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Phase 3a > Psychiatry > Flashcards

Psychiatry Flashcards

1
Q

subtypes of schizophrenia?

A

Paranoid - Auditory/ visual hallucinations, flat affect

  • Hebephrenic – disorganised type, thought disorder and flat
  • Catatonic – immobile or agitated. Waxy.
  • Undifferentiated
  • Residual – chronic negative symptoms
  • Simple – insidious and progressive negative symptoms, no Hx of psychotic symptoms
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2
Q

what are schneiders first rank symptoms?

A
  1. Thought alienation: echo, insertion, broadcasting or withdrawal
  2. 3rd person auditory hallucinations (DDx; if pt has conversation to voices therefore trauma or ficticious)
  3. Delusional perception: Grandiose, Erotomanic, Paranoia, Cotards (belief they are dead), Othello (pathologic jealousy), Capgras (someone/something they know replaced by imposter), persecutory, somatic
  4. Passivity and somatic passivity
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3
Q

what are the negative symptoms of shizophrenia?

A 
blunted affect
apathy
social isolation 
withdrawal
self-neglect
poverty of speech
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4
Q

diagnostic criteria of schizophrenia?

A

ICD-10 Dx: 1st rank symptoms or persistent delusions on most days for at least one month (delusional perception, passivity, delusions of thought interface, auditory hallucinations)

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5
Q

management of schizophrenia?

A

1st line: Clozapine, Olanzipine, Risperidone - (usually second gen)
2nd line: Quetiapine, Aripirazole
3rd line: Haloperidol, chlopormazine (atpical first gen but last resort, req blood checks for agranulocytosis)

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6
Q

subtypes of schizophrenia?

A

Paranoid - Auditory/ visual hallucinations, flat affect

  • Hebephrenic – disorganised type, thought disorder and flat
  • Catatonic – immobile or agitated. Waxy.
  • Undifferentiated
  • Residual – chronic negative symptoms
  • Simple – insidious and progressive negative symptoms, no Hx of psychotic symptoms
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7
Q

DDx for low mood?

A 
hypothyroidism
bipolar
cancer
DM
anaemia, B12, folate
vit D deficiency 
hypoglycaemia/electrolyte inbalances
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8
Q

what are the symptoms of depression?

A

major- low mood, anergia, anhedonia

minor- 
cognition 
feeling of guilt, uselessness
thoughts of suicide
loss of conc
low self esteem
change in sleep
weight loss
loss of libido 
slow in thoughts or actions
irritable
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9
Q

diagnostic criteria of depression?

A

ICD-10:
Mild = 2/3 core + 2 others >2 weeks
Mod = 2/3 core + 3 others + functioning symps >2 weeks
Severe = 3/3 core + 4 others inc suicidal and decline in functioning ± psychotic symptoms (mood congruent)

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10
Q

management of depression?

A

1st line: CBT, add SSRI (sertraline, fluoxetine, citalopram) if mod to severe.
2nd line: try second SSRI (then something different as 3rd)
3rd line: Serotonin Noradrenaline reuptake inhibitors (SNRI – Duloxetine/ venlafaxine), MAOI (phenelzine) , Tricyclic antidepressants (TCA - amitriptyline)

Continue for at least 6 months as relapse high before this time

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11
Q

which antidepressant is recommended in children/teens?

A

fluoxetine

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12
Q

how long does it take for SSRI’s to work?

A

4-6 weeks

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13
Q

S/E of SSRI’s?

A

sexual dysfunction, weight gain, headache, erratic bowel movement, agitation, initial increase in suicidal ideation, hyponatraemia

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14
Q

what is serotonin syndrome?

A

Serotonin syndrome is a drug induced syndrome characterised by a cluster of dose related adverse effects that are due to increased serotonin concentrations in the central nervous system.

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15
Q

symptoms of serotonin syndrome?

A
  • Mild- Mydriasis, Shivering, Sweating, Tachycardia
  • Mod- Alt mental state: agitation, disorientation. Autonomic: rigidity, hyperthermia. Neuromuscular: tremor, clonus, hyperreflexia
  • Life threatening- delirium, HTN, hyperthermia,
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16
Q

management of serotonin syndrome?

A

Supportive, stop meds, Benzodiazepines

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17
Q

what is malignant neuroleptic syndrome?

