic delusions
116
What are the different types of schizophrenia?
```
Paranoid
Hebephrenic
Catatonic
Simple
Undifferentiated
```
117
What is hebephrenic schizophrenia?
Irresponsible and unpredictable behaviour
Rambling
Incoherent speech and affect changes
Incongruous affect, poorly organised delusions and fragmented hallucinations
118
What allows for a diagnosis of delusional disorder over schizophrenia?
A lack of thought disorder, mood disorder, hallucination or flattening of affect
119
What are some risk factors towards delusions?
Advanced age, social isolation, low socioeconomic status, premorbid personality
120
What are the 6 main types of delusion?
```
Grandiose
Erotomanic
Jealous (Othello)
Persecutory
Somatic
Cotard's
Mixed
```
121
What time period do delusions need to occur over for a diagnosis to be main?
>3 month history
122
How are delusions managed?
Separation from focus of delusion
Antipsychotics
SSRIs
Individual therapy
123
Name some common misidentified delusional symptoms?
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
What are some organic differentials of schizophrenia?
Substance misuse
Psychotic disorder - epilepsy, tumour, head injury
Delirium, dementia
125
What are the first rank symptoms of schizophrenia?
Thought alienation
Passivity phenomena
Hallucinations
Delusional perception
126
What is the first line treatment of schizophrenia?
Antipsychotic medications - olanzapine
127
What’s the difference between a delusion and an overvalued idea?
A thought held with rigidity that someone can be argued out of
128
What are the different kinds of thought alienation?
```
Insertion
Withdrawal
Broadcast
Echo
Block
```
129
What is passivity?
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
What is circumstantiality?
Takes a patient a long time to get to a point but they will eventually get there
131
What is concrete thinking?
Loss of abstract thinking
132
What is anhedonia and what illness is it common in?
Lack of care, loss of enjoyment in activities previously found enjoyable - Depression
133
What symptoms and signs may suggest someone has an eating disorder? What habits may they have?
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
Suggest some causes and precipitating factors of an eating disorder?
Increased risk if a first degree relative
Family over-protectiveness, rigidity, attitudes
Poor self-esteem, body shape, occupation, peer pressure
Perfectionist, anxiety, control
135
Give 6 physical health problems that occur in people with eating disorders
```
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
When should someone with anorexia be treated as an inpatient?
If rapid weight loss
BMI <13
Suicide risk
Evidence of dangerous physical problems
137
What advice should you give someone wanting to stop an SSRI after only 8 weeks if they are feeling better?
To continue for at least 6 months as relapse of symptoms if you stop before is high in this period?
138
What are you most likely to see in blood tests for neuroepileptic malignant syndrome?
Raised WCC, Raised CK, Raised K+, Low Ca2-
139
Under what laws can you treat someone against their will?
Mental Health Act – Section 2 28 day admission, or section 3 6 month detection
Section 4 – emergency treatment for <72 hours
140
What is your management of a tricyclic overdose?
Sodium bicarbonate
