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Danny's Phase 3A Medicine > Psychiatry > Flashcards

Psychiatry Flashcards

1
Q

What is an Illusion?

A

Misperception of real external stimulus

Affect driven

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2
Q

What is a hallucination?

A

Disorder of perception

Percept experienced in absence of external stimuli

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3
Q

Describe the types of Hallucinations

A 
Auditory
Visual 
Olfactory 
Gustatory = taste
Tactile = feeling things

Hypnogogic = on falling asleep

Hypnopompic = on waking up

Autoscopic = seeing oneself

Reflex = stimulation in one modality produces hallucination in other

Extracampine - hallucinations outside of sensory fields

Charles Bonnet = visual hallucinations associated with eye disease

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4
Q

What is a Delusion?

A

Disorder of thought

A belief that is:

1) firmly held
2) Not affected by rational argument/evidence
3) Not a conventional belief

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5
Q

Types of Delusions?

A

▪ Persecutory (think someone is going to hurt them)

▪ Grandiose - inflated self-importance (e.g. I am God)

▪ Delusions of Reference – events/actions take on special significance to patient (e.g. black cars
monitoring me)

▪ Nihilistic – delusion of almost nothingness (e.g. nothing in bank account, insides rotting)

▪ Hypochrondriacal - firm belief they have a disease

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6
Q

What is Psychosis?

A

Severe mental disorder in which thought and emotions are so impaired that contact is lost with external reality

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7
Q

Neurosis?

A

Mild mental illness involving symptoms of stress but not a radical loss of touch with reality

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8
Q

Passivity Phenomena?

A

Controlled by someone else

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9
Q

Catatonia?

A

Significantly excited/ inhibited motor activity

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10
Q

Psychomotor retardation?

A

Slowing of thoughts/movements

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11
Q

State the 5 types of Thought Alienation

A

Thought Insertion

Thought Withdrawal = someone removing their thoughts

Thought broadcast

Thought Echo

Thought Block = can’t continue idea

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12
Q

Concrete thinking?

A

lack of abstract thinking = aspergers

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13
Q

What is Confabulation?

A

Korsakoff = most common

give false account to fill gap in memory

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14
Q

What is a Neologism?

A

New word formation = to them it seems like it fits

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15
Q

Anhedonia?

A

Inability to experience pleasure

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16
Q

Akathisia?

A

Inner restlessness and always in motion (rocking)

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17
Q

Pharmacokinetics?

A

What the body does to the drug (Absorption, distribution, metabolism, elimination)

ADME

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18
Q

Pharmacodynamics?

A

what the drug does to the body (receptor sensitivity, agonism/antagonism)

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19
Q

4 key neurotransmitters?

A

Dopamine
Serotonin
Acetylcholine
Glutamate

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20
Q

Where do the dopamine and serotonin pathways begin?

A

Dopamine = substantia nigra

Serotonin = Raphe Nuclei

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21
Q

SCHIZOPHRENIA

How is it caused?

A

Excess dopamine production

over activity of neurones = Mesolimbic = Hallucinations/delusions

Under activity of neurones = Mesocortical = blunted, anhedonia, apathy

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22
Q

What is Mesolimbic/ Mesocortical

A

Mesolimbic = positive symptoms

mesocortical = negative symptoms

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23
Q

SCHIZOPHRENIA

Treatments can cause side effects - Extra pyramidal side effects (EPSEs)

Name the EPSEs (from anti-psychotics)

A

Hours = Acute dystonic reaction (muscle spasms)

4 weeks = Parkinsonism (tremor, bradykinesia)

6-60 days = Akasthesia (inner restlessness)

Long term use = Tardive dyskinesia

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24
Q

SCHIZOPHRENIA

treatment of EPSEs?

A

Procycladine

Propanolol +/- cyproheptadine

Tetrabenazine

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25
Q

SCHIZOPHRENIA

What is Procycladine used for?

A

Treatment of the EPSE of Acute Dystonia/ Parkinsonism

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26
Q

SCHIZOPHRENIA

What is propanalol/ cyproheptadine used for?

A

Treatment of the EPSE of Akathesia

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27
Q

SCHIZOPHRENIA

What is Tetrabenazine used for?

A

Treatment of EPSE of Tardive Dyskinesia although its generally irreversible

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28
Q

SCHIZOPHRENIA

typical / 1st gen antipsychotics?

A

Haloperidol

Chlorpromazine

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29
Q

SCHIZOPHRENIA

Atypical/ new antipsychotics?

A

Olanzapine

Risperidone

Quetiapine

Aripiprazole

Clozapine

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30
Q

SCHIZOPHRENIA

Main dopamine and serotonin receptors?

A

D = D2

S = 5HT2a

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31
Q

SCHIZOPHRENIA

What does dopamine inhibit?

A

Prolactin = therefore dopamine antagonism increases prolactin

Hyperprolactinaemia Side Effects:

  • Galactorrhoea
  • Amenorrhoea and infertility
  • Sexual dysfunction
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32
Q

SCHIZOPHRENIA

Hyperprolactinaemia is a common SE of antipsychotics.

What is it generally not seen in?

A

Aripiprazole

Quetiapine

Clozapine

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33
Q

SCHIZOPHRENIA

What is the SE of weight gain seen in?

A

All Atypical

most with olanzapine/ clozapine

lowest with Aripiprazole

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34
Q

SCHIZOPHRENIA

Clozapine side effects?