A

The most widely accepted mechanism by which antipsychotics cause neuroleptic malignant syndrome is that of dopamine D2 receptor antagonism. In this model, central D2 receptor blockade in the hypothalamus, nigrostriatal pathways, and spinal cord leads to increased muscle rigidity and tremor via extrapyramidal pathway

Life threatening reaction of taking neuroleptic/ increased antipsychotic medication dose <2wks of first dose

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18
Q

symptoms of malignant neurolpetic syndrome?

A

High fever
Autonomic instability ( increased HR, sweating)
Stiffness/ rigidity of muscles (leadpipe), hyporeflexia
Seizures, Coma
Confusion, mutism, stupor
Extrapyramidal symptoms

Fast CARS
Fever, confusion, autonomic, rhabdo, seizure
gradual onset and slowly resolving

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19
Q

complications of malignant neuroleptic syndrome?

A

rhabdomyolysis (rapid breakdown of skeletal muscles), hyperkalaemia, kidney failure, seizures, pneumonia and thromboembolism

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20
Q

investigations of malignant neuroleptic syndrome?

A

ABG: metabolic acidosis, increased creatinine kinase, leucocytosis, prolonged QT

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21
Q

management of neurloeptic malignant syndrome?

A

supportive, fluids, stop drug

Dantrolene (prevents the release of calcium leading to muscle relaxation and treatment of pyrexia)

Alternatives:

Bromocriptine (dop agonist)
Lorazepam (Benzo for rigidity)

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22
Q

symptoms of abruptly discontinuing SSRI’s?

A

Increased mood change
Restlessness
Difficulty sleeping
GI: diarrhea, cramping

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23
Q

S/Eof tricyclics?

A

Anticholinergic (Blocks muscarinic receptors) dry mouth, blurred vision, urinary retention (leads to overflow incon), constipation
CNS: drowsiness, dizziness, sleep difficulties, confusion
Cardiotoxic: arrhythmias, heart block
Pyrexia
respiratory depression
Withdrawal can occur
Lowers seizure threshold

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24
Q

which questionnaires are used to screen for depression?

A

PHq-9
HAD
beck depression inventory

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25
Q

important questions to ask someone who has had a suicide attempt?

A

Wanted to die?
Wrote a note or will
Amount of planning/ method/ ability to act on plans
Still wants to die?

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26
Q

diagnostic criteria of bipolar disorder?

A

ICD-10

At least 2 episodes, including 1 manic/ hypomanic episode

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27
Q

what are the different types of bipolar disorder?

A

Bipolar I – underlying depression + episodes of mania interspersed (1:1)
Bipolar II – predominant depression + 1 hypomania (5:1) – can be easy to miss mania
Rapid Cycling - ?> 4 episodes/ year of mania + depression. Lasts days
Cyclomania: chronic mood fluctuations over > 2 yrs, with episodes of depression + hypomania

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28
Q

DDx for bipolar disorder?

A 
Depression
Emotionally unstable personality disorder
Cylothymia
Cocaine use
Hypomania
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29
Q

features of mania?

A
  • Euphoria/ elated modd
  • Irritable mood/ aggressive
  • Feeling of increased self-worth (grandiose, overconfidence)
  • Inappropriate social behaviour (sexual disinhibiton, compulsive actions, gambling, spending lots of money)
  • Delusions of reference, grandiose delusions, auditory
  • Jumping from project to project, not always finishing them
  • Flight of ideas (discernible links between ideas) vs Knights move (illogical leaps between ideas)
  • Increase in activity
  • Lack of sleep due to reduced ‘need’ of sleep
  • Pressure of speech/ difficult to interrupt
  • Psychoses congruent with current mood
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30
Q

management of manic episode?

A

1st line: acute anti-psychotic (olanzapine, risperidone, quetiapine) & mood stabiliser (lithium – inhibits cAMP formation).
Slowly ween off anti-psychotics after episode

2nd line: different mood stabiliser: valporate (s/e. birth defects therefore not for <50yo women/ reproductive age), lamotragine (use in pregnancy - s/e. steven-johnson syndrome)

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31
Q

management of depressive episode in bipolar disorder?

A

SSRI only. Stop during manic episodes. Caution of inducing mania or rapid-cycling. (Clozapine/ carbamazapine for rapid cycling)

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32
Q

maintenance treatment of bipolar disorder?

A

lithium

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33
Q

S/E of lithium?

A

Leukocytosis
Insipidius - Nephrogenic DI: lacks aquaporin channels
Tremors = fine, Tremors = coarse in Toxicity
deHydration - Dry mouth, diarrhoea, thirsty - must drink
Increased - GI, Skin (psoriasis, acne), memory problems
Under active thyroid (decreased TSH)
Metallic taste, Mums pregnancy = Ebsteins anomaly (Congenital tricuspid valve defect), Myopathy

(LITHIUM)

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34
Q

treatment range of lithium?

