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Phase 3a Medicine > Psychiatry > Flashcards

Psychiatry Flashcards

1
Q

What is neurosis?

A

Maladaptive psychological symptoms not due to organic causes or psychosis, usually precipitated by stress

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2
Q

Give 3 cognitive signs/symptoms of anxiety

A
  • Agitation
  • “Impending doom”
  • Poor concentration
  • Insomnia
  • Repetitive thoughts/activities
  • Obsessive concern about self and bodily functions
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3
Q

Give 3 somatic signs/symptoms of anxiety

A
  • Tension
  • Trembling
  • Hyperventilation
  • Headaches
  • Sweating
  • Palpitations
  • Nausea
  • “Butterflies in stomach”
  • “Lump in throat”
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4
Q

Give 3 behavioural signs of anxiety

A
  • Reassurance seeking
  • Avoidance
  • Dependence
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5
Q

Give 3 signs of anxiety in children

A
  • Thumb-sucking
  • Nail-biting
  • Bed-wetting
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6
Q

Give 3 risk factors for anxiety

A
  • Genetic predisposition
  • Stress
  • Events
  • Faulty learning
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7
Q

What therapy is most commonly used for anxiety?

A

Cognitive behavioural therapy (CBT)

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8
Q

What lifestyle change can help manage anxiety?

A

Regular (non-obsessive exercise)

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9
Q

What medication can be given to treat the somatic symptoms of anxiety?

A

Beta-blockers

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10
Q

What is the first line medication treatment for anxiety?

A

SSRI’s

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11
Q

What is the definition of compulsions?

A

Senseless repeated rituals, normally a way to reduce an obsession

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12
Q

What is the definition of obsessions?

A

Stereotyped, purposeless words, ideas or phrases that come into the mind

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13
Q

Which therapy is most commonly used to manage OCD?

A

Cognitive behavioural therapy (CBT)

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14
Q

What medications can be used to managed OCD?

A

Clomipramine (TCA) or SSRI’s

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15
Q

What is a phobia?

A

Anxiety only/predominantly experienced in certain situations that are not dangerous

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16
Q

What is agoraphobia?

A

Fear of leaving the house

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17
Q

What is the treatment for phobias?

A

Behavioural therapy - graded exposure

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18
Q

Give 3 symptoms of PTSD

A
  • Vivid nightmares and/or flashbacks
  • Autonomic - sweating, high HR and BP
  • Panic attacks
  • Avoidance of associations
  • Hypervigilance
  • Poor concentration
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19
Q

Non-pharmacological management of PTSD

A
  • CBT
  • EMDR
  • Hypnotherapy
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20
Q

What does EMDR stand for?

A

Eye movement desensitisation and reprocessing (EMDR)

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21
Q

What medications can be used to manage PTSD?

A

SSRIs, TCAs etc.

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22
Q

What does AMHP stand for?

A

Approved mental health professional

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23
Q

What is the purpose of a Section 2 detainment?

A

Assessment (although treatment can sometimes be given)

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24
Q

How long can a Section 2 detainment last for?

A

28 days (cannot be renewed)

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25
Q

What evidence is required for a Section 2 detainment?

A
  • Patient has a mental disorder that warrants detention in hospital for assessment
  • Detainment is for the patients own health or safety, or protection of others
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26
Q

What is the purpose of a Section 3 detainment?

A

Treatment

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27
Q

How long can a Section 3 detainment last for?

A

6 months (can be renewed)

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28
Q

What professionals are required for a Section 2 detainment?

A

2 doctors (1 S12), 1 AMHP

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29
Q

What professionals are required for a Section 3 detainment?

A

2 doctors (1 S12), 1 AMHP

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30
Q

What evidence is required for a Section 3 detainement?

A
  • Patient has a mental disorder that warrants detention in hospital for medical treatment
  • Treatment is in the interest of the health and safety of the patient and others
  • Appropriate treatment is available
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31
Q

What scenario is a Section 4 detainment used in?

A

Only in “urgent necessity” when waiting for a second doctor would lead to “undesirable delay”

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32
Q

How long can a Section 4 detainment last for?

