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Phase 3a Medicine > Psychiatry > Flashcards

Psychiatry Flashcards

1
Q

What is needed to diagnose dependence syndrome?

A

3 or more features present at the same time during the previous month.

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2
Q

Delirium Tremens

  • Peak incidence?
  • Tx? First, second?
  • What to use if psychotic features are present?
A
  • 72 hours after cessation.
  • IV Pabrinex then high dose benzo (oral Lorazepam.)
  • Haloperidol.
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3
Q

Describe an alcohol detox regime.

A

High dose Chlordiazepoxide 4x a day, start high and taper down.

Alongside oral Thiamine.

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4
Q

List the 3 drugs that can be used to prevent relapse.

A

Disulfiram.
Naltrexone.
Acamprosate.

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5
Q

Triad of Wernicke’s?

What is a memory feature of Wernicke’s?

A

COG:

  • Cognition change/confusion.
  • Ocular disturbances.
  • Gait is unsteady.

Antegrade amnesia - inability to form new memories.

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6
Q

List the 3 categories of child psych and the disorders the contain?

A

Neurodevelopmental:
ADHD.
ASC.

Conduct disorder.

Emotional disorders
Eating disorder.
PTSD.
Mood disorders.
Anxiety and OCD.
Psychosis.
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7
Q

What is the triad of autism?

A
  • Impaired social interaction.
  • Impaired communication.
  • Restricted and stereotyped interests and behaviours.
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8
Q

What is the triad of ADHD? And 7 diagnostic criteria?

A
  • Inattention.
  • Hyperactivity.
  • Impulsivity.
  1. Core Fx at home.
  2. Core Fx at school.
  3. Core Fz directly observed.
  4. No other criteria met.
  5. Onset <7 years.
  6. Duration >/= 6 months.
  7. IQ > 50.
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9
Q

Define ODD

A

Oppositional defiant disorder: defiant and disruptive behaviour against authority figures, without aggressive or antisocial acts (as in conduct disorder.)

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10
Q

First line Mx of ADHD? What needs to be monitored?

A

Methylphenidate (Ritalin.)

Growth and height every 6 months.

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11
Q

Define conduct disorder

A

Persistent, deceptive and aggressive behaviours.

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12
Q

First line for any child psychiatric disorder?

A

Family therapy.

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13
Q

Diagnostic criteria for anorexia nervosa?

A 
Deliberate weight loss.
Intense fear of fatness.
Distorted body image.
Endocrine disturbance.
BMI <17.5

Present for at least 3/12, with no bingeing or craving to eat.

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14
Q

What are the physical Sx of anorexia nervosa?

A 
Fatigue.
Hypothermia.
Bradycardia.
Peripheral oedema.
Lanugo hair.
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15
Q

What does persistent vomiting and laxative use show on blood gas?

A

Vomiting - metabolic alkalosis.

Laxative use - metabolic acidosis.

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16
Q

What are indications for inPx admission in anorexia nervosa?

A

BMI <14, severe electrolyte abnormalities.

Suicidal ideation.

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17
Q

What is the weight gain aim per week for anorexia?

A

0.5kg/week

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18
Q

Define refeeding syndrome.

Prevention and Tx?

A

Changes to phosphate (low), magnesium (low), potassium (low). Due to insulin surge.

Measure serum electrolytes and monitor daily. Start 122 kcal/day and increase every 5 days.

Replenish electrolyte levels oral/IV.

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19
Q

Diagnostic criteria for bulimia nervosa?

A

Compensatory behaviours.
Preoccupation with eating.
Fear of fatness.
Overeating (2 episodes/week for >3 months.)

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20
Q

Specific sign for bulimia?

A

Russell’s sign - callouses on back of hand due to abrasions from self-induced vomiting.

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21
Q

Tx for bulimia?

A

High dose SSRI (60mg)

CBT-BN, ITP therapy.

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22
Q

What are the 4 D’s that worsen Litihum?

A

Dehydration.
Drugs (ACE-i, NSAIDs.)
Diuretics.
Depletion of sodium.

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23
Q

Tx for Lithium toxicity?

A

Immediate cessation of Li.
High fluid intake.
IV NaCl.
Renal dialysis if severe.

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24
Q

What is the triad of Sx for serotonin syndrome?

A

Neuromuscular excitability.
Autonomic dysfunction.
Altered mental state.

