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Pass Medicine > Psychiatry > Flashcards

Psychiatry Flashcards

1
Q

What do antipsychotics in the elderly increase the risk of?

A

Stroke

VTE

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2
Q

What is conversion diisorder?

A

Patient is unconsciously feigning symptoms (motor or sensory function loss)

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3
Q

What is somatisation disorder?

A

Where patients have multiple physical symptoms present for at least 2 years
Patients refuse to accept reassurance/negative results

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4
Q

What is hypochondrial disorder?

A

Persistent belief in the presence of an underlying serious disease
Patients refuse to accept reassurance/negative results

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5
Q

What is dissociative disorder?

A

Where the patient separates off certain memories from normal consciousness
Usually involves more psychiatric type symptoms (e.g. amnesia, fugue, stupor)

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6
Q

What is factitious disorder (Munchausen’s)?

A

The intentional productiion of physical or psychological symptoms

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7
Q

What is malingering?

A

Fraudulent simulation/exaggeration of symptoms with the intention of gaining (financially or otherwise)

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8
Q

What can SSRI’s cause in the 3rd trimester?

A

Persistent pulmonary hypertension

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9
Q

What is pseudodementia?

A

Where severe depression mimics dementia but gives a global pattern of memory loss rather than just short-term memory loss

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10
Q

What is post-concussion syndrome?

A 
A syndrome that can be seen even after minor head trauma. Features include:
Headache
Fatigue
Anxiety/depression
Dizziness

Symptoms last >3 months

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11
Q

Features of post-traumatic stress disorder?

A

Re-experiencing (flashbacks, nightmares)
Avoidance (people, situations)
Hyperarousal (hypervigilence, sleep issues)
Emotional numbing

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12
Q

How do we treat PTSD?

A

CBT
Eye movement desensitisation and reprocessing
SSRI or venlafaxine

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13
Q

What is adjustment syndrome?

A

The development of an emotional/behavioural symptom occurring within 3 months of the onset of an identifiable stressor

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14
Q

What is acute stress disorder?

A

Like PTSD symptom wise except occuring within 1 month of trauma exposure

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15
Q

What is the characteristic side effect of mirtazapine?

A

Increase in appetite

Also causes sedation

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16
Q

What is the MOA of mirtazapine?

A

Alpha 2 adrenergic receptor blockage

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17
Q

What do patients often get upon discontinuation of SSRIs?

A

GI side effects (e.g. diarrhoea)

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18
Q

Side effects of ECT?

A

Headache
Nausea
Short-term memory loss
Cardiac arrhythmias

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19
Q

What is the SSRI of choice in adolescents?

A

Fluoxetine

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20
Q

What are the adverse effects of clozapine?

A 
Agranulocytosis
Neutropenia
Reduced seizure threshold
Constipation
Myocarditis
Hypersalivation
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21
Q

Tardive dyskinesia features?

A 
Extrapyramidal side effects:
Lip-smacking
Jaw pouting
Chewing
Repetitive blinking
Tongue poking
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22
Q

What causes tardive dyskinesia?

A

Typical>atypicial antipsychotics

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23
Q

What differentiates mania from hypomania?

A

Longer length of symptoms (>7 days), severity++, pyschotic symptoms in mania

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24
Q

Sleep paralysis treatment?

A

If troublesome, can give clonazepam

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25
Q

Section 2

A

Admission for assessment - 28 days

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26
Q

Section 3

A

Admission for treatment up to 6 months

Can be renewed

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27
Q

Section 4

A

72 hour reassessment order
Used in emergencies where section 2 would involve unacceptable delay
Often changed to section 2 upon arrival to hospital

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28
Q

Section 5(2)

A

A patient who is a voluntary patient in hospital can be legally detained for 72 hours

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29
Q

Section 5(4)

A

Allows a nurse to detain a patient voluntarily for 6 hours

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30
Q

What is akathisia?

A

Severe restlessness

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31
Q

Alcohol withdrawal onset of symptoms?

A

6-12 hours - Tremor, sweating, tachycardia, anxiety
36 hours - seizures
48-72 hours - delirium tremens

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32
Q

MOA of alcohol withdrawal?

A

Chronic alcohol usage increases inhibitory GABA and inhibits NMDA type glutamate receptors

Alcohol withdrawal leads to the opposite:
Decreased inhibitory GABA and increased NMDA glutamate transmission

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33
Q

How do we treat alcohol withdrawal?

A

Benzodiazepines - e.g. chlordiazepoxide (lorazepam if hepatic failure)
Carbamazepine

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34
Q

How do we treat anorexia nervosa?

A

CBT

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35
Q

How do we diagnose anorexia nervosa?

A
  1. Restriction of energy intake requirements leading to significantly low body weight in the context of age, sex, developmental trajectory and physical health
  2. Intense fear of gaining weight/becoming fat, despite being underweight
  3. Disturbance in the way in which one’s body weight or shape is experienced
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36
Q

How do we manage GAD?

