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year 3 > Psychiatry > Flashcards

Psychiatry Flashcards

1
Q

Name endocrinological causes of dementia

A
  1. Hypothyroidism, Hyperparathyroidism, Cushing’s and Addisons
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2
Q

Name vitamin deficiency that causes dementia

A

B12, folate and thiamine

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3
Q

Metabolic causes of demenntia

A
  1. Hypoglycaemia, calcium, magnesium and electrolyte imbalance
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4
Q

Clinical features of dementia

A
  1. Memory impairment
  2. Personality changes
  3. Fatigue
  4. Apathy
  5. Hallucinations and paranoid delusions
  6. Sundowner syndrome
  7. Seizures
  8. Catastrophic Reaction
  9. Pathological emotion
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5
Q

Differentials of dementia

A
  1. Delirium
  2. Depression
  3. Learning Disability
  4. Normal ageing
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6
Q

Investigations for Dementia

A
  1. FBC; LFT; U&E; glucose; erythrocyte sedimentation rate (ESR); thyroid-stimulating hormone (TSH); calcium; magnesium; phosphate; Venereal Disease Research Laboratory (VDRL) test for syphilis; HIV; vitamin B12 and folate; C-reactive protein; blood culture; LP; EEG; chest X-ray (CXR); ECG; CT (optima and axial protocol); MRI; SPECT
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7
Q

Management of dementia

A
  1. Assessment
  2. Cognitive enhancement (Ach esterase inhibitors - rivastigmine), antioxidants (selegiline)
  3. Treat psychosis
  4. Treat depression
  5. Treat medical illness
  6. Psychological support to patient and care-givers
  7. Functional management: maximise mobility, encourage indépendance
  8. Social management
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8
Q

What is catastrophic reaction

A

Happens when patients with dementia are asked to perform tasks that they are struggling with causing sudden anger, agitation and violence

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9
Q

What characterises fronts-temporal dementia

A
  1. Frontal lobe so personality changes are early

2. Language impairment

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10
Q

Onset of front-temporal dementia

A

Early-onset

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11
Q

What would a CT show for fronts-temporal dementia

A
  1. Atrophy of fronto-temporal cortex
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12
Q

What would a SPECT show for fronto-temporal dementia

A

fronto-temporal metabolism

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13
Q

What part of the cortex does alzheimer’s affect

A

Posterior-parietal

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14
Q

What characterises alzheimer’s

A
  1. Early memory and cognitive deficits

personality changes are later as frontal lobe starts to atrophy

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15
Q

Most common cause of dementia

A

Alzheimer’s

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16
Q

What can protect against Alzheimer’s

A

Smoking
Oestrogen
NSAIDs

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17
Q

What causes Alzheimer’s

A
  1. Amyloid plaques (beta-amyloid deposits)

2. Neurofibrillary tangles

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18
Q

Clinical symptoms of alzheimer’s (related to time)

A

Early symptoms: Memory problems, ADL issues, spatial dysfunction and changes to behaviour (e.g. irritability)
Middle: Intellectual and personality deterioration (aphasia, apraxia so struggling to dress) and agnosia (can’t recognise own body parts)

Impaired visuospatial skills

Late: Fully dependant with physical deterioration, incontinence, weight loss, primitive reflexes and extrapyramidal signs

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19
Q

Psychiatric symptoms of alzheimer’s

A
  1. Paranoid Delusions, auditory and visual hallucinations, depression
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20
Q

Factors for poor prognosis of alzheimer’s

A
  1. Sveerity of presentation
  2. Male
  3. <65
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21
Q

What assessment is used for Alzheimer’s

A

IQCODE

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22
Q

What imaging would be used for alzheimer’s

A
  1. CT: Cortical atrophy
  2. MRI: Atrophy of grey matter (hippocampus and amygdala)
  3. PET: 20-30% reduction in oxygen
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23
Q

How often should patients be reviewed if they are put on treatment for alzheimer’s

A

Every 6 months

MMSE should be above 12 to continue treatment

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24
Q

What drugs are given to patients with Alzheimer’s

A
  1. Donepezil or Rivastigmine

2. Memantine

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25
Q

Side-effect of AChEIs

A

GI bleeding

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26
Q

How does Memantine function

A
  1. NMDA-receptor antagonist which protects over-excitation of neurons.
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27
Q

Clinical features of Lewy-Body Dementia

A
  1. Dementia
  2. Parkinsonism
  3. Fluctuating cognitive performance
  4. Complex Hallucinations
  5. Depression
  6. Transient episodes of consciousness disturbances (mute and unresponsive for several minutes)
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28
Q

How long does it take to rapidly deteriorate from lewy body

A

1-2 years

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29
Q

Name two of three core features that are needed to diagnose lewy body

A
  1. Fluctuating cognition with variation in alertness and attention
  2. Recurrent visual hallucinations
  3. Spontaneous motor features of parkinsonism
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30
Q

When is Lewy Body less likely to be diagnosed

A

Presence of a stroke

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31
Q

Pathology of lewy body

A
  1. Phosphorylated neurofilament proteins with ubiquitin and A-synuclein

These deposit in substantial nigra and hippocampus

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32
Q

Differentials of lewy body

A
  1. Delirium
  2. Mania, depressive disorder
  3. Parkinson’s
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33
Q

Investigations of lewy body

A
  1. CT/MRI

2. SPECT

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34
Q

What is seen in CT/MRI in lewy body

A

deep white matter lesions and periventricular lucencies on MRI

Sparing of medial temporal lobes

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35
Q

How is Lewy Body treated

A
  1. Antipsychotics, AChEIs
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36
Q

Core features of FTD

A
  1. Gradual progression
  2. EARLY decline in social interpersonal conduct
  3. EARLY impairment in regulation of social conduct
  4. EARLY emotional blunting
  5. EARLY loss of insight
Supportive: Dietary changes (e.g. overeating, preferring sweet food)
Speech disturbances (e.g. mutism and echolalia)

Progressive symptoms: Primitive reflexes, Parkinsonism, MND

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37
Q

Investigations of FTD

A
  1. EEG should be normal despite evident dementia

2. Brain imaging

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38
Q

Pathology of FTD

A

Macroscopic: 1. Bilateral atrophy of frontal and anterior temporal lobes

Microscopic: loss of cortical nerve cells and spongiform degeneration

Pick: loss of large cortical nerve cells, no spongiform change, swollen neurones, widespread gliosis

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39
Q

Three main features of vascular dementia

A
  1. Cognitive deficits following a single stroke
  2. Multi-infarct dementia (from multiple strokes)
  3. Progressive small-vessel disease
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40
Q

Clinical Features of vascular dementia

A
  1. EARLY emotional and personality changes followed by cognitive deficits that fluctuate
  2. Depression and sundowner syndrome
  3. Neurological impairments
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41
Q

Investigations of Vascular dementia

A
  1. Routine screen
  2. Serum Cholesterol, clotting and vasculitis screen (ESR, CRP and RF, Anti DsDNA, APL), syphillis if young
  3. ECG, CXR, CT and MRI ESSENTIAL
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42
Q

Management of vascular

A
  • Establish causative factors.
  • Medical or surgical diseases that are contributory need to be treated early.
  • Daily aspirin may delay course of disease.
  • General health interventions include changing diet, stopping smoking, managing hypertension, optimizing diabetic control, and increasing exercise.
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43
Q

Pathology of neurosyphilis

A
  1. Spirochaetes go for frontal and parietal lobes and presents as progressive frontal dementia

Symptoms: Grandiosity, euphoria and mania

Tremor, Ataxia and trombone tongue

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44
Q

Pathology of Huntington’s

A

Triad repeat of CAG between 37 and 120 on chromosome 4

This decreases GABA neutrons in basal ganglia -> increased stimulation of thalamus and cortex of global pallid us.

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45
Q

Clinical features of huntington’s

A

TRIAD:

  1. Chorea (jerks, tics and involuntary movements of ALL parts of the body, grimacing, dysarthria and positive primitive reflexes, abnormal eye movement)
  2. Dementia
  3. History of HD

Psychiatric:
Anxiety and depression
Psychosis
Agression and violence

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46
Q

What does a CT/MRi show for huntington’s

A
  1. Atrophy of Basal Ganglia
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47
Q

Features of substance misuse dependance syndorme

A
  1. Drug seeking behaviour
  2. Increased tolerance to drug effects
  3. Loss of control of consumption
  4. Signs of withdrawal
  5. Signs of withdrawal
  6. Drug taking to avoid withdrawal symptoms
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48
Q

Stages of change

A
  1. Pre-contemplation (user doesn’t recognise problem)
  2. Contemplation
  3. Decision
  4. Action
  5. Maintenance
  6. Relapse
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49
Q

How do we screen for alcohol problems

A

CAGE

AUDIT and FAST assessment papers

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50
Q

Blood tests in heavy drinkers

A

MCV (raised)
GGT raised
CDT

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51
Q

Recommended units for men and female

A
  1. 21 - Men
  2. 14 - Female

Should be at least 2 days a week of non-drinking

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52
Q

Techniques of controlled drinking

A
  1. Pricing
  2. Motivational interview
  3. Counselling families
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53
Q

What is uncomplicated alcohol withdrawal syndrome

How long does this last

A
  1. Coarse tremor, sweating, insomnia, tachycardia and anxiety
  2. Transient hallucination
  3. Craving for alcohol

48Hours

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54
Q

When do withdrawal symptoms occur

A

4-12 hours after last drink

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55
Q

Onset of delirium tremens

A

1-7 days after drink, 48Hours usually

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56
Q

Clinical features of delirium trmeens

A
  1. Uncomplicated withdrawal symptoms
  2. Disorientation
  3. Loss of conscious
  4. Amnesia
  5. Hallucinations
  6. Paranoid delusions
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57
Q

Differentials of delirium

A
  1. Hepatic encepholapath y

2. Head Injury

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58
Q

How is alcohol withdrawal managed

A
  1. BDZ to manage tremor and anxiety
  2. Antipsychotics
  3. Dilsufiram (irreversible inhibition of Acetaldehyde Dehydrogenase which converts alcohol to water and co2)
  4. Acamprosate (anticraving)
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59
Q

Name two types of alcohol-induced amnesia

A
  1. En bloc - Well demarcated start and finish points

2. PartialL Episodes of island episodes which have been forgotten

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60
Q

Alcohol can cause Othello syndrome, what is this

A

Mono symptomatic Paranoid delusion disorder

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61
Q

What is Wernicke’s encephalopathy

A
  1. Acute onset of:
    Acute confusional state
    opthalmoplegia, nystagmus
    ataxic gait