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25
What are the key features of NMS?
Change in mental state. Rigidity. Fever. Autonomic dysfunction.
26
What is the key investigation in NMS and why?
CK (raised secondary to muscular rigidity.)
27
Define bipolar affective disorder.
Chronic, episodic mood disorder characterised by at least one episode of mania/hypomania and a further episode of mania/hypomania or depression. i.e. - 2 episodes in which a person’s mood and activity levels are significantly disturbed one of which must be mania or hypomania.
28
``` Define: Bipolar type 1. Bipolar type 2. Rapid cycling. Cyclothymia. ```
1. Mania and depression. 2. Severe depression and mild hypomania. 3. >4 mood swings in 12 months with no asymptomatic period. 4. Not meeting the criteria for diagnosis.
29
First line Tx for: 1. Acute mania/mixed Sx. 2. Depressive episode. 3. Maintenance.
1. Atypical antipsychotic. 2. Atypical antipsychotic + SSRI. 3. Lithium (can add valproate.)
30
Define mild, moderate, severe depression and their Tx.
Mild: 2 core, 2 other. Moderate: 2 core, 3/4 other. Severe: 3 core, 4+ other. Mild: psychotherapies (CBT self-guided, group of individual.) Recurrent or severe: SSRI + psychotherapy.
31
List the core depression Sx.
Anhedonia. Anergia. Low mood almost every day for at least 2 weeks.
32
What is the pathway for depression medications?
1. SSRI. 2. Increase SSRI dose. 3. Switch SSRI. 4. Try an SNRI, TCA, or Mirtazapine (NaSSa). 5. SSRI + TCA/Mirtazapine.
33
Risks of SSRIs in elderly and young?
Elderly - hyponatraemia or GI bleed. Young - suicidal thoughts.
34
Which SSRI is used in a) children b) cardiac issues?
a) Fluoxetine. | b) Sertraline.
35
Name: a) an SSRI. b) an SNRI. c) a NaSSa d) a TCA e) an MAOI
a) Sertraline. b) Venlafaxine, Duloxetine. c) Mirtazapine. d) Amitriptyline, Imipramine. e) Phenelzine, Isocarboxazid.
36
What type of SE does a TCA have and why?
Can't see, can't pee, can't spit, can't shit (anti-cholinergic.)
37
SE of Mertazapine.
Sedation and weight gain.
38
Define a) conversion disorder b) somatoform disorder
a) Sx that cannot be explained by a medical disorder, with a convincing association in time between the Sx and a stressful event. b) at least 2 years of at least 6 unexplained physical Sx, continually wanting tests.
39
Define hypochondrial disorder
Misrepresentation of normal bodily sensations leading to non-delusional preoccupation that they have a serious physical disease.
40
Define malingering
Faking Sx for gain.
41
Define factitious disorder/Munchhausen's syndrome.
Faking or causing Sx to adopt a sick role.
42
Define a) obsession b) compulsion
a) unwanted, repeated intrusive thoughts that are distressing and individual attempts to resist them. Ego-dystonic. Recognise they are not real. b) repetitive, stereotyped acts a person feels driven to perform.
43
OCD management
1. CBT with ERP. 2. Drugs: SSRI for 12 weeks (3 months.) then Clomipramine.
44
Define panic disorder and the Tx.
Recurrent panic attacks with no trigger. CBT. SSRI (try 12 weeks, switch to Clomipramine.
45
Define a) social phobia b) agoraphobia
a) fear of social situations with the fear they will lead to humiliation or criticism. b) fear of public spaces where immediate escape would be difficult.
46
Define PTSD
Intense, prolonged and delayed reaction to traumatic event. Within 6 months of the event, present for at least 1/12.
47
Define abnormal grief reaction
Delayed onset, more intense, >6/12.
48
Define acute stress reaction
Abnormal reaction to sudden stressor. Immediate onset, diminishes with 8 hours.
49
Define Adjustment disorder
Within 1 month of a situation, lasting less than 6. Adjusting to a new life event.
50
List the key Sx of PTSD
- Reliving. - Avoidance. - Emotional numbing. - Hyperarousal.
51
Management of PTSD.
- Mild and <4 weeks = watchful waiting. - Trauma-focussed CBT. - May do EMDR.
52
List the 3 Cluster A, Cluster B and Cluster C PD and the overall type.
A = odd/eccentric - Paranoid. - Schizoid. - Schizotypal. B = Dramatic - EUPD. - Histrionic. - Antisocial. C = Anxious. - Anxious. - Dependent. - Anankastic/OCPD.
53
List the 4 areas of EUPD Sx.
- Impulsivity. - Instability of relationships. - Affective Sx. - Self-image.
54
Personality disorder Tx?
DBT.
55
Define schizoaffective disorder, and delusional disorder.
Schizophrenia with depression or mania. Delusions are the only/most prominent psychotic Sx.
56
List and define the Schizophrenia subtypes.
Paranoid. Hebephrenic: disorganised. Catatonic. Residual: chronic, +ve Sx less marked.
57
# Define: a) Akathisia. b) Acute dystonia. c) Tardive dyskinesia. and their Tx.
a) restlessness. Propranolol. b) involuntary muscle contractions of the head and face. Procyclidine. c) More chronic involuntary facial muscle movements. Tetrabenazine.
58
What are the main SE of a) typical antipsychotics. | b) atpyical?
a) EPSE, raised prolactin. | b) weight gain and metabolic syndrome.
59
SSRI use in pregnancy?
Safe except Paroxetine.
60
Risks of antipsychotic in elderly?
Strone, VTE.
61
SE/ adverse effects of Clozapine?
- Constipation. | - Agranulocytosis.
62
From starting Lithium, what monitoring is needed and when?
- 12 hours after first dose , weekly until stable for 4 weeks, then every 3 months. - U&E, TFT every 6 months.
63
Section 2 - Define. - Who is needed? - Length. - Discharge?
Assessment. AMHP, 2 doctors (1 S12.) 28 days, converted to section 3. Responsible clinician, MHA manager, nearest relative (can be overruled.) Tribunal.
64
Section 3 - Define. - Who is needed? - Length. - Discharge?
Treatment AMPH, 2 Drs (1 S12.) Nearest relative must not object. 6 months. Responsible clinician, MHA manager, nearest relative (can be overruled), Tribunal. Entitled to section 117 aftercare.
65
Section 4 - Define. - Who is needed? - Length. - Discharge?
Cases of emergency. Using another section --> undesirable delay. AMHP, one Dr (not S12.) 72 hours, converted to section 2. No rights of appeal, only discharged by responsible clinician.
66
Section 5 - Define. - Who is needed? - Length. - Discharge?
Already admitted to hospital (not A&E.) 5(2) Dr holding power - 72 hours. 5(4) MH or LD nurses holding power - 6 hours. No rights of appeal.
67
Define CTO.
Someone on a section, who can be safely Tx in community but power to recall them to hospital.
68
Define sections 135 and 136.
135: person's house to a place of safety. 136: public places to place of safety.

Phase 3a Medicine (4 decks)

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