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Psychiatry Flashcards

1
Q

What are the components of MSE?

A

Appearance and Behaviour

Speech

  • rate
  • rhythm
  • volume
  • tone
  • coherence
  • flight of ideas?
  • clanging?

Mood and affect

Thought form

  • easy to follow
  • extra detail
  • do they answer questions

Thought content

  • positive/ negative
  • pre-occupied
  • plans

Perception
- hallucinations

Cognition

Insight

Risk

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2
Q

What are the different types of anxiety disorders?

A

Phobias

Generalised anxiety

Agoraphobia

OCD

PTSD

Somatoform and dissociative

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3
Q

What are the drug managements for generalised anxiety disorder?

A

1st line:
- SSRIs

2nd line:
- SNRIs (venaflaxine, duolexitine)

Beta blockers can be given as well

**adherence for 1 year

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4
Q

What should be some differentials for generalised anxiety disorder?

A

hyperthyroidism

Cardiovascular disease

Medication induced anxiety

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5
Q

What is the management for PTSD?

A

CBT

Eye movement desensitisation and reprocessing

High does SSRIs `

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6
Q

Which drug class are not recommended for Panic disorders?

A

Benzodiazepines

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7
Q

What is OCD with definitions:

A

Obsessions:
- recurrent intrusive thoughts

Compulsions
- senseless ritualistic actions - usually motor in order to neutralise the activity

the person has such a desire to carry out the compulsion to release the stress of the obsession.

*the thoughts are egodystonic

the person must acknowledge it is abnormal

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8
Q

What is the treatment for OCD?

A

CBT

Clomipramine

SSRIs

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9
Q

What is the drug of choice for tranquilisation in general hospital if the history of the person is unknown or there is cardiac pathologies?

A

Lorazepam
- 1 to 2 mg IM

review in 30mins and repeat if needed

Haloperidol can be used if not neuroleptic naive and no contraindications for use.

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10
Q

What important things should be monitored in a patient after giving a neuroleptic agent?

A

Temperature
Pulse
Blood pressure
Respiratory rate + oxygen saturations

every 10mins for 1 hour.

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11
Q

When treating Wernickes, you give what drugs?

A 
Pabrinex 
\+ 
Glucose 
\+
Magnesium
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12
Q

How could you carry out cognitive testing on a patient with alcohol withdrawal?

A

Addenbrookes cognitive examination - II (ACE - II)

MOCA

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13
Q

What is the term giving to symptoms that can not be explained by an underlying organic reason? and how are they treated?

A

Medically Unexplained Physical Symptoms

SSRIs
+
CBT

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14
Q

With regard to psychiatry, list some positive and negative symptoms:

A

Positive symptoms:

  • Delusions
  • Hallucinations
  • Thought disorders

Negative symptoms:

  • Avolition (decrease in motivation, purposeless)
  • Poverty of thought
  • Unresponsive
  • Social withdrawal
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15
Q

What is the treatment for bulimia nervosa?

A

Adults:

  • self help
  • CBT - for 4 weeks then:
  • CBT Eating disorder (CBT ED)

Children:
- Family focused therapy - (FT - BN)

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16
Q

What is the diagnostic criteria for anorexia nervosa?

A

Weight reduction due to significant nutritional restriction.
<17.5 BMI

Body dysmorphic
- seeing themselves as fat when they are not

Intense fear of being fat

*note that endocrinological effects have now been removed from diagnostic criteria. However amenorrhoea is often seen

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17
Q

What are some clinical features that may be seen in someone with anorexia nervosa:

A

Reduced BMI

Russel’s sign

Stained teeth

Bradycardia

Hypotension

Enlarged salivary glands

Lanugo hair - small hair across the body

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18
Q

What are the questions you wish to ask into anorexia nervosa?

A

SCOFF questionnaire:

Sick - every make yourself sick?

Control - need control over the food?

One stone loss in 3 months?

Fat - think you look fat?