A

Agranulocytosis - high risk of infection

Reduced seizure threshold

Sedating

Postural Hypotension

Toxic Megacolon (1 in 1800)

Cardiomyopathy (1 in 2500)

Extreme salivating

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35
Q

SCHIZOPHRENIA

which pathway causes excess prolactin?

A

Tuberoinfundibular

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36
Q

SCHIZOPHRENIA

Which pathway causes movement disorders?

A

Nigrostriatal

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37
Q

SCHIZOPHRENIA

Signs and symptoms of neuroleptic malignant syndrome?

A

REDUCED ACTIVITY

fever, altered mental status, muscle rigidity, and autonomic dysfunction.

Biological:
Elevated CK, WCC, metabolic acidosis

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38
Q

SCHIZOPHRENIA

which drugs can cause neuroleptic malignant syndrome?

A

Most frequently in patients taking haloperidol and chlorpromazine

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39
Q

What is Echolalia?

A

meaningless repetition of another persons spoken words

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40
Q

What is Incongruity of affect?

A

emotional responses that don’t match the situation

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41
Q

What is flat affect?

A

No emotional expression

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42
Q

mannerism?

A

repeated involuntary movements

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43
Q

Belle indifference?

A

Lack of concern for implications of symptoms

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44
Q

DEPRESSION

Name types of antidepressants

A

SSRIs

Serotonin Noradrenaline Reuptake Inhibitor (SNRIs)

Monoamines Oxidase Inhibitors

Tricyclics

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45
Q

Name types of SSRIs

A

Sertraline
Citalopram
Fluoxetine
Paroxetine

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46
Q

Name types of SNRIs

A

Venlafaxine

Duloxetine

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47
Q

Name types of MAO inhibitors

A

Rasagiline
Selegiline
Isocarboxazid
Phenelzine

avoid high fat diet as contains tyramine = hypertensive crisis

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48
Q

Name types of Tricyclics

Side effects?

A

Amitriptyline
Clomipramine

Tachycardic
dry mouth
blurred vision
(anti-cholinergic/muscarinic)

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49
Q

What is bipolar disorder?

A

Periods of elevated mood and depression

Hypomania/mania

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50
Q

Treatment of Neuroleptic Malignant Syndrome?

A

Bromocriptine – to reduce dopamine blockade (dopamine agonist)

Dantrolene – to reduce muscle spasms

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51
Q

treatment of Bipolar?

A

Lithium
Sodium Valproate, carbamazepine, lamotrigine

Antipsychotics

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52
Q

What is Lithium used for?

A

Acute treatment of mania

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53
Q

how does lithium work?

A

Inhibits cAMP production

cAMP inhibits monoamines

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54
Q

Side effects of lithium?

A 
Fine tremor
Impaired renal function
Nephrogenic DI (thirst)
Weight gain
Oedema
Hypothryoidism

Cardiac - t wave flattening/inversion

Leucocytosis
Teratogenicity

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55
Q

Signs of Lithium toxicity?

• Levels >1.0mmol/L

A 
• Onset = sudden
• Course tremor, 
- Ataxia
- Weakness
- N&V
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56
Q

Signs of Lithium toxicity?

• Levels >2.0mmol/L

A 
Nystagmus
Dysarthria
Impaired consciousness
Hyperactive tendon reflexes
Oliguria
Hypotension
Convulsions / coma
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57
Q

Cause of Serotonin syndrome?

A

SSRIs
MAO inhibitors
ecstasy

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58
Q

Symptoms of Serotonin syndrome

A

INCREASED ACTIVITY

  • Clonus/myoclonus
  • Hyperreflexia
  • Tremor
  • Muscle ridgity
  • Dilated pupils
  • Autonomic dysfunction (tachycardia/ unstable BP)
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59
Q

Signs of Serotonin Syndrome after testing?

A

Similar to NMS

  • Elevated CK, WCC
  • Deranged LFTs
    Metabolic acidosis
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60
Q

Treatments for serotonin syndrome?

A

Benzodiazepines

Cyproheptidine- 5HT-2a antagonist

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61
Q

Differences between Serotonin syndrome and Neuroleptic malignant syndrome?

A

Serotonin = increased activity and acute onset

Neuroleptic = reduced activity and insidious onset (4-11 days)

similar signs (CK,WCC, LFTs, metabolic acidosis)

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62
Q

Definition of Dependance?

A

Cluster of physiological, behavioural and cognitive phenomena in which a substance takes on a higher priority than other behaviours that once had greater value

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63
Q

Name the features of Dependance

A

Compulsion to drink

Tolerance - need more to get same effect

Difficulties controlling alcohol consumption

Physiological withdrawal

Neglect of alternatives to drinking

Persistent use of alcohol despite harm

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64
Q

Risk for factors for Dependance

A 
o Higher risk in men
o Low standard of education o Unemployment
o Younger age of usage o Mental illness
o Peer pressure
o Low self esteem
o High stress
o FHx of alcoholism / substance addiction 
o Genetic susceptibility
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65
Q

Alcohol dependance assessments?

A

CAGE (cut down, annoyed, guilt, eye-opener)

Audit

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66
Q

What does Tweak stand for

A

Tolerance (>6 drinks = 2pts)

Worried (yes = 2pts)

Eye-opener = 1pt

Amnesia = 1pt

Cut down = 1pt

> 3 = problem with alcohol

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67
Q

Investigation results of an alcohol dependant patient?