CAUSED: Thiamine deficiency

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62
Q

How is Wernicke’s encephalopathy treated

A
  1. IV Thiamine

2. ALL should have parenteral vitamins

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63
Q

How long can wernicke’s last untreated

A

72 weeks

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64
Q

What is Korsakoff’s syndrome

A
  1. Retrograde amnesia

2. But has working memory

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65
Q

How is korsakoff’s syndrome treated

A
  1. Oral thiamine
  2. Vitamin supplement
  3. Treat psychiatric comorbidity
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66
Q

Medical complications of alcoholic misuse

A
  1. ALD
  2. Gastritis, Barrett’s, Malloryy-weiss tears, peptic ulcers, chronic pancreatitis
  3. HTN, Dilated cardiomyopathy, CVA
  4. TB, Strep pneumonia
  5. Central pontine myelinolysis, optic atrophy, ceberellar degeneration
  6. Erectile problems, hypogonadism
  7. Gout, osteoporosis, Foetal alcohol syndrome
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67
Q

How do you assess the drug user

A
  1. Background
  2. Reason for consult
  3. Current drug use
  4. Lifetime drug use
  5. Complication
  6. Precious treatment
  7. Medical and psych history
  8. Fam
  9. Social
  10. Forensic
  11. Patient aims
  12. MSE
  13. Physical
  14. Urine screening essential
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68
Q

Symptoms of opiate withdrawal

A
  1. Sweating
  2. Dilated pupils
  3. Tachy cardia
  4. Hypertension
  5. Piloerection
    VOMITING
  6. Tremor and diarrhoea
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69
Q

What is given for opiate withdrawal

A
  1. Lofexidine (alpha-adrenergic agonist)

2. Methadone or Buprenophine

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70
Q

Symptoms of BDZ withdrowal

A
  1. Anxiety
  2. Insomnia
  3. Tremor
  4. Agitation
  5. Headache
  6. Seizures
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71
Q

How are BDZ symptoms treated

A

Smallest dose of diazepam that stops symptoms

Then dose is reduced

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72
Q

How is Schizophrenia diagnosed

A

AT LEAST ONE OF THE FOLLOWING:

  1. Thought echo, insertion, withdrawal or broadcasting
  2. Delusions of control, influence or passivity; clearly referred to body and limb movements
  3. Hallucinatory voices
  4. Persistent delusions

AT LEAST TWO OF THE FOLLOWING:

  1. Persistent hallucination
  2. Catatonic behaviour
  3. Negative symptoms
  4. Consistent change in behaviour

More than a month

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73
Q

What substances can induce shizocphrenia type symptoms

A
  1. Alcohol
  2. Stimulants
  3. Steroids
  4. Antihistamines
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74
Q

What causes schizophrenia

A
  1. Dopaminergic hyperactivity
  2. Glutaminergic hyperactivity
  3. Serotenergic overactivity
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75
Q

Why is there a 20% reduction in life expectancy with people having schizophrenia

A

Suicide

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76
Q

Which family members are most affected for schizophrenia

A

Twins

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77
Q

Investigations for schizo

A
  1. Routine blood tests
  2. CT or MRI if neurological deficits found
  3. CXR if comorbid respiratory etc
  4. Urine for drug screen
  5. EEG if history of seizures

Special: 24-hr collection for cortisol
24hr catecholamine for phaeochromotocytoma

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78
Q

Stage of schizophrenia

A
  1. Prodromal state (non-specific, negative symptoms)
  2. First episode where there is a direct event related to their condition
  3. Relapse and re-starting subsequent episodes
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79
Q

How is prodrome stage assessed

A

PACE

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80
Q

How is acute psychosis treated

A
  1. Rispiridone

2. Long acting BDZ to control behavioural disturbances

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81
Q

Extra-pyramidal effects of antipsychotics

A

Typical and atypical both cause them but less so with atypical:

  1. Dystonias
  2. Parkinsonism
  3. Akathisia
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82
Q

How is parkinsonism treated

A

Procyclidine

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83
Q

How should negative symptoms be treated

A

Mood medications

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84
Q

How can the effect of clozapine be enhanced

A

SSRI, lamotrigine or second antipsychotic

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85
Q

What is the first stage of discharge planning

A
  1. CPA
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86
Q

What should be done if oral medications are refused

A
  1. Depot injections
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87
Q

What types of psychological therapies can reduce relapse

A

Family therapy and psychoeducation

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88
Q

What assessments should be made at every schizo check up

A
  1. MSE
  2. Side-effects to drugs
  3. Recent life stresses
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89
Q

What advice would I give to a schizo patient

A
  1. Provide education on disease and treatment
  2. Concerns adressed
  3. Offer to meet family members
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90
Q

What type of injections are depots for antipsychotics

A

IM

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91
Q

Benefits of atypical psychotics

A
  1. Less likely to cause extra pyramidal side effects
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92
Q

What receptor does rispiridone act on

A

5-HT2

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93
Q

To avoid sedation what drug should be given

A
  1. High potency (haloperidol) or non-sedating (risperidone)
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94
Q

To avoid weight gain what drug should be given

A
  1. Haloperidol or fluphenazine
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95
Q

What antipsychotics cause postural hypotension

A

Phenothiazides

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96
Q

EPSE examples

A
  1. Acute dystonia (where contraction of muscle groups to maximal limit)
  2. Parkinsonism (tremour, rigidity and bradykinesia)
  3. Akathisia (restlessness of lower limbs)
  4. Tardive dyskinesia (athetosis and chorea of mouth)
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97
Q

How is acute dystonia treated

A

Parenteral procyclidine

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98
Q

How is TD treated

A

VIT E helps deterioration

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99
Q

Anticholingeric sideeffects

A
  1. Dry Mouth
  2. Blurred vision
  3. Urinary retention
  4. Constipation
  5. Glaucoma
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100
Q

Anti-adrenergic side-effects

A
  1. Postural hypotension
  2. tachycardia
  3. Sexual dysfunction
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101
Q

Antihistaminic side effects

A
  1. Sedation

2. Weight gain

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102
Q

Before considering treatment resistant schizo, what factors do we need to think about

A
  1. Drug non compliance

2. Lack of adequate treatment or contraindications

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103
Q

How is TRS managed

A
  1. Diagnosis clarified
  2. See if comorbid substance misses is occurring
  3. Psychoeducation for noncompliance
  4. Clozapine or depot
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104
Q

When is clozapine prescribed to schizo patients

A
  1. If patient with schizo has not adequately responded to treatment
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105
Q

Pharmacology of clozapine

A
  1. Blocks D1 and D4 receptors
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106
Q

Side effect of lithium

A

Lowers threshold for seizures

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107
Q

Side-effects of clozapine

A
  1. Constipation, fever, hyper salivation, hypertension, hypotension, nausea, agrunlocytosis, nocturnal enuresis, sedation, seizures, weight gain
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108
Q

Main two depot medications

A
  1. Haloperidol and risiridone
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109
Q

What is post-injection syndrome

A
  1. Immediate sedation, ESPEs, basically side effects after depot injection
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110
Q

What is schizoaffective disorder

A

• An uninterrupted period of illness during which there is a major depressive, manic, or mixed episode concurrent with symptoms that meet criterion A for schizophrenia.

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111
Q

How long before schizoaffective disorder can be diagnosed

A

2 weeks

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112
Q

What is Schizotypal disorder

A
  1. CLUSTER A PD

Clinical features of achizo without delusions or hallucinations

e.g. Ideas of reference (you guys are talking about me), Social anxiety, odd beliefs and magical thinking , odd speech

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113
Q

Differential for schizotypal

A
  1. Autism, asperger;s, PD cluster A
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114
Q

how is schizotypal disorder treated

A
  1. Rispiridone
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115
Q

What is schizophreniform disorder

A
  1. schizophrenia like psychosis that can’t be classified as schizo
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116
Q

What is De Clerambault syndrome

A
  1. Person believes that someone if in love with them
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117
Q

What is persecutory syndrome

A
  1. Patients believe someone wants to harm them
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118
Q

Risk factors for schizophreniform

A
  1. Social isolation

3. Low socio economic status

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119
Q

Definition of acute psychotic disorder

A
  1. Sudden onset, variable presentation (including perplexity, inattention, formal thought disorder/disorganized speech, delusions or hallucinations, disorganized or catatonic behaviour), usually resolving within less than 1mth (DSM-5) or 3mths (ICD-10).
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120
Q

Differentials of acute psychotic disorder

A
  1. organic disorders
  2. BAD
  3. Drugs and alcohol
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121
Q

What is folie a deux disorder

A

Shared delusions

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122
Q

What causes foil a deux disorders

A
  1. Psychodynamic (where people feel like they will lose the other partner if they do not share beliefs)
  2. Learning theory
  3. . Social isolation
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123
Q

How is folly a deus managed

A
  1. Separation
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124
Q

What is Capgras delusion

A
  1. the patient believes others have been replaced by identical or near identical imposter
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125
Q

What is fregoli syndrome

A
  1. an individual, most often unknown to the patient, is actually someone they know ‘in disguise’.
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126
Q

What is inter metamorphosis delusion

A
  1. the patient believes they can see others change (usually temporarily) into someone else (both external appearance and internal personality).
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127
Q

What is subjective doubles delusion

A

the patient believes there is a double (‘dopplegänger’) who exists and functions independently.

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128
Q

What is autoscopic syndrome

A

the patient sees a double of themselves projected onto other people or objects nearby.

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129
Q

What is reverse fregoli syndrome

A

the patient believes others have completely misidentified them.