A

72hrs

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33
Q

Which professionals are required for a Section 4 detainment?

A

1 doctor and 1 AMHP

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34
Q

What evidence is required for a Section 4 detainment?

A
  • Patient has a mental disorder that warrants detention in hospital for assessment
  • Detainment is for the patients own health or safety, or protection of others
  • Not enough time for a second doctor to attend (risk)
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35
Q

What is a Section 136 detainment?

A

Police section - person suspected of having a mental disorder in a public place

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36
Q

What is a Section 135 detainment?

A

Police section - needs court order to access patients home and remove them to a place of safety (unit or cell)

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37
Q

What is a Section 5(4)?

A

Patient already admitted (psych or general) but wanting to leave - nurses holding power until doctor can attend

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38
Q

How long can a Section 5(4) last for?

A

6hrs

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39
Q

What is a Section 5(2)?

A

Patient already admitted (psych or general) but wanting to leave - doctors holding power

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40
Q

How long can a Section 5(2) last for?

A

72hrs - allows time for S2/S3 assessment

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41
Q

What is the prevalence of schizophrenia?

A

Approx. 1%

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42
Q

What is schizophrenia?

A

A severe psychiatric disorder characterised by chronic or recurrent psychosis, consciousness and intellectual capacity are usually maintained

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43
Q

What is the cause of schizophrenia?

A

Multiple factors -> dysregulation of dopaminergic activity

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44
Q

Give 3 positive symptoms of schizophrenia

A
  • Hallucinations
  • Delusions
  • Disorganised thought
  • Disorganised speech
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45
Q

Give 3 negative symptoms of schizophrenia

A
  • Flat affect
  • Avolition
  • Alogia
  • Apathy
  • Anhedonia
  • Emotional and social withdrawal
  • Catatonia
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46
Q

What is avolition?

A

Lack of motivation

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47
Q

What is alogia?

A

Lack of ideas to talk about

48
Q

What is anhedonia?

A

Lack of pleasure in things previously enjoyed

49
Q

What is catatonia?

A

Behavioural syndrome characterised by abnormal movements and reactivity to the environment

50
Q

Give 3 risk factors for schizophrenia

A
  • Stress
  • Psychosocial factors
  • Frequent cannabis use
  • Family history
51
Q

Give 5 first rank symptoms of schizophrenia

A
  • Hearing thoughts spoken aloud
  • 3rd person hallucinations
  • Commentary hallucinations
  • Somatic/visual/tactile hallucinations
  • Thought withdrawal or insertion
  • Thought broadcasting
  • Delusional perception
  • Feelings/actions “made or influenced” by external agents
52
Q

What is schizotypal disorder?

A

Thinking, behaviour and affect similar to in schizophrenia, but no definite characteristic anomalies seen

53
Q

What is schizoaffective disorder?

A

Affective and schizophrenic symptoms present but don’t justify a diagnosis of either schizophrenia or affective disorder alone

54
Q

What percentage of people with schizophrenia attempt suicide?

A

Approx. 50%

55
Q

What are first generation antipsychotics?

A

D2 agonists that cause extrapyramidal side effects

56
Q

Give an example of a first generation antipsychotic

A

Chlorpromazine

Haloperidol

57
Q

What are second generation antipsychotics?

A

5HT2A and D2 agonists, lower risk of extrapyramidal side effects but more metabolic side effects

58
Q

Give 5 common side effects of antipsychotics

A
  • Extrapyramidal - tremor, slurred speech, dystonia
  • Hyperprolactinaemia -> sexual dysfunction
  • Weight gain
  • Diabetes mellitus
  • CVD - stroke, postural hypotension, long-QT
59
Q

Give an example of a second generation antipsychotic

A

Risperidone
Quetiapine
Clozapine

60
Q

What is the most concerning side effect of clozapine?

A

Agranulocytosis

61
Q

Give 3 risk factors for depression

A

Biological - genetics, personality, chronic illness, medication (BB, steroids), substance misuse
Psychological - life events, lack of education
Social - lack of support, low socio-economic status

62
Q

What are the 3 core symptoms of depression?