A

Raised MCV - macrocytic anaemia

▪VitaminB12+folate deficiency=withALCOHOL

o Deranged LFTs – GGT, AST/ALT

o Thrombocytopenia - reduced platelets
o Breath test
o Screening

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68
Q

Management of Alcohol dependance

A

▪ Acomprosate – reduces craving

▪ Disulfiram – gives hangover SE if alcohol consumed (alcohol intake causes inhibition of of
acetaldehyde dehydrogenase

▪ Naltrexone reduces pleasure alcohol brings

▪ Support groups / CBT / motivational interviewing

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69
Q

Management of alcohol withdrawal

A

▪ Chlordiazepoxide - Benzodiazepine

▪ IV Pabrinex 5 days - vitamin supplementation

▪ Thiamine 100mg BD

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70
Q

Alcohol withdrawal symptoms?

A 
▪ Tremors
▪ Sweating
▪ Nausea/vomiting
▪ Sound sensitivity (hyperacusis)
▪ Insomnia / sleep disturbance
▪ Mood disturbance – eg anxiety,
on edge, depression
▪ Autonomic hyperactivity –
tachycardia, HTN, pyrexia,
myadriasis
▪ Seizures seen - at 36 hours
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71
Q

What is Lilliputian?

A

Visual hallucinations of small animals

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72
Q

What is Formication?

A

Insects crawling on skin

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73
Q

KORSAKOFF’S SYNDROME

Triad?

Treatment?

A

▪ Anterograde amnesia
▪ Confabulation
▪ Psychosis (Lilliputian/formication)

o IV Pabrinex (high potency B1 replacement) and chlordiazepoxide

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74
Q

Management of Opioid overdose/ dependance?

A

• IV/IM naloxone - rapid onset + short

• Opioid dependance - detoxification (last up to 4weeks in residential / 12weeks in community)
o Methadone
o Buprenorphrine

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75
Q

Complications of Opioid misuse?

A

Infection due to sharing needles

VTE

Overdose- respiratory depression

Crime/prostitution

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76
Q

Opiate Intoxication symptoms?

A

Drowsy

Mood change

Bradycardia

HTN

Pupil constriction

Respiratory depression

Decreased body temperature

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77
Q

Opiate withdrawal symptoms?

A

muscle cramps

low mood

insomnia

agitation

Diarrhoea

Shivering

Flu like symptoms

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78
Q

DELIRIUM

Causes of delirium?

A

Pain

Infection/ Intoxication

Nutrition (vit deficiency- thiamine, B12, folate)

Constipation

Hypoxia/hydration

Medication/ substance abuse (benzodiazepines, anticholinergics, opiates, anticonvulsants)

Environmental

PINCH ME

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79
Q

DELIRIUM

Features?

A

inattention
disorientated
visual hallucinations
paranoia

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80
Q

DELIRIUM

3 clinical syndromes seen?

A 
▪ Hypoactive
• Apathy
• Withdrawal
• Quiet confusion
• Easily missed – o:en misdiagnosed as depression
▪ Hyperactive
• Agitation
• Lack of co-operation
• Delusions
• Disorientation
• Confused with schizophrenia

▪ Mixed

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81
Q

DELIRIUM

Ddx?

A 
Dementia
anxiety
Psychosis
withdrawal 
post-ictal
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82
Q

DELIRIUM

How can you differentiate from dementia?

A

Delirium vs Dementia

Acute vs gradual

outside of brain vs brain pathology

can improve vs can’t improve

inattention vs still alert

impaired consciousness vs conscious

fluctuating symptoms

treatable vs untreatable

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83
Q

DELIRIUM

Lifestyle Management?

A

Treat precipitating cause
Educate family and make environment safe

Avoid sedation unless severely agitated

Regular follow ups

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84
Q

DELIRIUM

Medication Management?

A

Consider

  • Haloperidol
  • Olanzapine
  • BDZs = Chlordiazepoxide (ONLY in alcohol withdrawal otherwise worsens delirium)
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85
Q

GENERALISED ANXIETY DISORDER

What is it?

A

Anxiety not specific to an environmental circumstance

Excessive worry about every day events/problems

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86
Q

GENERALISED ANXIETY DISORDER

Clinical features?

A

3 or more of :

  • Restlessness / on edge
  • Easily fatigued
  • Difficulty concentrating
  • Irritability
  • Muscle tension
  • Sleep disturbance
87
Q

GENERALISED ANXIETY DISORDER

Clinical features can be put into 5 categories :

Autonomic 
Chest/Abdomen
General 
Mental State
Non specific

state some features using these categories

A 
Autonomic : 
Increased HR
Sweating 
heart palpitations 
Dry mouth
shaking/trembling

Chest/Abdo :
Difficulty breathing
chest pain
N+V

General:
Hot flushes/cold chills
Numbness/tingling
Restlessness
muscle tension 
Lump in throat
on edge
Mental state:
Dizzy/faint
Derealisation
Depersonalisation
Losing control
Fear of death 
Non-specific:
Sleep disturbance
irritability 
Difficulty concentrating
Exaggerated response to normal stimuli
88
Q

GENERALISED ANXIETY DISORDER

risk factors?