A 
SSRIs
Buspirone
Beta blockers
Benzodiazepines
Cognitive behaviour therapy
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37
Q

What is bipolar disorder?

A

A chronic mental health disorder characterised by periods of mania/hypomania alongside episodes of depression

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38
Q

What characterises type I and type II bipolar disorders?

A 
Type I (most common):
Mania and depression

Type II:
Hypomania and depression

39
Q

How do we treat bipolar disorder?

A

Psychological interventions
Lithium is the mood stabiliser of choice
Valproate is 2nd line

Mania:
Consider stopping antidepressant
Antipsychotics: olanzapine/haloperidol

Depression:
Fluoxetine

40
Q

What does bipolar increase the risk of?

A

Diabetes
CVD
COPD

41
Q

How can we assess depression?

A

PHQ-9 questionnaire

42
Q

How do we treat mild/subthreshold depression?

A

CBT

43
Q

If a monozygotic twin has schizophrenia, how likely is the other twin to get it?

A

50%

FHx is a strong risk factor

44
Q

What are the symptoms of GAD?

A

Persistent anxiety with associated features

45
Q

Symptoms of panic disorder

A

Random panic attacks on a background of no anxiety

46
Q

Treatment for panic disorder?

A

CBT
SSRI
Tricyclic antidepressant
Pregabalin

47
Q

What is a pseudohallucination?

A

Where a patient has insight to the fact the hallucination is not real
Common in grieving patients

48
Q

What is antisocial personality disorder?

A

Failure to conform to social norms with respect to lawful behaviours - repeatedly performing acts that warrant arrest
Deception for personal gain/pleasure
Impulsiveness
Irresponsibility
Lack of remorse
Reckless disregard for safety of self or others

49
Q

Avoidant personality disorder

A

Avoidance of occupational activities which involve significant interpersonal contact for fears of criticism/rejection
Unwillingness to be involved unless certainty of being liked
Reluctance to take personal risks for fear of embarrassment
Views self as inept/inferior to others
Social isolation accompanied by craving for social interaction

50
Q

Borderline personality disorder

A

Efforts to avoid real/imagined abandonment
Unstable self image
Impulsivity with regards to self damaging behaviour
Recurrent suicidal behaviour
Unstable interpersonal relationships which alternate between idealization and devaluation

51
Q

Dependent personality disorder

A

Difficulty making everyday decisions without excessive reassurance from others
Need for others to take responsibility for major areas of their life
Difficulty expressing disagreement for fear of losing support
Lack of initiative
Unrealistic fear of being left to care for themselves

52
Q

Histrionic personality disorder

A

Inappropriate sexual seductiveness
Need to be centre of attention
Suggestibility
Self dramatization
Relationships considered more intimate than they are
Physical appearance used for attention seeking purposes

53
Q

Obsessive-compulsive personality disorder

A

Is occupied with details, rules, lists, order, organization, or agenda to the point that the key part of the activity is gone
Demonstrates perfectionism that hampers with completing tasks
Is extremely dedicated to work and efficiency to the elimination of spare time activities
Is meticulous, scrupulous, and rigid about etiquettes of morality, ethics, or values
Is not capable of disposing worn out or insignificant things even when they have no sentimental meaning
Is unwilling to pass on tasks or work with others except if they surrender to exactly their way of doing things
Takes on a stingy spending style towards self and others; and shows stiffness and stubbornness

54
Q

Paranoid personality disorder

A

Hypersensitivity and an unforgiving attitude when insulted
Unwarranted tendency to questions the loyalty of friends
Reluctance to confide in others
Preoccupation with conspirational beliefs and hidden meaning
Unwarranted tendency to perceive attacks on their character

55
Q

Schizoid personality disorder

A 
Indifference to praise and criticism
Preference for solitary activities
Lack of interest in sexual interactions
Lack of desire for companionship
Emotional coldness
Few interests
Few friends or confidants other than family
56
Q

Schizotypal personality disorder

A 
Ideas of reference (differ from delusions in that some insight is retained)
Odd beliefs and magical thinking
Unusual perceptual disturbances
Paranoid ideation and suspiciousness
Odd, eccentric behaviour
Lack of close friends other than family members
Inappropriate affect
Odd speech without being incoherent
57
Q

How do we treat schizophrenia?

A

Oral atypical antipsychotics are first line (olanzapine, quetiapine, risperidone)
CBT for all patients
High rates of cardiovascular disease in psychotic patients (due to meds/high smoking rates) - so keep an eye on this

58
Q

When might we use ECT?

A

Treatment resistant severe depression
Manic episodes
Life threatening catatonia

59
Q

Features of anorexia

A

Reduced BMI
Bradycardia
Hypotension
Enlarged salivary glands

Most things are low, but G's and C's raised:
Growth hormone
Glucose
Salivary glands
Cortisol
Cholesterol
Carotinaemia
60
Q

What are torticollis and oculogyric crisis signs of?

A

Acute dystonia (extra-pyramidal side effects of antipsychotics)

Torticollis - wry neck, an abnormal asymmetrical neck position
Oculogyric crisis - upward deviation eyes

61
Q

What is akathisia?