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130
Q

Core symptoms of depression

A
  1. Depressed mood
  2. Loss of interest
  3. Weight change
  4. Disturbed sleep
  5. Psychomotor agitation
  6. Fatigue
  7. Loss of libido
  8. diminished concentration
  9. Recurrent thoughts of death
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131
Q

What is anhedonia

A

Loss interest in things

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132
Q

Biological symptoms of depression

A
  1. Anhedonia
  2. Loss of appetite
  3. Loss of weight
  4. Loss of libido
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133
Q

Psychotic symptoms

A
  1. Delusions
  2. hallucinations
    Depressive stupor (lack of mental function)
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134
Q

What is non-melancholic depression

A
  1. Irritable or hostile depression
  2. Anxious depression (shy and withdrawn)

No somatic (biological) symptoms

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135
Q

What is melancholic depression

A

Has biological symptoms

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136
Q

Where is depression more common

A 
Female, young 
Marital status
Adverse life events
Physical illness
Low socio-economic status
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137
Q

Structural brain changes in depression

A
  1. Ventricular enlargement
  2. Sulcal prominence
  3. Hypoperfusion in frontal, temporal and parietal areas.
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138
Q

Assessment of depression

A
  1. HAM-D scale
  2. Check co-morbidity of anxiety with HAM-A
  3. MMSE
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139
Q

Investigations ofr depression

A
  1. Blood tests
  2. Urine
  3. Breath
  4. ABG
  5. Thyroid antibodies
  6. Antinuclear antibody
  7. Ayphilis serology
  8. Dexamthesone suppression test
  9. Cosyntropin stimulation test (addison)
  10. Lumbar puncture
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140
Q

Poor prognosis of depression

A
  1. Lack of support social

2. Low self confidence

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141
Q

When should patients on antidepressants be followed up

A
  1. 1-4 weeks
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142
Q

When should ECT for depression be considered

A
  1. Severe biological symptoms

2. First line for depression with psychotic symptoms

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143
Q

How should SSRIs be discontinued

A
  1. Gradually half the dose over months
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144
Q

First line treatment for psychotic depression

A
  1. Olanzapine and fluoxetine
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145
Q

Problems with dual combination in psychotic depression

A
  1. Antipsychotic can mask improvement on SSRI

2. Combination may worsen side-effects

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146
Q

Treatment resistant depression management

A
  1. Is diagnosis correct, conduct more blood tests
  2. Check compliance
  3. Consider change in antidepressant
  4. ECT?

TRYPTOPHAN

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147
Q

Atypical depressive features

A
  1. Depressed but reactive to experiences
  2. Hypersomnia
  3. Hyperphagia
  4. Leaden paralysis
  5. Oversensitivity to rejection
  6. Initial insomnia than early morning awakening
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148
Q

How is atypical depression treated

A

PHENELZINE (MAO inhibitor)

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149
Q

How is SAD treated

A
  1. Light Therapy

2. SSRI

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150
Q

What is Dysthymic disorder

A
  1. PD
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151
Q

Clinical features of dysthymic disorder

A
  1. Depressed mood
  2. Reduced appetite or increased
  3. Changes in sleep
  4. Low self esteem
  5. Poor conc
  6. Difficulties making decision
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152
Q

How does switching MAO medication differ from other drugs

A

MAO needs a washout period whereas cross-taper is usual for others.

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153
Q

Side-effects of MAOIs

A
  1. Hypertensive crisis as intestinal MAO are inhibited

2. Dietary tyramine needs to be avoided

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154
Q

Side-effects of SSRIS

A
  1. Agitation, GI upset, nausea, diarrhoea and headache as it affects 5-HT3 agonism
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155
Q

Side effects of SNRIs

A
  1. Nausea, GI upset, constipation, loss of appetite, sweating, headache and sexual dysfunction
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156
Q

Name types of SNRIs

A
  1. Vanlafaxine

2. Duloxetine

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157
Q

Sid effects of Tetracyclic antidepressants

A
  1. GI issues
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158
Q

Name a Serotonin antagonist reuptake inhibitor

A
  1. Trazodone
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159
Q

Mode of action of SARIs

A
  • 5-HT1A/1C/2Aantagonism—sedating/anxiolytic, less sexual dysfunction;
  • 5-HT agonism through the active metabolite (m-chlorophenylpiperazine)—antidepressant effect;
  • α‎1 antagonism—orthostatic hypotension;
  • H1antagonism—sedation and weight gain.
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160
Q

Side effect of mirtazepine

A
  1. Increase in appetite

2. Weight gain

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161
Q

What type of antidepressant is mirtazapine

A
  1. Noradrenergic and specific serotonergic antidepressant
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162
Q

Name a noradrenaline reuptak inhibitor

A
  1. Reboxetine
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163
Q

What type of antidepressant is Bupropion

A

Noradrenergic and dopaminergic reuptake inhibitor

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164
Q

Indications for ECT

A
  1. Depression, Treatment resistant psychosis and mania, catatonia, neuroleptic malignant syndrome, seizures
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165
Q

Side-effects of ECT

A

transient memory loss, seizures
Tonic contraction
Increase in cortisol
Raised ICP

Retrograde amnesia
Long-term emory loss
Confusion
Muscular aches
Clumsiness
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166
Q

Things to do before ECT is carried out

A
  1. Patient fasts for 8 hours
  2. establish IV access, oxygen mask, muscle relaxant
  3. Hyperventilation
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167
Q

How is ECT carried out

A
  1. Apply electrodes to scalp
  2. Test for contact between electrodes and scalp
  3. Monitor length of seizure
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168
Q

Types of ECT

A

Unilateral ECT and BECT

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169
Q

How often does ECt hav to be carried out

A
  1. Twice a week

6-12 for depression
catatonic in 3-5

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170
Q

If ECT is causing prolonged seizures how is this treated

A
  1. Administer IV diazemuls every 30s
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171
Q

Surgical methods for depression

A

Vagus nerve stimulation

Deep brain stimulation

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172
Q

What medications can INDUCE mania

A
  1. Anti-depressants
  2. BDZ
  3. Lithium
  4. DIsulfiram
  5. Anti-parkinsonian
  6. Propanolol
  7. Opioids
  8. Steroids
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173
Q

Clinical features of mania

A
  1. Elevated mood
  2. Increased energy (either over activity or reduced need for sleep)
  3. Though disorder (Pressured speech, flight of ideas, racing thoughts)
  4. Increased self-esteem (grandiosity, reduced social inhibition, over familiarity)
  5. Reduced attention
  6. Behaviours which can cause serious consequences

Agression, irritability

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174
Q

Psychotic symptoms of mania

A
  1. Grandios
  2. Suspiciousness
  3. Pressured speech to point where they can’t communicate
  4. Flight of ideas, proximity
  5. Irritation and aggression
  6. Catatonic features (Manic stupor)
  7. Loss of insight
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175
Q

Differentials of mania

A
  1. Anxiety
  2. PTSD
  3. ADHD
  4. Schizophrenia
  5. Alcohol misuse
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176
Q

How is mania managed

A
  1. Risk assessment and ensure safety
  2. Exclude other causes
  3. Address any specific psychosocial stressors
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177
Q

Hypomania Clinical features

A
  1. Mild elevation of mood
  2. Increased energy
  3. Increased self-esteem
  4. Sociability
  5. Talkativeness
  6. Over-familiarity
  7. Increased sex drive
  8. Reduced need for sleep
  9. Difficulty in focusing on one task alone
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178
Q

Differential diagnosis of hypomania

A
  1. OCD
  2. Substance misuse
  3. Physical illness
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179
Q

Characteristic Clinical features of bipolar spectrum disorder

A
  1. AT LEAST one depressive episode
  2. No spontaneous hypomanic or manic episodes

The history will include some of the following:

  • A family history of bipolar disorder in a first-degree relative.
  • Antidepressant-induced mania or hypomania.
  • Hyperthymic personality2 (at baseline, non-depressed state).
  • Recurrent major depressive episodes (>3).
  • Brief major depressive episodes (on average, <3mths).
  • Atypical depressive symptoms (DSM-IV criteria).
  • Psychotic major depressive episodes.
  • Early age of onset of major depressive episode (
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180
Q

Treatment of bipolar disorder

A
  1. Lithium/Valproate and SSRI
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181
Q

Why is SSRI not typically used for bipolar

A
  1. Causes rapid cycling
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182
Q

Bipolar diagnostic threshold

A
  1. AT least TWO episodes of mania and unipolar depression
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183
Q

What type bipolarism is associated with substance and medication use

A
  1. Type 2
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184
Q

What type bipolarism is associated with other medical conditions

A

Type 2

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185
Q

Main differences between type 1 or 2

A

Type 2 is mainly hypomanic , more episodes of depression

Type 1 is mainly mania with or without depression

There is also mixed

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186
Q

Investigations for bipolari

A

As for depression; full physical and routine blood tests to exclude any treatable cause, including FBC, ESR/CRP, glucose, U&Es, Ca2+, TFTs, LFTs, drug screen. Less routine tests: urinary copper (to exclude Wilson’s disease [rare]), ANF (SLE), infection screen (VDRL, syphilis serology, HIV test). CT/MRI brain (to exclude tumour, infarction, haemorrhage, MS)—may show hyperintense subcortical structures (esp. temporal lobes), ventricular enlargement, and sulcal prominence; EEG (baseline and to rule out epilepsy). Other baseline tests prior to treatment should include ECG and creatinine clearance.

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187
Q

Poor prognosis of bipolar disorder

A
  1. poor employment history; alcohol abuse; psychotic features; depressive features between periods of mania and depression; evidence of depression; male sex; treatment non-compliance.
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188
Q

Good prognosis of bipolar disorder

A

manic episodes of short duration; later age of onset; few thoughts of suicide; few psychotic symptoms; few comorbid physical problems, good treatment response and compliance.