A
  • Female
  • 35-54
  • Divorced / alone
89
Q

GENERALISED ANXIETY DISORDER

Investigations?

A

Rule out physical illness

  • Thyroid
  • B12/folate
  • medication
  • alcohol/ bento use (withdrawal symptoms)
90
Q

GENERALISED ANXIETY DISORDER

management?

A

Step 1:

  • Educate
  • Exercise
  • Stop smoking/drinking

Step 2:
- Psychological support/groups

Step 3:
- high intensity support CBT/ medication

91
Q

GENERALISED ANXIETY DISORDER

what medication?

A

Rapid response:
Benzodiazepine

Long term:

Sertraline/SSRIs
Clomipramine

92
Q

what is a panic attack?

A

period of intense fear characterised by group of symptoms that develop rapidly, reach peak at 10mins and generally don’t last longer than 20-30mins.

93
Q

PANIC DISORDER

Risk factors?

A
  • Loneliness
  • Living in a city
  • Poor education
  • Early parental loss
  • Sexual/physical abuse
94
Q

PANIC DISORDER

Management?

A

CBT

1st - SSRIs (Sertraline)
2nd- Clomipramine

95
Q

What is Agoraphobia?

A

Anxiety/panic over public. places that are difficult to escape

96
Q

management of Agoraphobia?

A

Short term = BDZ

SSRIs

Relaxation and exposure training/techniques

97
Q

OCD

What are obsessions?

A

Obsessions are unwanted intrusive thoughts, images or urges that repeatedly enter the person’s mind

98
Q

OCD

What are compulsions?

A

Compulsions are repetitive behaviours or mental acts that the person feels drive to perform

99
Q

OCD

Treatment?

A

▪ CBT - exposure + response
prevention - ERP

▪ SSRI – fluoxetine / sertraline

▪ TCA - Clomipramine - has specific non-obsessional action

100
Q

PTSD

Clinical features?

A
  • re-experiencing (flashbacks, nightmares)
  • Avoidance (avoiding people or circumstances resembling the traumatic event)
  • Hyperarousal (exaggerates responses to small threats)
  • Emotional numbing (feeling detached)
101
Q

PTSD

ICD-10?

A

Symptoms arise within 6mnths of traumatic event

Symptoms present for at least 1 month —> w/ significant distress / impairment in daily functioning

102
Q

PTSD

Treatment?

A

1st - • CBT
• EMDR - Eye movement desensitisation and reprocessing

2nd - SSRIs

103
Q

PTSD

Treatment of sleep disturbance?

A

Mirtazapine

104
Q

PTSD

Tx of anxiety symptoms?

A

BDZs

Antidepressants

Propanolol

105
Q

PTSD

tx of Intrusive thoughts / impulsiveness?

A

Carbamazepine, valproate, lithium

106
Q

PTSD

tx of psychotic symptoms?

A

Antipsychotics

107
Q

ANOREXIA

Diagnostic criteria?

A

Weight <85% of predicted

BMI <17.5

Intense fear of gaining weight

feeling fat when actually underweight

108
Q

ANOREXIA

What is the SCOFF questionnaire?

A 
Sick (make yourself)
Control (lost over eating)
One stone lost in 3 months
Feel fat
Food (dominates life)

Do you make yourself Sick because you feel uncomfortably full?
Do you worry you have lost Control over how much you eat?
Have you recently lost more than One stone in a 3 month period?
Do you believe yourself to be Fat when others say you are too thin?
Would you say that Food dominates your life?

109
Q

ANOREXIA

Red flags?

A

o BMI <13 or below 2nd centile o Weight loss >1kg / week

o Temperature <34.5

o BP <80/50

o Sa02 <92%

o Long QT, flat T waves

o Weakness in muscles

110
Q

ANOREXIA

management?

A

Restore nutritional balance

Involve carers

PSYCHOLOGICAL THERAPIES

  • Eating disorder focussed CBT (ED-CBT)
  • Maudsley anorexia nervosa treatment for adults (MANTRA)
111
Q

Signs of Re-feeding syndrome?

A

Drop in phosphate due to rapid initiation of food after >10 days of undernutrition

▪ Rhabdomyolysis
▪ Respiratory / cardiac failure
▪ LowBP
▪ Arrhythmias
▪ Seizures
112
Q

Management of re-feeding syndrome?

A

Slow refeeding

thiamine / vit B and multivits

Monitor for:

  • Low phosphate
  • Low potassium
  • high glucose
  • high magnesium
113
Q

BULIMIA

Signs?

A

Same as anorexia +

  • Oesophagitis (vomiting)
  • Russell’s sign (callouses on back of hands)
  • Oedema
  • Cardiomyopathy (laxatives)
114
Q

BULIMIA

What can laxatives and vomiting cause metabolically?

A

Metabolically alkalosis = vomiting (hypochloraemia/ hypokalaemia)

Metabolic acidosis = laxatives

115
Q

BULIMIA

Management?

A

EDU for severe

Self-help books

SSRIs

116
Q

DEPRESSION

3 core symptoms?

A
  • Low mood
  • low energy (anergia)
  • loss of enjoyment (anhedonia)
117
Q

DEPRESSION

Clinical features?

A 
DEADSWAMP:
• Depressed mood most of day
• Energy low
• Anhedonia
• Death thoughts -suicide
• Sleep disturbance (insomnia / hypersomnia)
• Worthlessness / guilt / hopelessness
• Appetite / weight change
• Mentation decreased - i.e. lack of
concentration
• Psychomotor agitation / retardation
118
Q

DEPRESSION

Criteria?

