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4th year medicine > Psychiatry > Flashcards

Psychiatry Flashcards

1
Q

first line medication for anxiety and depression

A

SSRIs (citalopram, sertraline)

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2
Q

ICD-10 vs DSM-V

A

DSM-V more up to date for how to classify disorders

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3
Q

main side effect of clozapine and how to test for it

A

agranulocytosis and neutropenia

test with regular FBC

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4
Q

type 1 vs type 2 bipolar affective disorder

A

type 1: mania

type 2: hypomania

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5
Q

how do you treat agranulocytosis from clozapine

A

stop clozapine

send to A&E

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6
Q

medical emergencies in psych

A

clozapine
NMS
serotonin syndrome

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7
Q

psych emergencies

A
  • acute psychosis
  • suicidal patient
  • acutely unwell and violent
  • eating disorders - more than 1kg weight per week/ regularly making themselves sick/ not eating –> ECG to check postural hypotension + bloods: FBC, U&Es
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8
Q

45yrs
long hx of severe depression with psychotic symptoms
multiple inpatient psychiatric admissions

which type of delusion is most compatible with his diagnosis of severe depression

A

nihilistic delusions
- self/part of self/body ceasing to exist - eg patient believing they are dead or dying –> indicates extreme depression (hopelessness and guilt)

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9
Q

generalised anxiety disorder

characteristic symptoms of generalised anxiety disorder?

A

long periods of worry

persistent anxiety

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10
Q

delusion

A

false unshakeable beliefs that can be present in a range of psychiatric disorders incl severe depression.

in mood disorders delusions are mood congruent

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11
Q

delusions of grandiosity

A

believe they’re someone else, may also have special abilities/ powers

typically seen in manic episodes

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12
Q

persecutory delusions

A

belief that you will be persecuted for something even without any evidence

in psychotic disorders

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13
Q

paranoid delusions

A

feeling that you’re under threat

in psychotic disorders

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14
Q

delusional perception

A

true perception, to which a patient attributes a false meaning.

e.g. a normal event such as the traffic lights turning red may be interpreted by the patient as meaning that the martians are about to land.

in psychotic disorders e.g. schizophrenia

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15
Q

most common psychiatric cause of intermittent chest pain and breathlessness or recurrent unexplained panic attacks?

A

panic disorder

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16
Q

compulsive checking behaviours

A

obsessive compulsive disorder

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17
Q

diagnosis of depression

A

all three of the below for >2weeks

  1. persistant low mood
  2. loss of pleasure

associated symptoms:

  • loss of appetite
  • loss of concentration
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18
Q

I started on an antipsychotic 2-10 days ago

  • fever
  • rigidity
  • altered mental state

diagnosis + signs and symptoms

A

neuroleptic malignant syndrome

FALTER:
FEVER
ARMS 
LEUKOCYTOSIS 
TREMORS 
ELEVATED CPK 
RIGIDITY - lead pipe 
signs :
HR: high 
Temp: high
BP: high or low 
RR: high
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19
Q

serotonin syndrome

A

usually occurs when SSRIs/ SNRIs are taken in conjunction with other serotonin (another antidepressant, st johns wort)

agitation 
confusion
twitching muscles
hypereflexia 
sweating 
shivering 
diarrhoea

seizures
arrhythmia
unconsciousness

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20
Q

neuroleptic malignant syndrome

management

A

stop antipsychotic

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21
Q

extrapyramidal side effects

what do you get them from and what are they

A

get with first generation/ typical antipsychotics
e.g. butyrophenones(haloperidol), phenothiazines (prochlorperazine)

  1. dystonia
  2. parkinsonian symptoms
  3. akathisia
  4. tardive dyskinesia
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22
Q

what is dystonia

A
  • early reaction to 1st gen antipsychotics
  • abnormal face and body movements
  • eyes rolling back
  • arching
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23
Q

what is parkinsonian symptoms

A
  • rigidity
  • bradykinesia
  • tremor

appears gradually

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24
Q

what is akathisia

A
  • restlessness
  • after large initial doses
    resemble an exacerbation of the condition being treated
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25
Q

what is tardive dyskinesia

A
  • rhythmic, involuntary movements of tongue, face, and jaw
  • e.g. lip smacking
  • develops on long-term antipsychotics
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26
Q

treatment for dystonia

A

anticholinergic drugs

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27
Q

what does risperidone cause to increase as a side effect

A

prolactin >6mg

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28
Q

side effects of aripiprazole

A
  • decreases prolactin

- decreases weight

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29
Q

atypical/ 2nd generation antipsychotics

A
  • clozapine
  • olanzapine
  • risperidone
  • quetiapine
  • aripiprazole
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30
Q

what tests need to be taken when on lithium

A

bloods - kidney/ thyroid function

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31
Q

NASSA drugs and helpful side effects

A

mirtazapine:

  • increased sedating
  • increased appetite

trazodone:
- better sleep

NASSAs good in old age for their side effects

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32
Q

which SSRI increases QTc interval on ECG?