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189
Q

How are catatonic symptoms (manic stupor) treated

A
  1. ECT or BDZ with Lithium
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190
Q

How is acute mania treated

A
  1. Lorazepam and haloperidol (low-dose antipsychotics)
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191
Q

If patient is already on prophylaxis for bipolarism, what do we need to do

A
  1. Check serum levels
  2. Exclude other problems
  3. Consider adding SSRI to mood-stabiliser
  4. OR if not already on antipsychotic, add quetiapine
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192
Q

If recent mood instability isn’t helped by lithium what is 2nd line treatment

A

Lamotrigine

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193
Q

1st line for life threatening depressive episode

A

ECT

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194
Q

Non-medical interventions for bipolar

A
  1. Psychoeducation
  2. CBT
  3. Family focused therapy
  4. Interpersonal and social rhythm therapy
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195
Q

Cyclothymia clinical features

A

Rapid cycling, mood swings

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196
Q

Treatment of cyclothymia

A
  1. Lithium low-dose, carbamazepine

2. At crisis, treat with low dose antipsychotic

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197
Q

How is Lithium monitored

A
  1. Thyroid function
  2. eGFR
  3. Blood serum levels (FBC, U and E)
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198
Q

When should lithium levels be checked

A

5 Days after starting, 5 days after dose change

Then every 3 months

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199
Q

How is lithium stipped

A

Gradually reduced

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200
Q

Side-effects of lithium

A
  1. Polyuria, Marked tremor, anorexia, nausea/vomiting, diarrhoea (sometimes bloody), with dehydration and lethargy.
  2. Kindey interstitial fibrosis, Hypothyroidism, teratogenicity
  3. T-waves change and QRS widens
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201
Q

When is valproateindicated

A
  1. Acute mania
  2. Acute depressive episode
  3. Prophylaxis of bipolar affective disorder
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202
Q

Side-effects of valproate

A
  1. Gi Upset, raised LFTs, tremor, sedation.
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203
Q

When is carbamazepine indicated

A
  1. Acute mania
  2. Acute depressive episode
  3. Prophylaxis of bipolar
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204
Q

What is psychoeducation

A
  1. Patients are given a theoretical and practical approach to understand their illness and the medication they are prescribed. Through understanding, patients can attain improved adherence to medication, recognize symptoms that might lead to decompensation, and recover occupational and social function.
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205
Q

What is CBT

A
  1. TIME-LIMITEd but focused education on condition and teach cognitive behavioural skills to cope with stressors
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206
Q

What is Interpersonal and social rhythm therapy

A
  1. to reduce lability of mood by maintaining a regular pattern of daily activities, e.g. sleeping, eating, physical activity, and emotional stimulation.
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207
Q

What is family-focused therapy

A

usually brief, includes psychoeducation (of patient and family members) with specific aims: accepting the reality of the illness, identifying precipitating stresses and likely

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208
Q

Describe schizoid PD

A
  1. Emotionally cold, detachment, lack of interest in others, excessive introspection and fantasy.
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209
Q

Describe Emotionally unstable–impulsive type

A

Inability to control anger, or plan with unpredictable behaviour

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210
Q

Describe Emotionally unstable–borderline type

A

Unclear identity, intense and unstable relationships, unpredictable affect, threats or acts of self-harm, impulsivity.

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211
Q

Describe Histrionic PD

A

Self-dramatization, shallow affect, egocentricity, craving attention and excitement, manipulative behaviour.

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212
Q

What are risk factors for Cluster B PDs

A
  1. Substance Misuse
  2. Easting Disorder
  3. Somatoform disorders
    4
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213
Q

Risk factors for cluster B PD

A
  1. Eating Disorder
  2. Neurotic disorder
  3. Depression
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214
Q

How is PD assessed

A

SELF-REPORT QUESTIONNAIRE: PDQ-IV

INTERVIES: SCID-5-PD

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215
Q

How is OCD treated

A

SSRI

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216
Q

Psychotherapy for borderline

A

DBT

Or Cognitive analytic therapy

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217
Q

What is Hyperventilation Syndrome

A
  1. Ventilation exceeds metabolic demands, leading to haemodynamic and chemical changes producing characteristic symptoms (dyspnoea, agitation, dizziness, atypical chest pain, tachypnoea, hyperpnoea, paraesthesias, and carpopedal spasm) usually in a young, otherwise healthy patient. HVS relatively common presentation; may be mistaken for panic disorder. Considerable overlap, hence inclusion here:
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218
Q

Clinical Features of HVS

A
  1. Chest pain/angina
  2. Tachypnoea, dyspnoea and wheeze
  3. CNS (hypocapnia): Dizziness, weakness, paraesthesias, visual hallucinations
  4. GI: Bloating, flats, epigastric pressure
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219
Q

Investigations for HVS

A
  1. Routine blood tests
  2. ABG
  3. Pulse oximetry
  4. PaCO2, HCO3 - low
  5. CXR
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220
Q

How is HVS treated

A
  1. Reassure patient
  2. Use BDZ for severe anxiety
  3. Establish normal breathing pattern

Education
Beta-blockers, BDZ prophylaxis

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221
Q

Define a panic attack

A

eriod of intense fear characterized by a constellation of symptoms (see Box 9.1) that develop rapidly, reach a peak of intensity in about 10min, and generally do not last longer than 20–30min (rarely over 1hr)

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222
Q

Define a panic disorder

A

Recurrent panic attacks, which are not 2° to substance misuse, medical conditions, or another psychiatric disorder.

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223
Q

Clinical features of panic attack

A
  • Palpitations, pounding heart, or accelerated heart rate.
  • Sweating.
  • Trembling or shaking.
  • Sense of shortness of breath or smothering.
  • Feeling of choking or difficulties swallowing (globus hystericus).
  • Chest pain or discomfort.
  • Nausea or abdominal distress.
  • Feeling dizzy, unsteady, light-headed, or faint.
  • Derealization or depersonalization (feeling detached from oneself or one’s surroundings).
  • Fear of losing control or going crazy.
  • Fear of dying (angor animus).
  • Numbness or tingling sensations (paraesthesia).
  • Chills or hot flashes.
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224
Q

How are panic disorders managered

A
  1. Citalopram
  2. BDZs: Lorazepam

2nd line use BDZs

CBT
Psychodynamic psychotherapy

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225
Q

Define agoraphobia

A

Anxiety and panic symptoms associated with places or situations where escape may be difficult or embarrassing (e.g. of crowds, public places, travelling alone or away from home), leading to avoidance.

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226
Q

How are phobias managed

A
  1. Exposure therapy

2. Severe: BDZs

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227
Q

Management of social anxiety

A

CBT and SSRI/beta blockers

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228
Q

Define GAD

A

‘Excessive worry’ (generalized free-floating persistent anxiety) and feelings of apprehension about everyday events/problems, with symptoms of muscle and psychic tension, causing significant distress/functional impairment.

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229
Q

How is GAD amanged

A
  1. CBT but less affective in these cases

Psychotic symptoms: Busprione

Somatic: BDZz

Depressive: SSRI

CV: Beta blockers

WORST CASE: Psychosurgery

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230
Q

Define OCD

A

A common, chronic condition, often associated with marked anxiety and depression, characterized by ‘obsessions’ (see Anxiety and stress-related disorders [link]) and ‘compulsions’ (see Anxiety and stress-related disorders [link]).

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231
Q

Psychological management of OCD

A
  1. CBT

2. Behavioural or cognitive therapy

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232
Q

If OCD becomes severe what must be considered

A
  1. ECT, psychosurgery

DBS but not benefit established

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233
Q

Define hoarding disorder

A

Persistent difficulties in discarding or parting with possessions (including pets), regardless of their actual value, which leads to distress associated with discarding them and results in the accumulation of possessions that clutter active living areas.

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234
Q

Denis type 1 trauma

A

single, dangerous and overwhelming events comprising isolated (often rare) traumatic experiences of sudden, surprising, devastating nature, with limited duration.

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235
Q

Define type 2 trauma

A

due to sustained and repeated ordeal stressors

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236
Q

What is an acute stress reaction

A

1 .A transient disorder (lasting hours or days) that may occur in an individual as an immediate (within 1hr) response to exceptional stress

237
Q

Clinical Features of acute stress reaction

A
  1. Anger
  2. Social withdrawal
  3. Hopelessness
238
Q

When does acute stress reaction begin to diminish under stress

A
  1. 24 to 48 hours
239
Q

Define acute stress disorder

A

Clear overlap with ‘acute stress reaction’ (symptoms of dissociation, anxiety, hyperarousal), but greater emphasis on dissociative symptoms, onset within 4wks, lasting 3 days to 4wks (after which diagnosis changes to PTSD).

240
Q

What defines an adjustment disorder

A

Acute stress reaction with psychotic/depressive symptoms

Within 1 month but no more than 6 months of stressor being present

241
Q

Define PTSD

A

Severe psychological disturbance following a traumatic event (see Anxiety and stress-related disorders [link]) characterized by involuntary re-experiencing of elements of the event, with symptoms of hyperarousal, avoidance, emotional numbing.

242
Q

When is PTSD classified

A

Within 6 months of the traumatic event or present for at least 1 month

243
Q

Clinical Features of PTSD

A
  1. Recurrent recollections of the event
  2. Nightmares
  3. Flashbacks
  4. Psychological distress when exposed to stressor
  5. Avoidance behaviour
  6. Inability to recall important aspect of trauma
244
Q

Psychological therapy of PTSD

A
  1. CBT
  2. Eye movement desensitisation and reprocessing (oluntary multi-saccadic eye movements to reduce anxiety associated with disturbing thoughts and help process the emotions associated with traumatic experiences)
  3. Hypnotherapy
  4. Psychodynamic
245
Q

How is sleep disturbance treated

A
  1. Mirtazapine
246
Q

How is hyperarousal treated

A

BDZs, SSRi or beta blockers

247
Q

What is depersonalisation syndrome

A

A rare disorder, characterized by persistent or recurrent episodes of a distressing feeling of unreality or detachment.

248
Q

How is depersonalisation syndrome assessed

A
  1. Cambridge depersonalisation scale
249
Q

How is depersonalisation syndrome managed

A
  1. Exclude organic cause
  2. SSRI
  3. CBT
250
Q

Onset of depersonalisation

A

Sudeen

251
Q

How long does hypomania last

A

4 days

252
Q

How long does mania last

A

More than a week

253
Q

First rank symptoms of schizo

A
  1. Thought alienation
  2. Passivity phenomena
  3. 3rd Person Auditory hallucination
  4. Delusional perception
254
Q

What secondary symptoms of schizo

A
  1. Delusions
  2. Hallucinations
  3. catatonia
  4. Negative symptoms
255
Q

Clinical Features of postpartum depression

A
  1. Anhyrdonia
  2. Fatigue
  3. Loss of appetite
  4. Overwhelmed they are not bonding with baby
256
Q

Onset of postpartum depression

A

Worsens and lastsover 2 weeks since having baby and

257
Q

Postpartum depression vs postpartum blues

A

Postpartum blues only lasts two weeks and resolves.