Mild
Moderate
Severe

A

Mild = 2 core 2 other

Moderate = 2 core 3+ other

Severe = 3 core 4+ other

119
Q

DEPRESSION

Assessments?

A

PHQ-9

HADs (Hospital Anxiety and Depression Scale)

120
Q

DEPRESSION

Management of mild?

A

Lifestyle:

Sleep hygiene
anxiety management
physical activity

Computerised CBT

121
Q

DEPRESSION

Management of moderate?

A

▪ Lifestyle
▪ Anti-depressants
▪ High intensity psychological therapies eg CBT via IAPT

122
Q

DEPRESSION

Management of severe?

A

▪ Rapid specialist mental health assessment with inpatient admission consideration

▪ ECT - Electroconvulsive therapy

123
Q

DEPRESSION

Pharmacological management?

A

1st line - SSRI
(prolonged QT in Citalopram)

2nd - alternative SSRI

3rd - NaSSA - Mirtazapine

4th - TCAs (Amitriptyline)

Moclobemide

124
Q

Side effects of Anti-cholinergics/muscarinics?

A
  • Tachycardia
  • Dry mouth
  • Blurred vision
  • Constipation
  • urinary retention
  • Drowsiness
125
Q

What are the components of the Mental State Examination

A

Appearance & Behaviour (body language, abnormal movements, alertness)

Speech (rate, tone, volume)

Emotions (mood)

Perceptions (are they responding to internal stimuli? E.g talking/laughing to themselves) / hallucinations

Thoughts (thought insertion/blocking

Insight (do you think you’re unwell/ need treatment?)

Cognition

126
Q

BIPOLAR

Criteria?

A

Requires at least two episodes, one of which must be mania/hypomania for a diagnosis

127
Q

BIPOLAR

Describe the types of Bipolar?

A

Bipolar I = Mania + Depression
Psychotic symptoms

Bipolar II = Hypomania
More episodes of depression and no psychosis
(do not meet full criteria of mania = hypomanic)

Cyclothymia = cyclic mood swings with subclinical features

128
Q

BIPOLAR

Signs of Mania? (over 1 week)

A
  • Uncontrollable elation
  • Over activity
  • Pressure of speech
  • impaired judgement
  • risk taking
  • social disinhibition
  • Grandiosity
  • psychotic symptoms
129
Q

BIPOLAR

Signs of Hypomania (over 4 days)

A
  • elevated mood
  • increased energy
  • increased talking
  • poor concentration
  • mild reckless behaviour
  • overfamiliarity
  • increased libido
  • increased confidence
  • decreased need for sleep
  • change in appetite
130
Q

BIPOLAR

possible causes?

A
  • post partum female
  • substance misuse
  • chronic illness
  • past trauma/ mental health problems
131
Q

BIPOLAR

Tx of acute mania?

A

Severe/ life threatening = ECT

Lithium (up to 2 weeks) +

Antipsychotics/ BDZs due to delayed effect:

  • Risperidone
  • Olanzapine
  • Haloperidol
132
Q

BIPOLAR

long term treatment?

A

1st = Lithium (inhibits cAMP)

check TSH, U&Es, hydration every 6 months

2nd = Valproate/ Lamotrigine if not tolerated

CBT can be helpful

ECT in SEVERE mania

133
Q

DEMENTIA

Clinical features?

A

PROGRESSIVE DECLINE

1) Cognitive impairment (memory, language, attention etc)

2) Psychiatric changes
(personality, emotional control, social behaviour, agitation, hallucinations, delusion)

134
Q

DEMENTIA

Types?

A

Alzheimer’s

Vascular

Lewy body (Parkinson’s)

Frontotemporal

Mixed

135
Q

DEMENTIA

signs of Alzheimers?

A
  • Cant remember conversations, names, events

Depression

Later: Poor communication, disorientation,

aphasia, apraxia, agnosia

136
Q

DEMENTIA

Alzheimer’s brain changes?

A

o Deposits of beta-amyloid protein fragment plaques

o Twisted strands of the protein tau (tangles)

o Evidence of nerve cell damage and death in the brain

o Reduced cortical ACh

137
Q

DEMENTIA

Presenting variables of Vascular Dementia?

A

1) Cognitive deficits following single stroke
2) Multi-infarct dementia (stepwise deterioration following multiple strokes)
3) Binswanger’s Disease (multiple microvascular infarcts)

138
Q

DEMENTIA

Difference in symptoms between Vascular and Alzheimers

A

In vascular, impaired:

  • Judgement
  • Decision-making
  • planning and organisation

comes before memory loss

139
Q

DEMENTIA

Signs of Dementia with Lewy bodies?

A

Quicker onset
Memory loss and thinking problems

DIFFERENCE ; well-formed visual hallucinations

140
Q

DEMENTIA

what are Lewy bodies?

A

Abnormal aggregations of protein alpha-synuclein in cortex

same as Parkinson’s but they aggregate in substantial nigra in PD

141
Q

DEMENTIA

Describe Frontotemporal Dementia

A

This includes
FTLD (onset at young age 45-60)

Pick’s Disease,

Progressive Supranuclear Palsy

(Change in personality and behaviour)

142
Q

DEMENTIA

Treatment?