A
  • Low mood
  • Anhedonia
  • Fatigue
63
Q

Give 3 “typical” symptoms of depression

A
  • Poor appetite
  • Disrupted sleep - early waking
  • Psychomotor retardation
  • Decreased libido
  • Agitation
  • Feelings of worthlessness, guilt or self-reproach
  • Suicidal thoughts
64
Q

Management of mild depression

A

Low intensity psychological interventions (e.g. computerised CBT) and education

65
Q

Management of moderate depression

A

Combination of an anti-depressant and high intensity psychological intervention (IAPT -> group or individual CBT)

66
Q

Management of severe depression

A

Rapid specialist mental health assessment, consider admission and ECT -> medication and therapy

67
Q

Which antidepressant should be given as first line for depression?

A

SSRI - fluoxetine, citalopram or sertraline

68
Q

Which SSRI should be tried first if the patient is under 18?

A

Fluoxetine

69
Q

Which SSRI should be tried first if the patient has IHD?

A

Sertraline

70
Q

Which antidepressant should be given as second line for depression?

A

A different SSRI - fluoxetine, citalopram and sertraline

71
Q

Which antidepressant should be given as third line for depression?

A

Mirtazapine (NaSSA) or venlafaxine (SNRI)

72
Q

Which antidepressant should be given as forth line for depression?

A

Keep trying different antidepressants until one works, consider older antidepressants

73
Q

Give 3 common side effects of SSRIs

A
  • Nausea, GI upset
  • Headache
  • Agitation
  • Sexual dysfunction
74
Q

What food can interact with MAO-Is and to cause hypertension?

A

Cheese

75
Q

What are the main triad of symptoms in serotonin syndrome?

A
  • Neuromuscular abnormalities
  • Altered mental state
  • Autonomic dysfunction
76
Q

What is delirium?

A

An acute, transient and reversible state of confusion, usually with an organic cause

77
Q

What are the 3 different types of delirium?

A
  • Hypoactive - drowsy and withdrawn, often ignored
  • Hyperactive - agitated and upset
  • Mixed/fluctuating
78
Q

Give 3 causes of delirium

A
  • Constipation
  • Infection
  • Metabolic disturbance
  • Stroke
  • Medications
  • Post-op
  • Environmental changes
  • Alcohol
  • Hepatic or renal impairment
79
Q

Give 5 signs of delirium

A
  • Confusion
  • Disorientation in time and place
  • Hallucinations
  • Delusions
  • Reduced movement
  • Agitation
  • Uncooperative with reasonable requests
  • Withdrawal
80
Q

What are the components of a confusion screen?

A
  • Vital signs
  • CT head
  • Bloods - FBC, U&Es, LFTs, TFTs, Ca, glucose, cultures, haematinics, coagulation
  • Chest x-ray
  • Urinalysis
81
Q

Management of delirium

A
  • Treat any organic cause
  • Optimize supportive surroundings and nursing care
  • Avoids sedatives
  • Low dose haloperidol (lorazepam if PD)
82
Q

Give 3 causes/triggers of a manic episode

A
  • Medications - steroids, illicit substances
  • Infection, stroke, neoplasm, metabolic disturbances
  • Life events
83
Q

What is bipolar type I?

A

Equal ratio of both mania and depression episodes

84
Q

What is bipolar type II?

A

More episodes of depression, only mild hypomania

85
Q

What is rapid cycling bipolar?

A

More than 4 episodes of depression and mania in a year

86
Q

What is cyclothymia?

A

A mild form of bipolar disorder

87
Q

Give 3 signs and symptoms of hypomania

A
  • Symptoms for 4+ days
  • Mildly elevated mood
  • Increased energy
  • Poor concentration
  • Mild reckless behaviour
  • Sexual disinhibition
  • Increased talkativeness
  • Increased confidence
  • Decreased need for sleep
88
Q

Give 3 signs and symptoms of mania

A
  • Symptoms for >1 week
  • Extreme elation
  • Overactivity
  • Pressure of speech
  • Impaired judgement
  • Extreme risk-taking behaviour
  • Social disinhibition
  • Grandiosity
  • Psychosis
  • Mood congruence/incongruence
89
Q

What investigations should you do if a patient appears manic?