258
Q

What is postpartum psychosis

A
  1. Occurs within 2 weeks of delivery
259
Q

When is mirtazapine given in depression

A

When there is significant weight loss (it increased weight)s

260
Q

Pharmacology of cocaine

A
  1. Stimulator of sympathetic nervous system, by inhibiting dopamine reuptake
261
Q

Complications of cocaine use

A
  1. MI
  2. Arrhythmia
  3. Seizures
262
Q

Symptoms of cocaine withdrawal

A
  1. Vivid dream
  2. Insomnia
  3. Increased appetite
263
Q

What structure does tryptylines effect

A
  1. They are norephinerphinre and serotonin reuptake inhibitors that act on the LOCUS COERULEUS feels which release these into the cortex
264
Q

Common clinical findings in Bulimia

A
  1. Thickened skin of knuckles (russet sign) and decayed tooth enamel from forced vomiting, irregular menses

One thing that distinguishes anorexia from bullaemia is that weight is normal or over normal (above 85th percentile)

265
Q

How is bulimia diagnosed

A
  1. Binge eating at least once a week for three months

2. Coupled with weight controlling behaviours

266
Q

How is acute autism presentation (aggression) treated

A

rispiridone as it is short-actiing

267
Q

Prophylaxis in autism

A

SSRI

268
Q

What is hypoactive sexual desire disorder

A
  1. Lack of desire for sexual activity lasting over 6 months

Caused by physical illness, medications

269
Q

How are wide QRS complexes in antidepressant side effects treated

A

Sodium bicarbonate

270
Q

How is sleep-onset insomnia treated

A

Zolpidem helps people fall asleep

271
Q

When do night terrors occur

A

Stage3 and 4 of sleep

272
Q

What is alexithymia

A

Where a patient can’t put their feelings into words (associated with somatisation and conversion disorder)

273
Q

What co-morbidity is associated with autism

A

Epilepsy

274
Q

What causes the complication of neuroleptic malignant syndrome

A

Antipsychotics

275
Q

Signs of NMS

A 
Increased body temperature >38 °C (>100.4 °F), or
Confused or altered consciousness
sweating
Rigid muscles
Autonomic imbalance
276
Q

Risk factors of NMS

A

LEVADPOA

Blocks d2 receptors

277
Q

Define Mental Disorder

A

Any disorder or disability of the mind

278
Q

How long does assessment for the MHA take

A

28 Days (section 2) - can’t be renewed

279
Q

What professionals are involved in MHA assessment

A
  1. Two doctors - S12 and AMHP
280
Q

What evidence is needed to assess a patient under the MHA

A
  1. Pt is suffering from a mental disorder that warrants detention in hospital for assessment
  2. The patient may be at risk of harming themselves or other people
281
Q

How long is treatment (section 3) under the MHA

A
  1. 6 months and can be renewed indefinitely (years)
282
Q

What professionals are involved in treatment

A
  1. 2 doctors and 1 AMHP
283
Q

What evidence is needed for section 3

A
  1. If the patient is suffering from a mental disorder or degree that makes it appropriate to be treated at hospital
  2. The treatment is in his or her interest and safety to others
  3. Appropriate treatment must be available
284
Q

What is section 2 of MHA

A
  1. Decide the patient needs further assessment and pt can be treated against consent under this act
285
Q

What is section 4 of MHA

A

Emergency ORder

286
Q

How long does sectioning under 4 of MHA last

A

72 Hours

287
Q

Professionals required to order section 4

A

1 Doctor

1 AMHP

288
Q

What evidence is required for an emergency order

A
  1. Patient is suffering from a mental disorder of a nature that warrants hospital assessment
  2. Patient ought to be detained for his or her own safety
  3. There is not enough time for 2nd doctor to attend
289
Q

What is Section 5(4)

A
  1. For patient ALREADY admitted but wanting to leave
  2. Nurses’ holding power until doctor can attend
    LASTS 6 hours
290
Q

Can patients be treated under section 5(4)

A

No

291
Q

What is Section 5(2)

A
  1. For a patient ALREADY admitted but wanting leave
292
Q

When is Section 5(2) applied

A

To allow time for S2 or 3 assessment

293
Q

How long can pt be detained for section 5(2)

A

72 Hours

294
Q

Can people be treated under section 5(2)

A

NO

295
Q

What category are Section 135 and 136 of the mHA

A
  1. Police Sections
296
Q

What is S136

A

Person suspected of having mental disorder in a public place

297
Q

What is S135

A

Needs court order to access patient’s home and remove them to place of safety or further assessment

298
Q

Onset of ADHD

A

12

299
Q

Treatment of ADHD

A

Ritalin

300
Q

What would be seen on an MRi of a patient with ADHD

A
  1. Decreased frontal lobe volume
301
Q

What are hypnogogic hallucinations

A

Hallucinations and paralysis occur when sleeping

302
Q

How long does mania last

A

at least 7 days

Hypomania - less than 7 days

303
Q

Characteristics of Cluster A

A
  1. Odd or eccentric: Paranoid, Shizoid and schizotypal
304
Q

Characteristics of Cluster B

A

Dramatic, emotional or erratic: Antisocial, histrionic, borderline, narcissistic

305
Q

Characteristics of Cluster C

A

Anxious or fearful: Avoidant, dependant or OCD

306
Q

How is GAD managed

A
  1. Step 1: Active monitoring and education
    Step 2: Low intensity psychological interventions (self help guides)
    Step 3: High intensity (CBT) or drug treatments
    Step 4: Highly specialist input
307
Q

Side-effect of lorazepam

A

Anterograde amnesia

308
Q

Side-effetcs of SSRIs

A
  1. Hyponatraemia
  2. GI bleeding
  3. Citalopram can cause prolonged QT
309
Q

What can SSRIs interact with

A

NSAIDs, warfarin/heparin, aspirin and triptans (avoid)

310
Q

Symptoms of discontinuing SSRI

A
  1. Restlessness
  2. Difficulty sleeping
  3. Sweating
  4. GI symptoms (pain, cramp, diarrhoea)
311
Q

Adverse effects of clozapine

A
  1. Agrunlocytosis or neutropenia
  2. Reduced seizure threshold
  3. Constipation
312
Q

Associations iwth OCD (other conditions)

A
  1. Depression
  2. Schizophrenia
  3. Tourrette’s
313
Q

What class drug is Clomipramine

A

Tricyclcic antidepressent: Wieght gain, dry mouth.

314
Q

Treatment of delirium tremens

A

Chlordiazepoxide

315
Q

What scale can be used to assess alcohol withdrawal severity

A

Clinical Institute withdrawal assessment for Alcohol

316
Q

Nam etwo screening tools toidentify patients who may have alcohol misuse issues

A

AUDIT

CAGE

317
Q

What screening tool is used to assess the severity of achizophrenia

A

The positive and negative syndrome scale

318
Q

Risk factors of insomnia

A
  1. Female
  2. Age
  3. Unemployment
  4. Divorce
319
Q

Investigations for insomnia

A
  1. Sleep diaries

2. Actigraphy

320
Q

Advice given to people sufferingf rom insomnia

A
  1. Do not drive if sleepy
  2. Limi caffeine intake
  3. No screens before bed
321
Q

What drug is used to treat moderate/severe tardive dyskensia

A

Tetrabenazine

322
Q

What is the tyramine cheese reaction

A

Hypertensive reactions to cheese/Marmite/ickled herring and broad beans

323
Q

How do monoamine oxidase inhibitors work

A

Stops metabolism of serotonin and noradrenaline by monoamine oxidase.

324
Q

When is clozapnie indicated for treatment resistant schziophrenia

A

Lack of clinical improvement after use of at least two antipsychotics for 6-8 weeks.

325
Q

What psychotic should be used if the patient is suffering from prolactin elevation

A

Aripiprazole

326
Q

Most common side effect of atypical antipsychotics

A

Weight gain

327
Q

What tests should be done to monitor antipsyhoctics

A
  1. Lipids, weight, fasting glucose, prolactin, BP, electrocardiogram.
328
Q

Side effect of Tazadone

A

Sedating -used if person has insomnia

329
Q

Side effect of venlafaxine

A

Raises BP

330
Q

What is ideas of reference

A

When you can relate to things around you (people on TV talking about subject matter and you think they are talking about you)

331
Q

What is a delusional perception

A

‘there is a rainbow in the sky which means the world is going to end’ - taken out of context

332
Q

What is narrowed repertoire

A

Where someone cuts down on their drinking but frequency stays the same (goes from a bottle of wine and beer to just a beer)

333
Q

How does inhibition from alcohol occur physiologically

A

GABA acts as an off switch for brain activity - ethanol is a GABA agonist and activates opioid receptors causing release of endorphins
Bind to nucleus accumbent and causes release of serotonin.
Blocks glutamate

334
Q

Treatment for withdrawal

A

Disulfiram (deactivates acetaldehyde dehydrogenase causes hangover which deters from drinking further)
Calcium Acromposate (can be administered immediately to reestablish gaba pathways)
Naltrexone
Chlordizapeoxide

335
Q

What is DoLS

A

Deprivation of liberty safeguarding: Taking civil rights of an individual because they have a lack of capacity

336
Q

What is Lasting Power of Attorny

A

Allows you to appoint an attorney to manage finances.

337
Q

Dementia vs Delirium

A

Global Amnesia vs Seletcive Amnesia
Acute vs Gradual
Impaired function of neutrons vs death of neurons

338
Q

If a person is a risk to themselves and run out of the hospital; what should you do

A

Phone the police to section her for further assessment s(136)

339
Q

Rapid tranquilisation

A

IM lorazepam and haloperidol

IM Promethizine - sedaing histamine

If that doesnt wokr, olanzapine or ariprizole (especially if CVD issues)

340
Q

NMS can cause catatonia, what is used to treat this

A

Lorazepam

341
Q

How is akathisia treated

A

Propranolol

342
Q

Treatment of TR schizo

A

Arirprizaole and clozapine combo

343
Q

Clinical features of serotonin syndrome

A
  1. Neuromuscular abnormalities
  2. Altered mental state
  3. Autonomic dysfunction
  4. Fever
  5. Diarrhoea
    Tremor
    Agitation

CLONUS

SUDDEN ONSET

344
Q

Treatment of serotonin syndrome

A

Cyproheptadine (5-HT@ antagonist)

345
Q

Clinical Features of Psychosis

A

Positive Symptoms:
Hallucinations
Delusions

Negative:
Flattered affect 
Cognitive difficulties
Poor motivation 
Social Withdrawal
346
Q

What pathway causes positive symptoms

A

Meso limbic pathways

347
Q

What pathway causes negative symptoms

A

Mesocortiyal pathway

348
Q

Side effect of olanzapine

A

Weight gain

349
Q

What condition increases the risk of NMS

A

Lewy Body Dementia

350
Q

Blood test results in NMS

A

Raised CK

351
Q

Side effects of clozapnine

A

Agranulocytosis
Hyper salivation
Constipation

352
Q

What elusions would you see in Depressive psychosis

A

Nihilistic delusions

353
Q

Types of delusions in paranoid schizophrenia

A
  1. Persecutory
  2. Ideas of reference
  3. Delusions of thought withdrawal
354
Q

What antipsychotics are given to CAMHS or young women

A

Rispiridone

355
Q

Safest antipsychotics with people with CVD

A

Aripiprazole

356
Q

What antipsychotic is given for Parkinson’s

A

Quetiapine or Clozapine

357
Q

Side effects of clozapine

A
  1. Induced bowel obstruction

2. Myocarditis

358
Q

State some dynamic risk factors of suicide

A

Intent
Anxiety
Psychological Stress
Isolation

359
Q

State some static risk factors of suicide

A 
Age
Gender
Ethnic Group
Marital Status
Socioeconomic
360
Q

What is the SADPERSONS criteria for suicide

A

S: Male sex → 1
A: Age 15-25 or 59+ years → 1
D: Depression or hopelessness → 2
P: Previous suicidal attempts or psychiatric care → 1
E: Excessive ethanol or drug use → 1
R: Rational thinking loss (psychotic or organic illness) → 2
S: Single, widowed or divorced → 1
O: Organized or serious attempt → 2
N: No social support → 1
S: Stated future intent (determined to repeat or ambivalent) → 2

361
Q

Define hallucination

A

An experience involving an apparent perception of something not present

362
Q

How is LD assessed

A 
Information from staff and family 
Obs
Symoblic understanding 
Comprehension: Understanding phrases and words used in his nevironment 
Expression: Naming objects
Choice making 
Pragmatic profile.