A

citalopram

33
Q

which SNRI increases blood pressure

A

venlafaxine

34
Q

somatisation disorder

A

multiple physical SYMPTOMS present for at least 2 yrs

patient refuses to accept reassurance or negative test results

35
Q

illness anxiety disorder (hypochondriasis)

A

persistent belief in presence of underlying serious DISEASE

refuses to accept reassurance or negative test results

36
Q

conversion disorder

A

loss of motor or sensory function
patient doesn’t consciously feign the symptoms (factitious disorder) or seek material gain (malingering)
patients indifferent to disorder (la belle indifference)

37
Q

dissociative disorder

A

‘separating off’ certain memories from normal consciousness

involves psychiatric symptoms e,g amnesia, fugur, stupor

38
Q

factitious disorder

A

also known as Munchausens syndrome

intentional production of physical or psychological symptoms

39
Q

malingering

A

fraudulent simulation or exaggeration of symptoms with the intention of financial or other gain

40
Q

generalised anxiety disorder first line mx

A

SSRI = sertraline

if ineffective then alternative SSRI or SNRI

41
Q

panic disorder mx

A

CBT or SSRI

42
Q

side effects of tricyclic antidepressants

A 
e.g. amitriptyline, clomipramine
drowsiness
dry mouth 
blurred vision 
constipation 
urinary retention 
lengthening of QT interval
43
Q

mx for personality disorders

A

dialectical behavioural therapy

44
Q

side effects of lithium

A

for prophylaxis of bipolar disorder

side effects:
fine tremor 
nephrotoxicity: polyuria, can cause nephrogenic diabetes insipidus 
thyroid enlargement, hypothyroidism 
weight gain 
intracranial HTN 
leucocytosis 
hyperparathyroidism and resultant hypercalcaemia
45
Q

monitoring of lithium therapy

A

check lithium levels 12hrs post dose
lithium levels checked weekly until concentrations stable
then checked every 3 months
after change in dose, levels checked a week later and weekly until levels stable
TFTs and U&Es - every 6 months

46
Q

other side effects of antipsychotics except extra pyramidal

A

increased risk of STROKE AND VTE in elderly
dry mouth, blurred vision, urinary retention, constipation
sedation
raised prolactin - galactorrhoea
neuroleptic malignant syndrome: pyrexia, muscle stiffness
reduced seizure threshold
prolonged QT interval (haloperiodol)

47
Q

how long can benzodiazepines be prescribed for

A

2-4 weeks due to tolerance and dependence

slow withdrawal

48
Q

benzodiazepines vs barbiturates for chloride channels

A

benzos increase freq of Cl channels

barbiturates increase duration of Cl channels

FREQuently BENd - DUR BARBeque

49
Q

side effect of benzodiazepines

A

respiratory depression

50
Q

visual impairment + visual or auditory hallucinations

no other psychiatric symptoms

A

charles - Bonnet syndrome

51
Q

repetition of someone else’s speech including the questions being asked

A

echolalia

feature of schizophrenia

52
Q

the inability to answer a question without giving excessive, unnecessary detail

A

circumstantiality

53
Q

wondering from a topic without returning to it

A

tangentiality

54
Q

when ideas are related to each other only by the fact they sound similar or rhyme

A

clang associations

55
Q

loosening of associations, where there are unexpected and illogical leaps from one idea to another.

A

knights move thinking

schizophrenia

56
Q

leaps from one topic to another but with discernible (apparent) links between them.

A

flight of ideas

Mania

57
Q

repetition of ideas or words despite an attempt to change the topic.

A

preservation

58
Q

antidepressant which causes sedation and increased appetite - can help in elderly

A

mirtazapine

59
Q

on MMSE depression vs dementia

A

depression: dont know (dont try with answers)
dementia: try but get it wrong

60
Q

how long do symptoms need to be present for for a diagnosis of PTSD

A

at least 1 month

61
Q

what drugs should be avoided on SSRIs

A

NSAIDs: take PPI at same time
warfarin/heparin: take mirtazapine instead
triptans and MAOIs - risk of serotonin syndrome

62
Q

anorexia features

A

most things low

G’s and C’s raised: growth hormone, glucose, salivary glands, cortisol, cholesterol, carotinaemia

63
Q

WBC high on lithium mx

A

safety net if symptoms develop, repeat bloods as per usual under notmal monitoring schedule
can cause leucocytosis

64
Q

adverse effects of clozapine

A 
agranulocytosis, neuropaenia 
reduced seizure threshold 
constipation 
myocarditis: baseline ECG 
hypersalivation

dose adjustment might be needed if smoking is started and stopped during treatment

65
Q

most likely SSRI leading to long QT and torsades de pointes

A

citalopram

66
Q

mx for alcohol withdrawal

A

benzodiazepines e.g. chlordiazepoxide

lorazepam in hepatic failure

67
Q

indications for ECT

A

treatment resistant severe depression (catatonia)
manic episodes
episode of moderate depression known to respond to ECT in past
life threatening catatonia

68
Q

short term side effects of ECT

A

short term memory impairment
memory loss of events prior to ECT
cardiac arrhythmias

69
Q

what is a poor prognostic indicator of schizophrenia

A 
gradual onset 
strong family hx 
low IQ
prodromal phase of social withdrawal
lack of obvious precipitant
70
Q

schizophrenia mx

A

first line: oral atypical antipsychotics

CBT to all patients

71
Q

what psychotic more likely to be used in drug resistant schizophrenia

A

clozapine

should only be tried after at least 2 other antipsychotics for 6-8 wks

72
Q

clozapine + infection

A

worry about neutropaenia - check FBC

73
Q

scoring system for alcohol withdrawal severity

A

CIWA (clinical institute withdrawal assessment)

74
Q

mania vs hypomania

A

mania: psychotic symptoms (delusions of grandeur, auditory hallucinations)

hypomania = no psychotic symptoms

75
Q

tardive dyskinesia

A

chewing, jaw pouting or excessive blinking due to late onset abnormal involuntary movements on typical antipsychotics

76
Q

neuroleptic malignant syndrome

A 
started on antipsychotic 
tetrad:
- hyperthermia 
- muscle rigidity
- autonomic instability
- altered mental status
77
Q

citalopram side effect

A

long QT syndrome

78
Q

man believes they can/have transformed into an animal

A

clinical lycanthropy

79
Q

thinking theyre rotting away

A

Cotard delusion

4th year medicine (8 decks)

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