A
  • CT head
  • EEG
  • Screen for drugs/toxins/infection
90
Q

Give the 1st and 2nd line management of an acute manic episode

A

1st line - SGA (risperidone, clozapine)

2nd line - valproate/lamotrigine or lithium

91
Q

Give 1st and 2nd line management of a depressive episode in a patient with bipolar affective disorder

A

AVOID ANTIDEPRESSANTS
1st line - SGA (risperidone, clozapine)
2nd line - add lamotrigine or lithium

92
Q

Give 1st and 2nd line medications for general maintenance of bipolar affective disorder

A

1st line - lithium (requires good compliance and monitoring)

2nd line - valproate, anticonvulsants

93
Q

What is anorexia nervosa?

A

Compulsive need to control eating and body shape, BMI <17.5

94
Q

Give 3 behaviours that may exist in someone with anorexia

A
  • Voluntary avoidance of food
  • Self-induced vomiting
  • Excessive exercise
  • Appetite suppressant use
  • Diuretics use
95
Q

When is anorexia most commonly diagnosed?

A

Mid-adolescence

96
Q

Give 3 risk factors for anorexia nervosa

A
  • Genetics
  • Psychological - depression, anxiety, OCD, low self-esteem
  • Development - relatives attitudes to food
  • Sociocultural - social media, image-aware activities, substance abuse
97
Q

How is anorexia managed?

A
  • Aim to restore nutritional balance, slowly build up feeds
  • Treat complications of starvation
  • Explore comorbidities
  • Involve family/carers
98
Q

Give 2 differentials for a suspected eating disorder

A
  • Other mental health disorder
  • GI problem, e.g. IBD
  • Hypothalamic tumour
99
Q

What is bulimia?

A
  • Recurrent episodes of binge eating
  • Regular use of mechanisms to overcome fattening effects of binges
  • BMI <17.5
100
Q

Give a risk factor for bulimia that is not a risk factor for anorexia

A

Urbanisation

101
Q

How should bulimia be managed?

A
  • Support
  • Food diary
  • Treat medical complications
  • Antidepressants
102
Q

What is the average age of onset of bulimia?

A

18yrs old

103
Q

Give 5 signs or symptoms of an eating disorder

A
  • Amenorrhoea > 3mths
  • Constipation, bloating, abdo pain
  • Headaches
  • Fainting, dizziness
  • Fatigue
  • Palpitations
  • Cold intolerance
  • Dry skin, hair loss
  • Polyuria, polydipsia
  • Sore throat, dental enamel erosion
  • Lanugo hair
104
Q

What questionnaire is used to assess for an eating disorder?

A

SCOFF questionnaire

105
Q

Give 3 red flag signs in someone with a suspected/confirmed eating disorder

A
  • BMI<13
  • Weight loss >1kg/wk
  • Temperature <34.5
  • BP <80/50
  • Pulse <40bpm
  • Deranged U&Es
  • Long QT
106
Q

What is circumstantiality?

A

The inability to answer a question without giving excessive, unnecessary detail - differs from tangentiality in that the person does eventually return the original point.

107
Q

What is tangentiality?

A

Wandering from a topic without returning to it

108
Q

What are neoligisms?

A

New word formations, which might include the combining of two words

109
Q

What are clang associations?

A

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

110
Q

What is word salad?

A

Completely incoherent speech where real words are strung together into nonsense sentences

111
Q

What is Knights move thinking?

A

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

112
Q

What is flight of ideas?

A

Thought disorder where there are leaps from one topic to another but with discernible links between them - feature of mania

113
Q

What is perseveration?

A

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

114
Q

What is echolalia?

A

The repetition of someone else’s speech, including the question that was asked

115
Q

What is confabulation?

A

Giving a false account to fill a gap in memory

116
Q

What is somatic passivity?

A

Delusional belief that one is a passive recipient of bodily sensations from an external agency

Phase 3a Medicine (4 decks)

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