Food - does food control your life?

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19
Q

What are some organic differential diagnosis’s to anorexia nervosa?

A

Addison’s disease

Crohn’s disease

Hypothalamic dysfunction

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20
Q

What is the management of anorexia nervosa?

A

Adults:
- Maudsley Anorexia nervosa treatment for adults -
(talking to therapist and guided weight gain)

Children/ Adolescents:

  • Family therapy for Anorexia Nervosa
  • the parents are initially in control of the food then this is slowly handed back to the adolescent/ child
  • SSRIs can be used as well

Severe:
- Management of really sick patients with anorexia nervosa / MARISPAN

  • admit to eating disorder unit
  • care of dieticians
  • mental health act can be used to refed
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21
Q

How is refeeding syndrome treated?

A

Dietician input for a slow refeeding input.
- 50% feeds to begin with

Monitoring electrolytes

  • phosphate
  • glucose
  • Mg2+
  • K+

**remember K+ and MG+ are pulled into the cell as well with increase in insulin.

Pabrinex Thiamine prescription
*often thiamine is low as well

Vitamin B complex

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22
Q

What are the various types of personality disorders?

A

Cluster A:

  • paranoid
  • Schizoid

Cluster B:

  • Dissocial
  • Emotionally unstable - borderline
  • Histrionic
  • Narcissistic

Cluster C:

  • Anankastic
  • Anxious
  • Dependent
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23
Q

What are some organic causes of depression that should be investigated for?

A 
Hypothyroidism 
Cushing syndrome 
Steroids/ beta blockers
Brain tumour
Parkinson's disease
Autoimmune diseases - Polymyalgia rheumatica and SLE
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24
Q

What are some differentials for depression?

A

Physical illness

  • Hypothyroidism
  • Dementia

Drugs

  • alcohol
  • withdrawal

Grief

Cyclothymia / Bipolar

Psychotic depression

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25
Q

What questionnaire can be used to assess for postnatal depression?

A

The Edinburgh Postnatal Depression Scale - EPDS

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26
Q

What findings on a mental state examination would suggest depression:

A

Speech:

  • poverty
  • slow

Mood:

  • Low mood, tearful
  • irritability
  • anhedonia

Thoughts:
- slow, pessimistic

Perception:
- pseudo-hallucinations

Cognition:

  • poor memory
  • poor concentration
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27
Q

List some cognitive and physical signs of depression:

A

Cognitive:

  • Low self esteem
  • poor memory
  • Guilt
  • Worthlessness

Biological:

  • Sleep disturbance
  • Reduced/ increased appetite
  • Weight changes - usually gain
  • Loss of libido

or CALS

  • Concentration
  • Appetite
  • Libido
  • Sleep
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28
Q

What are some of the predisposing, precipitating and perpetuating causes of depression?

A

Predisposing:

  • Unemployment
  • social isolation
  • poor social networks
  • female
  • previous past medical history

Precipitating

  • acute stressful event
  • poor compliance with medication

Perpetuating

  • poor insight
  • alcohol misuse / substance misuse
  • unable to solve the precipitating factor
29
Q

What are the key traits that make up dependence?

A

Strong desire or compulsion to use the substance

Difficulties controlling the substance taking behaviour

Physiological withdrawal symptoms

Evidence of tolerance

Neglect of other duties/ pleasures

Continual use despite evidence of ill effect

30
Q

What are the aetiologies to substance abuse?

A

Social learning model

Disease model

Genetic abnormalities / susceptibility

31
Q

What are some psychosocial interventions into substance abuse?

A

Motivational enhanced interviewing

Brief interventions

12 step programs

Peer support

32
Q

What is the strongest predictor of suicide in people with a substance abuse?

A

Alcohol

33
Q

What are some of the features of opioid misuse:

A

Rhinorrhoea

Pinpoint pupils

Drowsiness

Watering eyes

Yawning

~may be needle tracts?

34
Q

What is the drug given for benzodiazepine overdose?