A

Severe restlessness

62
Q

What medication can cause psychosis?

A

Steroids

63
Q

Name 2 examples of SNRIs

A

Venlafaxine

Duloxetine

64
Q

How long for symptoms of depression to be classified as a depressive episode?

A

2 weeks

65
Q

Features of a mild depressive episode?

A

2/3 of the main symptoms
At least 2 other symptoms present
Minimum duration 2 weeks
Able to continue functioning, despite being distressed by symptoms

66
Q

Features of a moderate depressive episode?

A

2/3 of the main symptoms.
At least 3 additional symptoms
Individuals have difficulty continuing with normal work/social functioning

67
Q

Features of a severe depressive episode?

A 
All three typical symptoms present
Four additional symptoms
Minimum duration 2 weeks
May experience psychotic symptoms
Individuals show severe distress/agitation
68
Q

What are the 3 main symptoms of depression?

A

Depressed mood
Anhedonia
Anergia (low energy levels)

69
Q

What are Schneider’s first rank symptoms?

A

Features of schizophrenia:

Auditory hallucinations
Thought disorder
Passivity phenomena
Delusional perceptions

70
Q

In Schneider’s first rank symptoms, what are the types of auditory hallucinations?

A

Two plus voices discussing the patient in the third person
Thought echo
Voices commenting on patient’s behaviour

71
Q

In Schneider’s first rank symptoms, what are the types of thought disorder?

A

Thought insertion
Thought withdrawal
Thought broadcasting

72
Q

What is passivity phenomena?

A

Bodily sensations being controlled by an external influence

Actions/impulses/feelings - experiences which are imposed on the individual or influenced by others

73
Q

What are the stages of delusional perceptions in Schneider’s first rank symptoms?

A

1 - A normal object is perceived

2. A sudden intense delusional insight into the object’s meaning for the patient

74
Q

What are the negative symptoms of schizophrenia?

A

Incongruity/blunting of affect, anhedonia (inability to derive pleasure), alogia (poverty of speech), avolition (poor motivation)

75
Q

Treatment of opioid overdose

A

Naloxone

76
Q

Treatment of benzodiazepine overdose

A

Flumazenil

We usually manage benzo overdose supportively though because flumezanil has a high risk of seizures

77
Q

Management of ethylene glycol overdose

A

Fomepizole (inhibitor of alcohol dehydrogenase)
Alcohol second line
Haemodialysis

78
Q

Cyanide poisoning

A

Hydroxocobalamin

79
Q

Management of paracetamol overdose

A

Activated charcoal if <1 hour

N-acetylcysteine

80
Q

Salicylate overdose treatment

A

IV sodium bicarbonate

Haemodialysis

81
Q

Management of tri-cyclic antidepressant overdose

A

IV bicarbonate (reduces seizure/arrhythmia risk)

82
Q

Lithium overdose management

A

Saline resuscitation
Haemodialysis
Sodium bicarbonate is sometimes used

83
Q

Salicylate overdose presentation

A

Aspirin overdose:

Mixed respiratory alkalosis and metabolic acidosis

Hyperventilation
Tinnitus
Lethargy
Sweating/pyrexia
Nuasea/vomiting
Coma
84
Q

Tricyclic antidepressant overdose presentation

A

Amitriptyline and dosulepin:

Anticholinergic properties: dry mouth, dilated pupils, agitation, blurred vision, sinus tachycardia

Arrhythmias
Seizures
Metabolic acidosis
Coma

85
Q

Opiate overdose features

A 
Rhinorrhoea
Needle track marks
Pinpoint pupils
Drowsiness
Watery eyes
Yawning
86
Q

Complications of opioid misuse

A

Viral infections (HIV, hep B/C)
VTE
Respiratory depression, death

87
Q

Management of alcohol misuse

A

Acute withdrawal - benzodiazepines
Disulfram promotes abstinence
Acamprosate (reduces craving)

88
Q

Neuroleptic malignant syndrome

A

A rare condition that can be caused by taking antipsychotic medication (dopaminergic drugs)

Essentially you get a massive release of glutamate and subsequent neurotoxicity + muscle damage

89
Q

Neuroleptic malignant syndrome features

A

Usually hours to days after starting the drug

Pyrexia
Muscle rigidity
Autonomic lability (HTN, tachyc/tachyp)
Delirium

90
Q

What might you see raised in neuroleptic malignant syndrome

A

Creatinine kinase

You may also see an AKI

Leukocytosis occasionally

91
Q

Management of neuroleptic malignant syndrome

A

Stop offending drug
IV fluids to prevent AKI
Dantrolene
Bromocriptine (dopamine agonist)

92
Q

Serotonin syndrome features

A

Neuromuscular excitation (e.g. hyperreflexia, myoclonus, rigidity)
Autonomic nervous system excitation (hyperthermia)
Altered mental state

93
Q

Management of serotonin syndrome

A

Supportive
IV fluids
Benzos
Chlorpromazine

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