A

Occupational support (living at home)

Medications: Donepazil mainly

1) Cholinesterase inhibitors
2) Glutamate regulators

143
Q

DEMENTIA

Medication treatment

A

Alzheimer’s =
Donepazil/ Rivastigmine/ Galantamine (cholinesterase inhibitors)

Rivastigmine = Tx for Parkinsons/Dementia = Lewy body

3) Glutamate regulators = Memantine = Severe Alzheimer’s

144
Q

DEMENTIA

What may delay course of vascular dementia?

A

Daily aspirin

145
Q

What is the Biopsychosocial formulation?

P’s

A

An approach to understanding a patient that takes into account biological, psychological and social perspectives.

Predisposing factors
Precipitating factors
Perpetuating factors
Protective factors

146
Q

How could you breakdown the component of thought?

A

Stream- thought blocking?

Form- poverty of thought, thought disorder. Do they make sense?

Content - obsessions, delusions

(Insertion, withdrawal, broadcast)

147
Q

What may a CT/MRI scan show on a dementia patient

A

CT = areas of infarct in vascular dementia

MRI = cerebral atrophy in Alzheimer’s

Imaging can rule out space occupying lesions and chronic haemorrhage

148
Q

SCHIZOPHRENIA

What is the strongest risk factor?

A

Family history

149
Q

SCHIZOPHRENIA

First Rank Symptoms?

A

Passivity phenomena

Thought disorders (withdrawal, insertion, broadcasting)

Hallucinations - 3rd person auditory

Delusional perception - delusions of passivity, influence or control

150
Q

SCHIZOPHRENIA

What is the ICD-10?

A

ONE or more of:

  • Passivity phenomena
  • Thought disorders
  • Hallucinations (3rd person auditory)
  • Delusional perception

OR TWO or more of:

  • Any hallucination
  • Catatonic behaviour
  • negative symptoms ( no talking, acting incorrectly, no pleasure/motivation)
  • Breaks in train of thought
  • change in behaviour
  • impaired insight
  • neologisms
151
Q

SCHIZOPHRENIA

subtypes?

A
  • Paranoid
  • Hebephrenic / Disorganised
  • Catatonic
  • Undifferentiated
  • Residual (low intensity)
  • Simple (progressive)
152
Q

SCHIZOPHRENIA

Investigations?

A

Rule out drugs = urine screen

Rule out alcohol = LFTs, FBC, macrocytosis, thrombocytopenia

Rule out syphilis = sero test

Rule out brain lesion = CT head

153
Q

SCHIZOPHRENIA

What is the Psychosis risk assessment?

A

risk to self
risk to others
risk from others
risk of criminal damage to property

154
Q

SCHIZOPHRENIA

1st line Management?

A

CBT early on 3rd person hallucinations

  • Atypical 2nd Gen D2 and 5HT antagonist:
  • Olanzapine
  • Resperidone
  • Quetiapine
  • Paliperidone
  • Aripiprazole
155
Q

SCHIZOPHRENIA

Side effects of first line treatment

A
  • Atypical 2nd Gen D2 and 5HT antagonist:
  • weight gain
  • sudden cardiac arrest
  • HTN, hyperlipidaemia/ hypercholesterolaemia
156
Q

SCHIZOPHRENIA

2nd line management?

A
  • Typical 1st gen D2 antagonist:
  • Haloperidol
  • Chlorpromazine
157
Q

SCHIZOPHRENIA

Side effects of 2nd line management?

A
  • Typical 1st gen D2 antagonist:

EPSEs!

  • raised prolactin
  • risk of stroke/VTE in elderly
158
Q

SCHIZOPHRENIA

3rd line management?

A

Clozapine for treatment resistant schizophrenia

159
Q

What is Schizoaffective disorder?

A

Mixture of schizophrenia and mood disorders

symptoms of both mania and depression in small time frame

treatment = mood stabilisers and anti-psychotics

160
Q

PERSONALITY DISORDERS

Definiton?

A

Severe disturbance of a persons characteristics and behavioural tendencies of the individual

161
Q

PERSONALITY DISORDERS

Diagnosis?

A
  • Requires inhibition of self and social functioning
  • One or more pathological personality traits
  • Impairments are stable across most situations
  • The impairments cannot be explained as “normal” for the individual’s developmental stage or socio-cultural environment
162
Q

PERSONALITY DISORDERS

Risk factors?

A
  • Past abuse
  • bullying
  • childhood trauma
  • expelled
  • Self-harm
163
Q

PERSONALITY DISORDERS

Management?

A

non-pharmacological = BEST

  • Dialectical behavioural therapy (DBT) - especially borderline / cluster B personalities

Benzos for short term

164
Q

What is meant by Cluster A, B and C personalities?

A 
A = Eccentric MAD
B = Flamboyant BAD
C = Fearful/anxious SAD
165
Q

Describe a simple overview of cluster A

A
  • Paranoid (delusional, jealousy, conspiracies)
  • schizotypal (weird and magical, circumstantial, bizarre and peculiar)
  • schizoid (voluntarily withdraw from social interaction)
166
Q

Describe a simple overview of cluster B

A
  • Antisocial (impulsive, lack of guilt, low anger tolerance)
  • Borderline (act without regard of consequences, unstable affect, mood swings, self harm/suicide)
  • Histrionic (dramatic, shallow, extrovert, sexually inappropriate)
  • Narcissistic (grandiosity, egotistical)
167
Q

Describe a simple overview of cluster C

A
  • Avoidant (tense and apprehensive)
  • Dependant (need to be cared for, can’t make own decisions)
  • Anankastic (stubborn, perfectionism, egosyntonic, inflexibility) OCPD
168
Q

What is the difference between Avoidant and Schizoid?