Main: Informayion, comprehennsion and prgamatic profiel

363
Q

Intervention for LD

A

Adjusting verbal communication
Strategies for developing language
Makaton: signing system to support spoken language

364
Q

LD severities

A

50-70 = mild
35-49 = moderate
20-34 = severe
20 or less = profound

365
Q

LD vs learning difficulty

A

Difficulty doe snot affect general intelligence while LD is overall cognitive impairment

366
Q

What receptors generally do antipsychotics act on

A

D2

367
Q

Signs and symptoms of lithium toxicity

A 
Tremour
Nystagmus
Retrograde amnesia
Ataxia
Vomiting and diraahoea
Brugadda syndrome
Nephrogenic DI 
Weight Gain 
Change in mental state
368
Q

SSRI and st john’s wart can cause serotonin syndrome

A

N/a

369
Q

Side-effect of SSRI

A

Can cause hyponatraemia and then SIADH

Constipation/Diarrhoea/vomiting

370
Q

Signs and symptoms of lithium toxicity

A 
Tremour
Nystagmus
Retrograde amnesia
Ataxia
Vomiting and diraahoea
Brugadda syndrome
371
Q

Side-effect of SSRI

A

Can cause hyponatraemia and then SIADH

372
Q

Risk factors for delirium

A
  1. Male
  2. Drugs and drug-dependance
  3. Alcohol dependence
  4. Dementia
373
Q

Treatment of Delirium Tremens

A
  1. Alcohol
  2. BDZ (Chlordiazepoxide)

Complication of DT is status epilepticus

374
Q

What else can cause korsakoff’s syndrome (lack of thiamine)

A
  1. Eating disorders

2. Malnutrition

375
Q

Clinical features of delirium

A
  1. Inattention
  2. Memory impairment
  3. Disorientation
  4. Disordered thinking
  5. SLEEP DISTURBANCES
  6. Mood lability
376
Q

Huntington’s psychiatric symptoms

A
  1. Impulsivity

2. Psychosis

377
Q

Effects of long term atypical antipsychotics on the body

A

Glucose dysregulation and diabetes: Polyuria and polydipsia.

378
Q

What are the five stages of bereavement

A

DABDA:

Denial
Anger
Bargaining
Depression
Acceptance
379
Q

When checking lithium levels, when should the sample be taken

A

12 hours after the first dose.

380
Q

Treatment for tardy dyskinesia

A

Tetrabenazine

381
Q

What is acute dystonia

A

Acute contraction of a group of muscles.

382
Q

ECG findings in citalopram overuse

A

QT prolongation and Torsades de pointes.,

383
Q

What is hoover’s sign

A

Pressure if felt under the paretic leg when lifting the non-paretic left against pressure - used to differentiate between organic and non-organic causes of leg paresis.

384
Q

Treatment of tricyclic antidepressant overdose/side effects

A

Acetylcholine esterase inhibitors (physostigmine)

385
Q

What is the most potent benzodiazepine

A

Clonazepam

386
Q

What is Stevens-Johnson syndrome

A

This is an Upper respiratory tract Infection which progresses to the non pruritic burning rash onto face and upper torso, can also cause inflamed oral mucosa

387
Q

What psychiatric drug can trigger Stevens-johnson syndrome

A

Lamotrigine.

388
Q

First line treatment for nephrogenic diabetes insipidus

A

Hydrochlorothiazide

389
Q

What drug can cause nephrogenic diabetes inspires

A

Lithium

390
Q

The immediate treatment of a paracetamol overdose

A

Oral activated charcoal

N-Acetylcysteine is only used a few ours after when serum levels are checked.

391
Q

What is prosoopagnosia

A

Unable to identify faces due to lesions in the occipital or temporal regions

Appreceptive: Cannot perceive if the two faces are the same or different

Associative: Canot associate a face with memories but can differentiate the,.

392
Q

Anticholinergic syndrome: Red as a beet, dry as a bone, blind as a bat, mad as a hatter and hot as a hare.

A

N/a

393
Q

What is the impact of SSRIs on an ECG

A

Qt Elongation.

394
Q

Pneumonic for serotonin syndrome

A

HARMED:

Hyperthermia
Autonomic Instability
Rigidity
Myoclonus
Encephalopathy 
Diaphoresis
395
Q

What is late neurosyphilis

A

This happens after 10+ years of undiagnosed neurosyphilis:

TABES DORSALIS

This Ataxia comes from generation of the dorsal roots and columns of the spinal cord, with associated back pain from this.

They lack positional sense so will life their legs really high.

396
Q

What is blunted affect

A

Difficulties expressing emotions.

397
Q

What is la belle indifference

A

Lack of concern shown by patients towards their symptoms

398
Q

What are SSRIs commonly co prescribed with

A

PPIs.

399
Q

How long should SSRIs be continued for

A

6 months

400
Q

How is Buprenorphine given for opiate withdrawal

A

Sublingual.

401
Q

What is perseveration

A

Repeating the same words/answers.

402
Q

What is neologism

A

Making up new words.

403
Q

Signs of Factitious Hypoglycaemia

A

Usually results from Patient’s overuse of insulin secretagegogues (e.g., Sulfonylureas)

remember, C-Peptide -> Proinsulin -> Insulin

C-Peptide is equivalent to the amount of ENDOGENOUS insulin produced. As the patient is injecting EXOGENOUS sources for insulin, endogenous insulin and C-Peptide will be lower.

404
Q

What is Asterixis

A

Flapping Tremor - Caused in hepatic failure

405
Q

What is Kluver Bucy Syndrome

A

Bilateral lesions of the temporal lobes (a manifestation of meningoencephalitis)

406
Q

Signs of Kluver Bucy Syndrome

A

Disease of the HYPER:

  1. Hyperphagia
  2. Hypersexuality
  3. Hyperorality
  4. Hyperdocility

Visual agnosia, aphasia and disinhibition

407
Q

What can cause Kluver Bucy Syndrome

A

HSV - remember, meningoencephalitis

408
Q

What is Torsades de Pointes

A

A type of tachycardia arrhythmia -> ventricular fibrillation and sudden cardiac death

409
Q

Treatment of Torsades de Pointes

A

IV Magnesium Sulfate

410
Q

How do we reverse a Benzo overdose

A

Flumazenil

411
Q

How to treat tricyclic antidepressant overdose

A

IV Sodium Bicarbonate

412
Q

First Line Treatment of alcohol withdrawal

A

Benzodiazepines or Carbamazapine

413
Q

What is Creutzfeldt-Jakob Disease

A

TRIAD:

Dementia
Myoclonus
Personality Changes

414
Q

What causes Creutzfeldt-Jakob Disease

A

A prion disease (incorrectly folded proteins that causes misfiling of other proteins) - Mad Cow Disease

415
Q

Signs of Neonatal Abstinence Syndrome

A 
High-pitched cry 
Irritability 
Hypertonia
Feeding Difficulties
Failure to Thrive
416
Q

What substance usually causes neonatal abstinence syndrome

A

Opioids

417
Q

What protein is found in Creutzfeldt-Jakob Disease

A

14-3-3

418
Q

What medication may treat a Parkinson’s patient with Parkinsonism and psychosis

A

Clozapine - It Is the only antipsychotic that does not affect the nigrostriatal dopaminergic system: the only one that improves parkinsonian symptoms

419
Q

What is psychogenic polydipsia

A

Excessive fluid intake, causes polydipsia and polyuria. Followed by hyponatraemia

  1. Increased water surpasses ADh secretion = Excess water excretion and dilute urine
  2. Hyponatraemia as water intake overcomes the capacity to excrete urine
420
Q

Pharmacology of Zolpidem and other sleeping medications

A

GABA receptor agonist

421
Q

How long does it take for an SSRI to fully work

A

Allow up to 2 weeks, about 6 weeks to reach its optimum and take full affect.