A

Level - 0.4 to 1.0 mmol/L,

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35
Q

S/E of sodium valproate?

A 
Valproate s/e:
Appetite 
Liver failure
Pancreatitis
Reversible hair loss
Oedema
Ataxia
Teratogenicity
Encephalopathy
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36
Q

features of dependence syndrome?

A
  1. Tolerance
  2. Withdrawal
  3. Persistent desire/ unsuccessful attempt to stop
  4. substance used for longer periods than intended
  5. Important social or recreational activities given up/ reduced due to substance abuse
  6. Much time spent in seeking/ recovering from effects of substance
  7. Persistence use despite being aware substance is causing damage
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37
Q

complications of alcohol dependence?

A

delirium tremens

wernickes encephalopathy

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38
Q

screening tools for alcohol dependence?

A

CAGE questionnaire
AUDIT tool
FAST questoinnaire

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39
Q

features of alcohol dependence syndrome?

A 
CANT SSTOP
•Compulsion to drink
•Aware of harms, but persists
•Neglecting other activities
•Tolerance of alcohol
  • Stopping causes withdrawal
  • Stereotyped pattern
  • Time pre-occupied by alcohol
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40
Q

timeline of symptoms for alcohol withdrawal once someone has stopped drinking?

A

> 6-12hrs: Tremor, nausea, vomiting, anxiety, insomnia, raised pulse, temp and BP

36hrs: peak incidence of Seizures, risk of status epilepticus

48-72hrs: peak incidence of Delirium tremens: hallucinations (auditory & visual), delusions (persecutory), confusion, agitation, coarse tremor, fever

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41
Q

features of delirium tremens?

A 
coarse tremor
delusions
hallucinations- small insects
fever
tachycardia 
ataxia
panic attacks 
autonomic hyperactivity
death
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42
Q

management of acute withdrawal?

A

diazepam
chlordizapoxide
pabrinex

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43
Q

features of wernickes encephalopathy?

A
  • Ataxia (loss of voluntary control of movements)
  • Ophthalmoplegia
  • Nystagmus
  • Confusion
44
Q

cause of wernickes encepahtlopathy?

A

cell death secondary to thiamine B1 deficiency

45
Q

mangement of wernickes encephalopathy?

A

pabrinex

46
Q

management of alcohol dependence (not acute)?

A

disulfuram - inhibits acetaldehyde dehydrogenase- causes hangover
acamproste- inhibits glutamate
Naltrexone- opiate antagonist - reduces positive rewards of alcohol
Pabrinex

47
Q

what is the pathophysiology of alzhiemers?

A

atrophy of brain tissue due to accumulation of amyloid protein plaques and neurofibrillary tangles (tau protein)

48
Q

features of alzhiemers?

A

4A’s:
Amnesia- recent memory, disorientation of time and space
Apraxia- clothes, appropriate clothing
Agnosia- recognising parts of body
Aphasia- mixture of receptive and expressive

49
Q

management of alzheimers?

A

anticholinesterase- donepazil, galantamine, rivastigmine

NMDA receptor antagonost- memantine

50
Q

features of lewy body dementia?

A

1) fluctuating cognitive
impiarement and alertness
2) visual hallucinations
3) feautres of parkinsons- cog-wheel rigidy, tremor, bradykinesia, postural instability

51
Q

Pathophysiology of lewy body dementia?

A

accumulation of lewy bodies (deposits of alpha synuclein) in brain-stem and neo-cortex

52
Q

pathophysiology of front-temporal dementia (picks)?

A

atrophy of fronto-temporal area of brain without the protein deposits seen in Alzheimers

53
Q

feautres of fronto-temporal dementia?

A 
apathy 
dis-inhibition 
emotional blunting 
loss of empathy 
aphasia 
language changes
intellectual functioning 
memory impairment - may occur later but not the main feature
54
Q

investigations of dementia?

A

FBC anaemia, Ca2+, ESR/CRP, U+E, blood glucose, LFT, TFT (hypothyroidism- can cause memory deficits), B12/folate, syphilis
MSU
CXR
ECG
MRI- shrinkage of hippocampus, cerebellar cortex, enlarged ventricles

55
Q

what are some tools used for screening for dementia?

A

Addenbrooks cognitive examination
MMSE
Abbreviated Mental Test (AMT)

56
Q

what are the differences between delirium and dementia?