A
  • Schizoid VOLUNTARILY withdraw

Avoidant - desire companionship but too afraid of rejection

169
Q

Difference between OCPD and OCD?

A

Obsessive compulsive personality disorder = they’re okay with how they are

OCD = do not like the obsessions/ compulsions = egodystonic

170
Q

What is Egosystonic and Egodystonic?

A

Egosystonic = behaviour is consistent with ones ideal self image (does like their own thoughts/behaviours)

Egodystonic = conflict with ones ideal self image (does not like their own thoughts / behaviours)

171
Q

Name 4 types of Sleep Disorders

A

Narcolepsy

sleep apnoea

Circadian rhythm disorder

Parasomnia

172
Q

What is Narcolepsy?

A

Always tired through the day that they cannot resist

173
Q

what is sleep apnoea?

A

repeated and intermittent upper air collapse during sleep

174
Q

what is circadian rhythm disorder?

A

Mismatch between sleep-wake cycle and circadian rhythms (jet lag/shift work)

175
Q

What is parasomnia?

A

restless leg syndrome

nightmares/ night tremors

sleep walking/talking

176
Q

State some sleep hygiene advice?

A

1) Limit : Caffiene, alcohol, cigarettes
2) Less noise/lights/screen use
3) Reduce sleep
4) regular pattern

177
Q

Name some short acting benzodiazepines

A

Chlorazepate

Midazolam

Triazolam

178
Q

Name some non-benzodiazepine hypnotic agents

A

Zopiclone

Zaleplon

Zolpiderm

179
Q

State the suicide risk assessment

A

SADPERSONS

o Sex - (males > females)
o Age – peaks in young and old
o Depression
o Previous attempts and severity of means
o Ethanol abuse - ALCOHOL
o Rational thinking loss – eg Schizophrenia
o Support network loss
o Organised plans – eg note, alone, avoid detection, planned/impulsive
o No significant others
o Sickness – eg physical disease

o 0-2 – no real problems, keep watch
o 3-4 – send home, but check frequently
o 5-6 – consider hospitalisation, involuntary or voluntary
o 7-10 – definitely hospitalise, involuntary or voluntary

180
Q

MENTAL HEALTH ACT

For each section state the:

  • Duration
  • Reason
  • Approved by
  • Evidence

SECTION 2

A

Duration: 28 days

Reason: Assessment

Approved by: 2 Drs + 1 AMHP

Evidence: Patient suffers from disorder and detained for own and others safety

181
Q

MENTAL HEALTH ACT

For each section state the:

  • Duration
  • Reason
  • Approved by
  • Evidence

SECTION 3

A

Duration: 6 months

Reason: Treatment

Approved by: 2 Drs + 1 AMHP

Evidence: Patient suffers from disorder and detained for own and others safety

182
Q

MENTAL HEALTH ACT

For each section state the:

  • Duration
  • Reason
  • Approved by
  • Evidence

SECTION 4

A

Duration: 72hrs

Reason: emergency order- urgent when waiting for 2nd Dr would cause undesirable delay

Approved by: 1 Dr and 1 AMHP

Evidence: Patient suffers from disorder and detained for own and others safety and not enough time for 2nd Dr

183
Q

MENTAL HEALTH ACT

For each section state the:

  • Duration
  • Reason
  • Approved by
  • Evidence

SECTION 5 (4)

A

Duration: 6hrs

Reason: Patient admitted but wanting to leave

Approved by: Nurse holding power

Evidence: Cannot be coercively treated

184
Q

MENTAL HEALTH ACT

For each section state the:

  • Duration
  • Reason
  • Approved by
  • Evidence

SECTION 5 (2)

A

Duration: 72hrs

Reason: Allows time for section 2&3

Approved by: Doctors holding power

Evidence: Cannot be coercively treated

185
Q

MENTAL HEALTH ACT

For each section state the:

  • Duration
  • Reason
  • Approved by
  • Evidence

SECTION 136

A

Reason: Mental disorder in public - further assessment - section 2/3

Approved by: Police sections

Evidence:

186
Q

MENTAL HEALTH ACT

For each section state the:

  • Duration
  • Reason
  • Approved by
  • Evidence

SECTION 135

A

Reason: Mental disorder at home - further assessment - section 2/3

Approved by: Police sections

Evidence: Needs court order to access Patient home and remove them

187
Q

5 Principles of Mental Health Act?

A

▪ 1. Assume capacity
▪ 2. Individual supported to make own decision
▪ 3. Unwise decisions do not mean lack of capacity
▪ 4. Best interests
▪ 5. Least restrictive practice

188
Q

what does having capacity mean?

A

Able to:

1) Understand
2) Retain
3) weigh up
4) Communicate decision

189
Q

What are advanced statements and advanced decisions?

A

Statements: NOT legally binding. Person documents their wishes should they lack capacity in the future

Decisions: LEGALLY binding document.
Made with capacity
may be refusing medical interventions - witness

190
Q

What is a last power of attorney?