If a patient is complaining about their SSRI before then, reassure and ask them to wait

422
Q

What Co-morbidity is usually associated with ADHD

A

Oppositional Defiant Disorder

423
Q

Key lab findings in Psychogenic Polydipsia

A

Normal Serum Electrolyte values and an a negative water deprivation test (osmolality increases over time)

424
Q

What waves are visible on an EEG for nocturnal Eneuresis in children

A

Delta Waves - N3

425
Q

What is characteristic about frontotemporal dementia

A

SUDDEN change in personality and no changes in visuospatial skills (unlike Alzheimer’s)

426
Q

What is the major side effect of Chlorpromazine

A

Severe Sunburns and causes blue pigmentation as if the patient is cyanotic

427
Q

What medication is given for Narcolepsy management

A

Pitolisant

428
Q

Name three typical antipsychotics

A
  1. Haloperidol
  2. Chlorpromazine
  3. Anything ending in -zine.
429
Q

Name four atypical antipsychotics

A
  1. Clozapine
  2. Olanzapine
  3. Quetiapine
  4. Any psychotics ending in -pine, -zole (e.g., aripiprazole) and -done.
430
Q

How do typical antipsychotics work

A

Bind to D2 receptors in the mesolimbic region - REDUCING positive symptoms

Blocks D2 receptors in the mesocortical region - WORSENING negative symptoms

431
Q

What are some positive side-effects to typical antipsychotics

A
  1. Blocks Dopamine receptors in the chemoreceptor trigger zone - DECREASES vomiting
  2. Blocks H1 Receptors - Antipruritic and Sedative
432
Q

What are the adverse effects seen in both typical and atypical antipsychotics by binding to the tuberoinfundibulnar zone

A

Oligomenorrhoea
Gynecomastia
Galactorrhoea

433
Q

How do atypical antipsychotics work

A
  1. Blocks D2 receptors in the mesolimbic regions - REDUCING positive symptoms
  2. Blocks 5-HT2 receptors in mesocortiyal system - REDUCING negative symptoms
434
Q

What atypical antipsychotic has the least impact on weight gain

A

Aripiprazole

435
Q

What are side-effects specific to atypical antipsychotics

A

METABOLIC SYNDROME: CV risk, Dyslipidaemia, Weight Gain, Diabetes (Polydipsia, Polyuria)

Seizures

Agronulocytosis (usually in Clozapine)

436
Q

What is the purpose of a Section 2

A

Admission for Assessment: Can be medicated against your will

437
Q

What section allows a sectioned patient to leave

A

A ‘Section 17’ leave

438
Q

Why is a Section 4 used

A

It keeps the patient in hospital for 72 hours, to allow a second doctor to come and confirm if you need to be kept in - if they say yes, you will removed to a section 2 or 3 for further assessment

439
Q

Can a patient be medicated on Section 4 against their will

A

No, you have the right to refuse medication

440
Q

What is the difference between a section 2 and 3

A

Section 2: If the diagnoses is unclear and we don’t know how to treat them

Section 3: Diagnoses is clear (pre-existing) and treatment is readily available.

441
Q

What score on the SADPERSONS scale would indicate hospital admission

A

> 8

6-8 = Psychiatric consultation

442
Q

What is the difference between the pars compact and pars reticulate

A

Pars Compacta: Projection into the basal ganglia (supplies striatum with dopamine)

Pars Reticulata: Conveys signs from the basal ganglia to other brain structures (has GABA neurones rather than dopamine)

443
Q

What symptoms does bitermporal lesions cause

A

1, Deafness

  1. Apathy
  2. Impaired learning and memory
  3. Amnesia, Korsakoff Syndrome and Kluver-Bucy Syndrome
444
Q

What disease causes bilateral temporal atrophy

A
  1. Frontotemporal Dementia (Pick’s)
  2. HSV (meningoencephalitis) -> causes similar symptoms
  3. Neurosyphilis

All result in memory loss/agnosia

445
Q

What part of the lobe is responsible for memory

A

Medial Temporal Lobe (home to the hippocampus)

446
Q

Signs of Brugada Syndrome

A

Caused in Lithium Toxicity:

ST-Elevation
Right Bundle Branch Block (Right ventricle depolarising normally).

447
Q

What psyhictaric symptoms can threadworm cause

A

Hair-pulling disorder and pica (a compulsive need to eat non-nutritious food like ice, hair and dirt).

Pica and trichotolomania (hair pulling) is caused by iron-deficiency anaemia (if they’re hypo chromic, microcytic anaemia is present, think PICA rather than OCD)

448
Q

What PHQ score indicates Severe depression

A

20+

449
Q

Onset of NMS vs Serotonin Syndrome

A

NMS happens over a few weeks

Serotonin Syndrome happens within hours of administration

450
Q

Why are bentos absolutely contraindicated with opioid use

A

They both cause muscle relaxation = respiratory failure.

451
Q

What causes respiratory alkalosis

A

Tachypnoea as CO2 is blown off, causing hypocapnia

As CO2 levels drop, there is less inhibition on albumin carrying H+ ions which release these. Albumin has free space which binds to calcium ions instead, causing hypocalcaemia.

452
Q

What medication should women on bipolar disorder be switched to, during the course of their pregnancy

A

Lamotrigine

453
Q

Name two medications that reduce prolactin levels (as opposed to raising them)

A

Clozapine and Olanzapine

454
Q

What medication can cause a rise in Lithium levels

A

NSAIDs - DO not give for pain relief in bipolar

Give Aspirin instead

455
Q

Sign of Carbamazepine toxicity

A

Ataxia

456
Q

Treatment od Delirium (medication)

A

Physostigmine

457
Q

Signs of Cocaine intoxication

A

REMEMBER: Hyperstimulation of the sympathetic nervous system 9ismonia, vivid dreams, tachycardia, mydriasis, HTN and sweating)

Also, Hyper-alertness and aggression

And ‘COCAINE BUGS’, when patients think that bugs are crawling over them

458
Q

A main side-effect of Fluoxetine

A

Tremours

459
Q

How do SSRIs affect sleep cycles

A

They cause REM disruption (so treatment-caused insomnia)

460
Q

What kind of therapy is used to treat PD, behavioural problems and Schizophrenic patients

A

Milieu Therapy

461
Q

What distinguishes Schizophreniform disorder over Schizophrenia

A

Schizophreniform disorder is basically the same, except it lasts between 1-6 months (think of it as a precursor for Schizophrenia -> most people get diagnosed with this later)

462
Q

What antidepressant has the lowest sexual side effect (does not have a loss of libido)

A

Buproprion

463
Q

Define Copropaxia

A

Involuntary performing of obscene or forbidden or inappropriate touching

464
Q

Define Echopraxia

A

Meaningless repetition or imitation of movements

465
Q

Describe Palilalia

A

Automatic repetition of one’s own words, phrases or sentences

466
Q

Define De Fregoli Syndrome

A

Delusion of identifying a familiar person in various people they encounter

467
Q

Define Ekborn Syndrome

A

Delusion of infestation

468
Q

GAD vs Panic Disorder

A

GAD has a background of persistent anxiety vs Panic Disorder which is more associated with random panic attacks on a background of no anxiety

469
Q

What medication can precipitate serotonin syndrome from SSRIs

A

Rasagiline (MAO-Is)

470
Q

Metabolic consequences of Lithium

A

Hyperparathyroidism (hypercalciuria, hpophosphataemia)

Hypothyroidism.

Nephrogenic Diabetes Insipidus

T wave inversion

471
Q

When are the biological/somatic symptoms of Depression

A
  1. Diurnal mood variation
  2. Anhedonia
  3. Early Morning Waking
  4. Psychomotor agitation or retardation
  5. Loss of appetite and weight
  6. Loss of Libido
472
Q

What is the first line management for addictions

A

Motivational Therapy

473
Q

What is the first line management of an acute psychotic episode

A

Non-Therapeutic de-escalation

Then oral lorazepam

Then IM Lorazepam/Haloperidol + Promethazine

474
Q

What is the first Line intervention used for someone with heart palpitations

A

Even in suspected anxiety, a new onset of palpitation with no real cause should be given a 48 hour ECG

475
Q

What type of dementia has a rapid progression from mild memory loss to myoclonus, speech and language impairment

A

CJD

476
Q

What are the first line medications given for mild Alzheimer’s

A

Donepezil

Rivastigmine

477
Q

Side effect of Alzheimer medications donepezil and rivatstigmine

A

Diarrhoea

478
Q

What is the first line intervention for acute manic episdoes

A

ORAL BDZs or atypical antipsychotics (not haloperidol)

479
Q

What is characteristic about vascular dementia

A

Sudden deterioration and then the symptoms plateu. Then deteriorate again

480
Q

Knight’s Move vs Flight of Ideas

A

Knight’s Move - illogical leaps between ideas

Flight of Ideas - Meaningful links, just hard to catch on to what they say

481
Q

Describe the levels of management used for depression

A

If less than 5 core symptoms (NICE):
First Line: Low Intensity psychological interventions / group-based CBT

Otherwise:
Second Line: Sertraline OR CBT

482
Q

First line management of paracetamol overdose

A

Activated Charcoal: Only if the patient presents <1 hour since ingestion

Otherwise, N-AcetylCysteine if taken many hours before (it has already reached the stomache)

483
Q

What is the first investigation that should be done in a patient with gradual forgetfullness

A

FBC: As this rules out any reversible causes of dementia

Think simple before CT Head

484
Q

What is Pellagra

A

B3 Deficiency: Dementia, Dermatitis and Diarrhoea

And a big old tongue

485
Q

What would a lumbar puncture show for autoimmune encephalitis

A

Increased lymphocytes in the CSF

486
Q

First line management of autoimmune encephalitis

A

IV methylprednisolone
IV Ivg

Second Line: Rituximab

487
Q

What structure atrophies in Alzheimer’s

A

Hippocampus

488
Q

Sign of corticobasal degeneration

A

Apraxia on one side of the body - alien limb

Where the patient thinks their limb is floating about their body independently

489
Q

First line treatment of panic disorders

A

CBT

490
Q

Causes of Delirium

A 
D - Drugs or Alcohol 
E - Eyes, Ears, Emotional 
L - Low Output states (MI, PE)
I - Infections
R - Retention (urinary)
I - Ictal
U - Underhydration/nutrition 
M - Metabolic (thyroid, wernicke's, electrolyte imbalance)
491
Q

Define Derailment

A

The conversation moves quickly from one topic to another

492
Q

What is the first line management of opioid withdrawal

A

Symptomatic management only

493
Q

What is the first line treatment of an Alzheimer’s patient, experiencing QT prolongation

A

REMEMBER, QT elongation makes anti-cholineesterase inhibitors unsafe (so no donepezil or rivastigmine)

First Line: Cognitive Stimulation Therapy

494
Q

What are other contraindications to anti-cholinesterase therapy in Alxheimer’s

A

Prolonged QT
Bradycardia (<50)
Second or Third degree heart block

495
Q

What is characteristic of Alzheimer’s over all the other dementias

A

Early deterioration in memory (if memory is the main symptom or first symptom in the exam - think Alzheimer’s)

496
Q

What is the first line treatment of schizophrenia

A

Rispiridone (remember, atypical always preferred to typical like haloperidol)

497
Q

What is the first line investigation for elderly patients, exhibiting signs of dementia, incontinence, mood swings

A

Urine Cultures - rule out UTIs over anything else

498
Q

Name a first generation antihistamine

A

CHlorphenamine

499
Q

What is the first line management of Lithium Toxicity

A

Fluid Resuscitation (remember, can cause nephrogenic DI)

500
Q

How is methadone given

A

Orally

501
Q

What organic disorders can mimic schizophrenia

A

Hyperparathyroidism
Hyperthyroidism

Infections, brain disease and CNS

Steroids

502
Q

What is interpersonal therapy

A

Primarily focuses on the way our relationships affect us (great for postpartum depression)