A

delirium- acute onset, fluctuating, impaired attention, reduced consciousness, reversible

dementia- gradual onset, non-fluctuating, consciousness preserved, irritable

57
Q

management of delirium?

A

try talking the patient down
offer oral lorazepam
give IM lorazepam
treat underlying cause

58
Q

causes of delirium?

A 
Drugs
Electrolyte imbalances
Lack of drugs 
Infection 
Reduced sesnory inout
Intracranial 
Urinary retention/fecal impaction 
Myocardial
59
Q

what are the types of personality disorder?

A

Cluster A – ‘eccentric’: paranoid, schizoid, schizotypal
Cluster B – ‘dramatic’: antisocial, emotionally unstable, narcissistic, histrionic
Cluster C – ‘anxious’: avoidant, dependent, obsessive compulsive

60
Q

what is the definition of GAD?

A

Generalised persistent and excessive anxiety or worry about a number of events that individuals find difficult to control for at least 3 months

61
Q

features of GAD?

A 
persistent anxiety- out of proportion with life events
Apprehension 
Motor tension- muscle stiffness, tension headaches, tremor 
tachycardia 
tachypnoea
sweating
palpitations 
diarrhoea 
hypervigilance 
panic attack
62
Q

management of GAD?

A

first line- CBT
second line- SSRI (sertraline)
pregabalin for physical symptoms
short course of benzodiazepines if acutely anxious

63
Q

definition of panic disorder?

A

recurring panic attacks for more than 4 months

64
Q

features of panic disorder?

A

at least 1 of the attacks is followed by a month of:
persistent worry about future attacks
avoidance behaviours
hypervigilance

65
Q

what are panic attacks?

A

brief intensive periods of episodes of extreme fear and anxiety

66
Q

features of panic attacks?

A

physical- sweating, palpitations, dizziness, SOB, chest pain, hyperventilation, blurred vision

psychological- feeling of impending doom, derelisation , depersonalization, fear of losing control, fear of dying

67
Q

management of panic disorder?

A

CBT
SSRI
benzodiazepines for acute treatment

68
Q

definition of OCD?

A

obsessive thoughts and compulsive acts that are present for most days for more than 2 weeks and are distressing and interfere with activities.

69
Q

what is an obsession?

A

a preoccupying idea (often unpleasent, repetitive, and intrusive- recognised as patients own thoughts)

Recurrent/ persistent, intrusive thoughts, or urges that cause anxiety or distress

Accompanied by attempts to suppress these thoughts/ urges

70
Q

what is a compulsion?

A

An irresistible urge to behave a certain way

Repetitive behaviours or thoughts that the individual feels forced to perform by the obsession

Intensions to prevent or reduce anxiety, distress or a dreaded event. Behaviours are excessive

71
Q

examples of obsessions in OCD?

A 
fear of being contaminated by germs
fear of losing control 
worrying about catching HIV
intrusive violent thoughts
worrying about causing an accident
72
Q

what are some examples of compulsions in OCD?

A 
excessive washing of hands or body 
excessive cleaning of clothes 
checking items are arranged just right and constantly adjusting 
mental rituals 
checking light switches
73
Q

what is PTSD?

A

Triad of intrusive flashbacks, hyper arousal and avoidance following a stressful event of an unexpected and catastrophic nature

74
Q

management of OCD?

A

first line- CBT

second line- SSRI

75
Q

features of maternal baby blues?

A 
transient condition lasts up to 2 weeks after birth 
mood lability
difficulty sleeping
disconnection with baby
anxiety
tearful 
depressive symptoms
76
Q

management of maternal baby blues?

A

not appropriate to give antidepressants

support and reassurance

77
Q

what is the difference between post-natal depression and baby blues?

A

post-natal depression does not tend to appear until later (usually 6 weeks after birth, but can be up to a year) and lasts 2 weeks or longer

baby blue usually peaks 5 days after birth and does not last longer than 2 weeks

78
Q

RF for post-natal depression?

A 
baby blues
px mental health issues 
unplanned pregnancy
no support network 
unemployed 
abuse
79
Q

what scale is used to grade severity of post-natal depression?

A

Edinburgh post-natal depression scale

80
Q

management of post-natal depression?

A

psychological therapy

SSRI’s

81
Q

when does post-natal psychosis present?

A

within 2 weeks of birth

82
Q

features of post-natal psychosis?

A 
gross mood swings 
suicidal ideation 
delusions 
mutism 
confusion 
mixed features of psychosis and mania
83
Q

management of post-natal psychosis?