A

Person to make decisions for them if they lack capacity in future

191
Q

What is the court of protection?

A

Makes decisions if no lasting power of attorney

192
Q

What is DOLS?

A

Deprivation of Liberty Guards

Allows deprivation of someones liberty who lacks capacity under legal framework in hospital or care environment if its in patients BEST interests

193
Q

Causes of Delirium?

A 
Pain 
Infection/ intoxication
Nutrition (metabolic imbalance)
Constipation
Hydration

Medication
Environment

194
Q

management of Delirium?

A

Haloperidol

Olanzapine

Risperidone

quetiapine

195
Q

Ddx for Dementia?

A 
o Alzheimer’s Disease 
o Vascular Dementia
o Lewy Body Dementia 
o Pick’s Disease
o Creutzfeldt-Jacob Disease 
o Huntington’s Disease
o HIV infection (AIDS)
o Neurosyphilis
o Wilson’s disease
o Normal pressure hydrocephalus 
o Alcohol-induced dementia
196
Q

Ddx of Psychosis?

A 
o The difference in presenting symptoms between a psychosis and a neurosis 
o The difference between positive and negative psychotic symptoms
o Schizophrenia
▪ Paranoid
▪ Hebephrenia 
▪ Catatonic
▪ Residual
▪ Simple
o Positive and negative psychotic symptoms 
o Acute and transient psychosis
o Persistent delusional disorder
o Schizoaffective disorder
o Puerperal psychosis
197
Q

Ddx for Neuroses?

A 
o Generalised Anxiety Disorder 
o Phobias
▪ Specific
▪ Agoraphobia 
▪ Social
o Panic Disorder
o Obsessive Compulsive Disorder (OCD) 
o Post-traumatic stress disorder (PTSD) 
o Adjustment Disorder
o Malingering
o Dissociative (conversion) Disorder
o Somatisation Disorder
o Hypochondriacal Disorder
o Persistent Somatoform Pain Disorder
198
Q

Ddx for mood disorder?

A 
o Hypomania
o Mania and bipolar disorder o Depressive disorder
o Mild; Moderate; Severe
o Persistent mood disorder 
o Cyclothymia; Dysthymia
o “Baby blues”
o Post-natal depression
199
Q

Name types of Therapies

A
  • Counselling
  • Behavioural Therapy
  • Cognitive Therapy
  • Psychodynamic Therapy
  • Electro-convulsive Therapy
200
Q

What are the 4 core features of PTSD?

A

1) Hyperarousal
2) Emotional numbing
3) Avoidance
4) Re-experiencing

201
Q

Give an example of a NaSSAs and its side effects

A

Mirtazapine

  • Sedation
  • Weight gain
202
Q

Name side effects of SSRIs

A
  • Headache
  • Nausea
  • Insomnia
203
Q

Name side effects of TCAs

A

Anti-cholinergic
Postural hypotension
sedation
weight gain

204
Q

Side effect of MAO- inhibitors

A

Tyramine- cheese reaction (hypertensive crisis)

205
Q

Contraindication of Electroconvulsive Therapy?

A

Raised ICP!!

  • Arrhythmias
  • Headache
  • Nausea
206
Q

Name some side effects of hyperprolactinaemia?

A

Galactorrhoea

Amenorrhoea

Infertility

Sexual dysfunction (vaginal dryness)

LONG TERM = osteoporosis

207
Q

Features of Mania?

A

I DIG FASTER

Irritability

Disinhibited (sexual, financial)
Insight impaired
Grandiose delusions

Flight of ideas
Activity/Appetite increased
Sleep decreased
Talkative (pressure of speech)
Elevated mood/energy increase
Reduced conc/ reckless/ risk taking
208
Q

Diagnostic criteria of Mania?

A

> 1 week elevated mood + >3 of:

Increased Energy or Activity

Distractibility

Decreased need to sleep

Increased libido

Grandiosity
Talkativeness (Pressured Speech)

Flight of ideas

Psychomotor Agitation (Aggressiveness) / Irritability

I DDIG FP

209
Q

Lithium side effects?

A
  • Leukocytosis
  • Interstitial nephritis/ Insipidus (Diabetes)
  • Tremor (Fine -> Coarse)
  • Hydration decreased (Dry mouth, Diarrhoea, Thirst), causes Polyuria
  • Increased GI, skin and memory problems
  • Underactive thyroid
  • Mum’s beware (Teratogenic)
210
Q

Lithium Toxicity signs?

A

Plasma levels >1.5mmol/L

Coarse Tremor

N+V, Diarrhoea

Neuro complications (Fasiculation/Myoclonus, Hyperreflexia, Ataxia, Dysarthria, 
Confusion/ Delirum)

Seizures

Renal failure

Death

211
Q

Signs of Wernicke’s encephalopathy?

A

triad

1) ophthalmoparesis with nystagmus
2) Ataxia
3) Confusion

212
Q

Cause of Wernicke’s encephalopathy?

A

Thiamine deficiency (vit B1)

213
Q

what is hebephrenic schizophrenia?

A

predominated by thought. disorders with a poor prognosis

214
Q

What are the different features between paranoid and simple schizophrenia?

A

Paranoid = Lots of positive symptoms

Simple = mainly negative symptoms with a history of psychosis

Danny's Phase 3A Medicine (10 decks)

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