A

Flumazenil IV

35
Q

What are the first rank symptoms of schizophrenia?

A

Auditory hallucinations
- usually 2nd person or 3rd person

Thought disorder

  • thought insertion
  • thought withdrawal
  • thought broadcasting

Passivity phenomena

  • Body sensations controlled by external influence
  • Feeling/ impulses controlled by external influence

Delusional perceptions

36
Q

What are the phases of schizophrenia?

A

Prodromal phase

  • socially withdrawn
  • irritable

Psychotic phase
- hallucinations/ delusions

Residual phase

  • flat affect
  • social withdrawing
37
Q

What factors can help differentiate the cause of psychosis?

A

Most auditory hallucinations not associated with falling asleep or waking up are due to schizophrenia

Visual and tactile hallucinations are more common in drug use and organic illnesses such as Lewy body dementia
- a visual hallucination should steer away from non-organic causes

Physical signs of addiction

  • needle marks
  • signs of liver failure

Age
- schizophrenia starts in young adults. Psychosis >middle age is unlikely to be schizophrenia

38
Q

What are some key features of addiction to alcohol?

A

Increased tolerance

Difficulty/ failure to abstain

Withdrawal symptoms

Often aware of level of alcohol

39
Q

What are the classical signs of Delirium tremens?

A 
Marked confusion 
Seizures
Increased Pulse 
Low blood pressure 
Tremor 
Hallucination - usually formication (feels things crawling under skin)
40
Q

What is the timeline of alcohol withdrawal symptoms?

A

Symptoms star at about 6-12 hours

Seizures peak at 36 hours

Delirium tremens 48-72 hours

41
Q

What are some risk factors for developing generalised anxiety disorders?

A 
Genetic predisposition 
Personality disorder *cluster C 
Social isolation 
Stress - especially work related 
Living with someone who has anxiety *fault learning 
Being a lone parent
42
Q

What is the disorder called in which someone develops paralysis or sensory dysfunction despite there being no organic cause?

A

Conversion Disorder

- typically neurological symptoms, loss of sensation, loss of power

43
Q

What are some features of PTSD?

A

Re-experience - flashbacks
Avoidance
Hyperarousal
Emotional numbing

Depression
Addiction
Anger
Physical symptoms

44
Q

What is the diagnostic criteria for Transsexualism?

A
  1. Desire to live and be accepted as the opposite sex, usually with surgery involved.
  2. Feelings present for >2 years
  3. Disorder is not a symptom of another mental health disorder
45
Q

What is the World Professional Association for Transgender Health’s staged approach for intervention in a child with transsexualism?

A

Stage 1.
- therapeutic exploration of the nature of the gender identity

Stage 2.
- puberty suppression - with GnRH

Stage 3.
- Gender confirming hormones
>16 years

Stage 4.
- Gender reassignment surgery
>18 years

46
Q

What is an important aspect to consider in the risk assessment of someone who has tried to commit suicide, which will influence greatly your next step of management?

A

On going suicidal thought

47
Q

Which psychiatric conditions are highly associated with suicide?

A

Depression

Schizophrenia

Substance abuse

Bipolar Disorder
- 50% will attempt suicide

48
Q

What is a common illegal action which can precipitate the onset of schizophrenia?

A

Marijuana

49
Q

List several organic differentials to schizophrenia:

A

Brian tumour

Hepatic encephalopathy

Substance abuse
- especially opioids

Delirium

50
Q

What are the treatments for OCD?

A

1st line:

  • CBT
  • Exposure therapy

2nd line:

  • SSRI
  • CBT

Clomipramine can be used for OCD. but is not 1st line

51
Q

What factors need to be taken into consideration when prescribing medication to someone depressed?

A

Suicide risk
- No TCAs

Co-morbidities
- previous M.I - sertraline

Interactions

Drug allergies

52
Q

What MMSE score suggest what?