A

admittance to mother and baby unit
neuroleptics
lithium

84
Q

features of anorexia?

A 
obsessive fear of weight gain 
secondary amenorrhoea 
poor insight
very low BMI 
lanugo hair disturbed 
concentration and memory
hypokalaemia, bradycardia, hypotension
secondary osteoporosis
85
Q

investigations of anorexia?

A

Growth Hormone - ↑due to reduced carb intake
FSH, LH – maybe reduced
Prolactin - ↓at night
Impaired glucose tolerance
TFTs – do not treat hypothyroidism as secondary to amenorrhea. T3 low
Cortisol - high/ normal

most things low
G+C’s raised- growth hormone, glucose, glands, cortisol, cholesterol

86
Q

management of anorexia?

A

psychotherapies: CBT, interpersonal therapy, pscyhodynamic
admit to hospital and antidepressants if needed
encourage weight gain

87
Q

complication of anorexia?

A

re-feeding syndrome

88
Q

what is re-feeding syndrome?

A

massive insulin release after rapid food intake causes extracellular to intracellular displacement of Mg, K, PO3-

89
Q

what are the electrolyte results of re-feeding syndrome?

A

hypophosphataemia
hypoK+
hypoMg+
thiamine deficiency

90
Q

hwo to avoid refeeding syndrome?

A

feed at no more than 50% of requirements for 2 days

91
Q

what is bulimia?

A

Cycles of binging followed by compensatory measures to counteract weight gain (usually via self-induced vomiting or starving) - does not lead to severe weight loss

92
Q

features of bulimia?

A 
body image concern 
urge to overeat
isolated binges
depressed mood
social withdrawal
self-induced vomiting 
impaired conc.
93
Q

what are the physical features of bulimia?

A 
oesophagitis
erosion of dental enamel 
dry skin
brittle nails 
swollen salivary glands
knuckle collapses
94
Q

what is seen on blood gas for bulimia?

A

hypokalaemia, metabolic alkalosis

95
Q

management of bulimia?

A

CBT
fluoxetines
thiamine and vit B supplements

96
Q

management of ADHD + S/E of each drug?

A

Methphenidate (Ritalin)
- s/e: appetite suppression
Atomoxetine
- s/e liver dysfunction, suicidality

97
Q

what is section 2 of the MHA, how long does it last and what are the requirements?

A

Assessment period
Lasts 28 days - cannot be renewed

People required:
AMP + 2 doctors (one S12 approved, one >F2)
Evidence required:
-pt suffering of mental health disorder that warrants hospital admission
-pt has to be detained for safety of themselves or others

98
Q

what is section 3 of the MHA, how long does it last and what is required?

A

Treatment section

lasts up to 6 months, can be renewed

people required: AMP, 2 docs (one S12 approved, one >F2)

evidence required:

  • pt suffering from mental health condition that requires tx in hospital
  • tx is in their best interests
  • tx is required for safety of patient and others
  • tx is available to the patient in the hospital
99
Q

what is section 4, how long does it last and who can put on in place?

A

emergency order - gives time to find another doctor to convert to section 2

lasts 72 hours

AMP + one doctor of any stage

100
Q

what are the two parts of section 5, how long does it last and who can put it in place?

A

5: 2- doctors holding power, detain anyone admitted to hospital consensually for 72 hours - holds patient for assessment, cannot be treated
5: 4- nurses holding power, same as above but only 6 hours

101
Q

what is a section 135?

A

police order- able to enter patients premises and remove them to a place of safety

social worker must be present

unable to treat patient under this order

102
Q

what is a section 136?

A

police order- able to remove person from public place and detain them in a place of safety - no warrant needed

103
Q

what is a community treatment order?

A

patient must turn up to appointments and take their treatment or they will be returned to hospital for 72 hours or S2/3 for treamtent

104
Q

what is the MCA act?

A

Provides legal framework to make decisions for those who lack capacity to do so themselves.
Protects people who lack capacity.

105
Q

what are the 5 statutory principles of the MCA?

A
  • Assume capacity until proven otherwise.
  • Supported to make their own decisions
  • Retain right to make poor/ unwise decisions
  • Act in patients best interests
  • Least restrictive intervention
106
Q

what is the criteria for deciding if someone has capacity?

A

1) is patient able to understand information
2) are they able to retain the information for long enough to make a decision
3) are they able to weigh up the pros and cons of the decision
4) are they able to communicate their decision

Phase 3a (4 decks)

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