503
Q

What are the clinical signs for referring syndrome

A

Confusion
Tachycardia (Hypokalaemia)
Oedema (loss of phosphates)

504
Q

What blood level is Lithium considered severe

A

2.0

505
Q

What is found in Pcik’s disease at post-mortem

A

TAU proteins that stain silver

506
Q

What are the three core symptoms of GAD

A

Apprehension
Motor Tension
Autonomic Overactivity

507
Q

What is formal thought disorder

A

The inability to express thoughts in an organised way

508
Q

What antidepressant is contraindicated in heart disease

A

Tricyclic Antidepressants

509
Q

Side effect of memantine

A

Can Cause Seizures

510
Q

What hormone contributes to referring syndrome

A

A rise in insulin

511
Q

What is the first line pharmacological treatment of a manic episode

A

ORAL Antipsychotics with mood stabilising properties: Quetiapine, Haloperidol, Rispiridone, Olanzapine, Aripiprazole

+ Psychological interventions

512
Q

What drug classes cause delirium in the elderly

A
  1. BDZs
  2. Opitates
  3. Antiparkinsonian agents
  4. Tricyclic antidepressants
  5. Digoxin
  6. Beta blockers
  7. Steroids
  8. Antihistamines
513
Q

What is DBT

A

To recognise extreme emotions by letting patients experience, recognise and accept them

514
Q

What is comorbid PTSD

A

PTSD + another disorder (usually alcohol use disorder)

515
Q

If someone is presenting with bipolar depression and refusing to take lithium, what should be given

A

Offer fluoxetine + Olanzapine

Or Quetiapine on it’s own

Or Second line lamotrigine, Sodium Valproate

This is because quetiapine and olanzapine are mood stabilising antipsychotics

516
Q

If Lithium is at maximum level for bipolar disorder, what should be done

A

Add Olanzapine + Fluoxetine

Or Quetiapine on it’s own

OR second line, lamotrigine, valproate etc

517
Q

How often does someone’s lithium levels have to be observed

A

Every 3 months for the first year

Every 6 months after that

518
Q

A characteristic of olanzapine

A

Sedating

519
Q

Why is Haloperidol given as second line rapid tranquillisation

A

Given alongside IM Promethazine

Because Haloperidol can be given both as oral and IM

Rispiridone is only found as oral

ONLY DONE IF ORAL IS NOT POSSIBLE

520
Q

In what form are Quetiapine and Clozapine given

A

PO

521
Q

Barbituates vs BDZ

A

BarbiDURATES increase duration + FREndodizapines increase frequency of chloride channel opening

522
Q

How does Acromposate reduce craving

A

Enhances GABA transmission, reducing craving

523
Q

Pharmacology of Naltrexone

A

Opioid antagonist - reduces pleasurable affect of alcohol

524
Q

Pharmacology of Disulfiram

A

Causes build up of acetaldehyde - causing hangovers

525
Q

What is an absolute contraindication to ECT

A

Raised Intracranial Pressure

526
Q

How do SSRIs affect BDZs

A

They enhance the concentration of BDZs

527
Q

What is the first line treatment of Delirium

A

PO Haloperidol 0.5mg

528
Q

What is the first line management of PTSD

A

CBT

Then EMDR

529
Q

How often should thyroid and renal function be checked on Lithium

A

Every 6 months

530
Q

What PHQ score is normal

A

0-4

531
Q

What PHQ score is mild

A

5-9

532
Q

What PHQ score is moderate

A

10-14

533
Q

What PHQ score is Moderate - Severe

A

15-19

Severe = 20+

534
Q

What is the first line management of assisted withdrawal from alcohol

A

Chlordiazepxide

Delivered either:

Inpatients: >30 units a day, comorbidities or 15-30 minutes gap between drinks

Community if these do not apply

535
Q

What are extracampine hallucinations

A

Hallucinations beyond realm of possibility

536
Q

What are lilliputian hallucinations

A

Seen in delirium tremens - seeing lots of small people

537
Q

What is the significance of an AUDIt score, why is it used

A

To determine if a patient should be hospitalised or be kept and treated in the community

538
Q

In what people is lithium contraindicated or avoided in

A
  1. History of brugadda syndrome and DI
  2. Cardiac disease associated rhythm disorders
  3. Elderly (reduce dose)
  4. Epilepsy (causes seizures)
  5. Receiving ECT (causes seizures)
  6. Breastfeeding
  7. Those who refuse regular blood tests
539
Q

What is the initial adverse effects of Lithium

A
  1. FINE tremours
  2. Polyuria and Polydipsia
  3. Nausea, diarrhoea, vertigo
  4. Feeling dazed

In long term, fine tremors become COARSE tremors

540
Q

What drugs can interact with Lithium

A
  1. Diuretics
  2. NSAIDs
  3. Haloperidol
  4. Carbamazepine
  5. Antidepressants
  6. ACEi
  7. Drugs that prolong QT-interval
541
Q

How often does Clozapine need to be monitored for

A

Every week for 18 weeks

542
Q

What Questionnaire is used to check for Autism

A

AQ-10

543
Q

Criteria for ADHD

A
  1. Meet the diagnostic criteria of ICD-10

2. Occur in 2 or more important settings

544
Q

Do people with ADHD have to tell the DVLA

A

Yes

545
Q

At what age are medications for ADHD recommended

A

> 5 Years

546
Q

What should be done in an individual with ADHD, suffering from an acute manic episode

A

Stop any medication for ADHD

547
Q

How often should height be measured in people with ADHD

A

Every 6 months

548
Q

Other than height, what other things need to be monitored in children with ADHD

A

Weight every 3 months <10 years

549
Q

Name some side effects of ADHD stimulants

A
  1. Cardiotoxicity
  2. Height restriction and Weight loss
  3. TICS
  4. Sexual Dysfunction
  5. Seizures
  6. Sleep problems
550
Q

What is second line treatment of Bipolar disorder

A

Sodium Valproate -> Then Lamotrigine (especially for women)

551
Q

How long is haloperidol given for delirium

A

Usually about one week

552
Q

What is the first line management for bullaemia nervosa in adults

A

Focused self-guided programmes

Then CBT-ED, but doesn’t usually have an impact on body weight

553
Q

What is the first line management of bullaemia for children

A

Bullaemia-nervosa focused family therapy

554
Q

First line management of anorexia nervosa in adults

A
  1. CBT-ED
  2. Maudsley Anorexia Treatment for Adults
  3. Specialist Supportive Clinical Management
555
Q

First Line management of anorexia in children

A

Family Focused Therapy

556
Q

First line treatment for children with a first episode of psychosis

A
  1. Oral antipsychotic medication + psychological interventions (CBT + Family Therapy or Arts Therapy)

This is the same for recurrent episodes

557
Q

When is Arts Therapy indicated for schizophrenia or psychosis

A

Helps to alleviate negative symptoms

558
Q

First Line intervention for a first episode of psychosis in adults

A

NO antipsychotics unless inpatient

559
Q

If Clozapine is not working in schizophrenia, what should be done

A

Add a second antipsychotic to augment the treatment (should not compound the common side effects of clozapine)

560
Q

First Line SSRI to give if on Warfarin/Heparin

A

Mirtazapine or Venlafaxine

561
Q

Complication of using Lithium + NSAIDs

A

Kidney Damage

562
Q

Complication of using Lithium + Diuretics

A

Dehydration

563
Q

Are seizures common in delirium tremens?

A

No, they do not form the criteria for delirium tremens - this happens in the first 24-48 hours after stopping drinking

564
Q

What are indications for in-patient medical detoxification

A
  1. Severe withdrawal symptoms
  2. Older age
  3. High Severity of Dependance
  4. Abnormal LFTs
  5. Previous BDZ use as they may be develop tolerance
565
Q

Give an example of a 12-step programme for substance management

A

Alcoholics Anonymous

566
Q

What SSRI is used in the management for alcohol induced depression as part of the nicotine replacement therapies

A

Buproprion

567
Q

What defines severe cognitive function on a MMSE

A

<10

568
Q

What is moderate cognitive decline on an MMSE

A

10-20

569
Q

When does Memantine become the first line drug treatment for Alzheimer’s

A

Severe Alzheimer’s (MMSE <10)

570
Q

What psychiatric disorders are most commonly associated with epilepsy

A

Depression and Anxiety

571
Q

What is Anterograde memory loss

A

Loss of memory from head injury to resumption of normal memory

572
Q

What part of the MMSE is used to check for semantic memory loss

A

Using dates for WW2

573
Q

How do we test attention in MMSE

A

Spell WORLD backwards

574
Q

What antipsychotics increase the risk of Strokes and Falls in the elderly

A

Second generation antipsychotics

575
Q

When is agitation of delirium worse

A

AT night

576
Q

What co-morbidities are found in ADHD

A
  1. BPD
  2. OCD
  3. Substance misuse disorders
  4. Depression
577
Q

What is Anankastic Personality Disorder

A

An An OCD-type personality disorder with excessive doubt + caution and preoccupation to details

578
Q

What is the problem of smoking when being given antipsychotics

A

They increase the metabolism of antipsychotics (e.g., Clozapine), making them sub-therapeutic

579
Q

How is life expectancy affects din psychotic disorders

A

Reduced by 15-20 years

580
Q

What is the first line management of clozapine induced DM in Schixophrenia

A

Metformin

581
Q

What kind of obesity is seen in atypical antipsychotic use

A

Central, must measure waist circumference

582
Q

What complication of DM is seen in Schizophrenic patients

A

DKAs

583
Q

Medical indications for admitting someone with anorexia

A
  1. BMI <13
  2. Syncope
  3. Postural myopathy
  4. Electrolyte imbalances
  5. Hypoglycaemia
  6. Petechial Rash + Low platelets
584
Q

What symptoms is commonly seen in chronic fatigue syndrome

A

Post-Exertion fatigue

585
Q

What receptors are involved in causing tremours

A

Dopaminergic receptors

586
Q

What interacts with Lithium

A

NSAIDs
ACEi

These increase Lithium levels and cause toxicity

587
Q

What receptors cause GI upset with SSRIs

A

5-HT3 stimulation

588
Q

What is psychoanalysis and psychodynamic psychotherapy

A

These focus on an individual’s maladaptive functioning in the present that may have developed from early life experiences

589
Q

Define displacement

A

Constant frustration in X, is expressed as aggression or agitation towards Y

year 3 (25 decks)

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