A 
>27: normal 
24-27: mild impairment 
20-24: Dementia 
10-20: moderate dementia 
<10 severe dementia
53
Q

What are some of the other symptoms out with the 1st ranked symptoms of schizophrenia?

A

Impaired insight

Blunting affect

Thought block

Incoherence of speech

  • Knights move
  • circumferential
  • tangential speech

Neologisms (made up words)

Catatonia

  • freezing
  • bursts of excitement

Negative symptoms

  • anhedonia
  • alogia - poverty of speech
  • avolition - lack of motivation
54
Q

What is the action of venlafaxine?

A

SNRI

55
Q

What is Schizoaffective disorder?

A

This is where a mood disorder is seen along with psychotic features. The dominating disorders is worked out by which one presented by itself for >2 weeks

56
Q

Highlight some differences between adult depression and adolescent depression:

A

Extremely sensitivity to criticism

Irritability and swinging moods

Worsening performance/ school trouble

Unxplained aches and pains
- somatic

57
Q

When first prescribing anti-depressant medication - what important information should be told the patient regarding the onset of effectiveness?

A

Inform patient that symptoms may get worse in the first initial weeks.
Perseverance is needed.
*if no response after 4-6 weeks then different drug should be considered.

Increased risk of suicide in first 2 weeks due to increased motivation.
- follow up in 1 week with <30 years old

58
Q

What bloods should be monitored with SSRIs?

A

FBC
- Risk of G.I bleeding

U&Es

  • urea for G.I bleeding
  • Risk of hyponatremia
59
Q

How do you change a patient across different anti-depressants and what are some important drugs to be aware of?

A

Usually drugs should be cross tapered.
- starting one new drug on low dose and build up, whilst lowering the dose gradually of another.

MAOIs should not be cross tapered.

60
Q

What needs to be monitored first before prescribing lithium?

A

U&Es
- can induce diabetes insipidus

ECG
- contraindicated with Brugada disease

TFTs
- can cause hypothyroidism

61
Q

What are the signs of lithium toxicity?

A

*difficult to acutely poisoning in naïve individual. needs accumulative build up.

Mild:

  • Blurred vision
  • Dizziness

Moderate:

  • Confusion
  • blackouts
  • fasciculations
  • Chorea movements

Severe:

  • Ataxia
  • cerebellar signs
  • Coma
  • ECG - AV block
62
Q

When starting someone on an antipsychotic what monitrong should be in place?

A

Patient weight

Blood pressure

FBC (clozapine)

ECG
- long QT

Lipid profile

Glycaemic control

LFTs and Prolactin should also be measured.

63
Q

What is the drug of choice to treat acute dystonia which can occur with antipsychotic use?

A

Procyclidine
- blocks the ACh thus equalising the balance between dopamine and ACh within the basal ganglia reducing drug induced parkinsonian

64
Q

Why is stopping smoking important with antipsychotic use?

A

Smoking promotes metabolism which can break down the drug faster
- therefore requiring higher doses.

65
Q

Who is needed in order for a short term detention Certificate to be ordered? and how long does it last?

A

Approved medical practitioner/ psychiatrist
+
Mental health officer

Lasts 28 days.

*treatment can be initiated

Can be appealed by patient

66
Q

OCD can develop in childhood, but if it starts abruptly over the course of days to weeks what is an important thing to differentiate?

A

Paediatric Autoimmune Neuropsychiatric Disorders associated with Strep (PANDAS)

  • this can often present as OCD
67
Q

What is the triad of the autistic triad?

A

Qualitative impairment in reciprocal interactions

Deficits in the use of language and social communication

Stereotyped behaviour, sensory sensitivities and restricted interests

**all components must be there to fulfil the criteria

68
Q

What are some of the physical symptoms and signs of anorexia nervosa?

A

Weight loss + Atrophy

Lack of weight gain/ growth

Amenorrhoea/ delayed puberty

Lanugo body hair growth

Bruising

Brittle nails

Abdominal discomfort

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