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Year 4 > Psychiatry > Flashcards

Psychiatry Flashcards

1
Q

What are the ICD-10 ‘3 core symptoms’ of depression?

A

Low mood
Lack of energy
Anhedonia (lack of enjoyment of activities which the patient formerly enjoyed)

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2
Q

What is the monoamine theory of depression, and what are the 3 main monoamines in the brain?

A

Theory = depression is due to a reduction in the production/reduced sensitivity to monoamines, which include:

  • noradrenaline
  • dopamine
  • serotonin
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3
Q

What is sertraline?

A

SSRI

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4
Q

What is fluoxetine?

A

SSRI

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5
Q

What is citalopram?

A

SSRI

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6
Q

What is reboxetine?

A

NARI (noradrenaline reuptake inhibitor)

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7
Q

What are the S/Ex of SSRI’s

A 
GI = N&V, diarrhoea, ulcers
CNS = insomnia, fatigue, anxiety, dizzy
Other = sexual dysfunction, restlessness
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8
Q

What is amitryptiline?

A

tricyclic antidepressant (stop serotonin and noradrenaline reuptake)

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9
Q

What is clomipramine?

A

tricyclic antidepressant (stop serotonin and noradrenaline reuptake)

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10
Q

What are the side effects of tricyclic antidepressants?

A

Due to HAM antagonism:
Block H1 receptor -> anti-histamine action (sedation and drowsy)
Block Adrenergic receptors -> cause anti-adrenergic effects like dizzyness and postural hypotension)
Block M1 receptor -> antimuscarinic effects (dry mouth, tachycardia, constipated, urinary retention)

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11
Q

What is venlafaxine?

A

SNRI (serotonin noradrenaline reuptake inhibitors) - better tolerated than TCA’s

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12
Q

What is duloxetine?

A

SNRI (serotonin noradrenaline reuptake inhibitors) - better tolerated than TCA’s

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13
Q

What is mirtazepine?

A

NaSSA - noradrenaline specific serotonin antidepressant

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14
Q

What is phenelzine?

A

MAOI = monoamine oxidase inhibitor (inhibit the action of monoamine-oxidase enzymes which break down serotonin and noradrenaline)

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15
Q

What is tranylcypromine?

A

MAOI = monoamine oxidase inhibitor (inhibit the action of monoamine-oxidase enzymes which break down serotonin and noradrenaline)

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16
Q

What is the worrying side effect of MAOI’s

A

TYRAMINE LOAD

Tyramine is a component of our diet and is normally degraded by MAO in the gut, therefore dangerous if inhibited

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17
Q

Describe the ICD-10 criteria for mania

A
  • a persistently elevated mood (above normal)
  • mood sustained for 1/week
  • 3 or more of the following (with severe interference of daily living)
  • > physical restlessness
  • > talkative
  • > reduced sleep
  • > flight of ideas/racing thoughts
  • > increased self-esteem
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18
Q

Describe the ICD-10 criteria for hypomania

A
  • a persistently elevated mood (above normal)
  • mood sustained for 4 days
  • 3 or more of the following (with some interference of daily living)
  • > physical restlessness
  • > talkative
  • > reduced sleep
  • > flight of ideas/racing thoughts
  • > increased self-esteem
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19
Q

What disorders is lithium used to treat, and how does it work?

A

Mania
BPAD

Modulates neurotransmitter activation in messenger pathways

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20
Q

What are the S/Ex of lithium treatment?

A 
Teratogenic -> Ebstein anomaly
Hypothyroidism
Hyperparathyroidism
Renal failure
Lithium toxicity -> tremor, N&V, dizziness, coma, death
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21
Q

What is Ebstein anomaly?

A

Teratogenic effects of lithium:

  • Dysarhythmias
  • ASD
  • R heart enlargement
  • Tricuspid incompetence
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22
Q

What is sodium valproate used for?

A

Acute mania
BPAD prophylaxis
Epilepsy

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23
Q

What are the side effects of sodium valproate?

A

Teratogenic -> neural tube defects

Increased OCP metabolism

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24
Q

What is carbemazipine used for?

A

Prophylaxis BPAD

Epilepsy

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25
Q

Describe the physical and psychological S/Sx of anxiety

A

Physical: dizzy, reduced libido, increased autonomic system, chest pain

Psychological: restless, on-edge, AVOIDANCE, fears

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26
Q

Define psychosis

A

A mental state in which reality is grossly distorted

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27
Q

Describe the 5 parameters of symptoms in psychosis

A

PANT-P

Perception (illusions and hallucinations)
Abnormal beliefs (delusions/over-valued ideas)
Negative symptoms -> reduced self care, blunting
Thought disorders -> Knight’s move thinking
Psychomotor -> catatonia

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28
Q

Define schizophrenia and the ICD-10 outlines

A

Type of psychotic disorder
Symptoms should be present for most of the time for 1 month
No set ICD criteria, but should include:
- delusions (bizarre delusions or delusions of control)
- hallucinations

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29
Q

Define delusion

A

Fixed false belief out-with a persons normal social/cultural/religious background

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30
Q

What is schizoaffective disorder?

A

Typical schizophrenia, but with mood symptoms (manic or depressive co-existing symptoms)

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31
Q

Describe the dopamine hypothesis of schizophrenia

A

Schizophrenia is thought to be due to:

  • increased dopamine in the mesolimbic pathway (A) -> causes positive symptoms
  • decreased dopamine in the mesocortical pathway (B) =-> causes negative symptoms
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32
Q

What is haloperidol/chlorpromazine?

A

1st gen typical antipsychotics
They block dopamine in the mesolimbic pathway (A)
to reduce positive symptoms

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33
Q

What are the side effects of haloperidol?

A

Hyperprolactinaemia (galactorrhoea and infertility)

EPSE (extra-pyramidal side effects)

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34
Q

Describe EPSE and why they occur

A

Due to a deficiency of dopamine, and an XS of acetylcholine
Include:
- parkinsonism = BRTP (bradykinesia, rigidity, tremor, postural instability)

Treated with anticholinergic drugs

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35
Q

What is clozapine and what are its side effects?

A

2nd gen atypical antipsychotic

  • has very few EPSE’s
  • can cause agranulocytosis
  • SMOKING -> reduces clozapine levels as smoking induces hepatic enzymes which metabolise clozapine faster, therefore cessation of smoking increases clozapine effectiveness!
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36
Q

Which type of anti-hypertensive drug can also cause depression?

A

Beta-blockers

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37
Q

Define an ego-dystonic thought

A

A thought which is out-with a persons normal beliefs/values

38
Q

Define an ego-syntonic thought

A

A thought which is in-line with a persons normal beliefs/values

39
Q

What is the first line treatment for OCD

A

Sertraline

40
Q

Describe the following thought disorders:

  • tangential thinking
  • knight’s move thinking
  • flight of ideas
A

Tangential -> patient diverts from initial train of thought

Knight’s move -> thoughts jump between loosely related ideas (seen in schizophrenia)

Flight of ideas -> randomly linked thoughts that may rhyme/have puns (seen in mania)

41
Q

What are neologisms and idiosyncratic word use?

A

Part of thought form

Neologisms = patient uses new words

Idiosyncratic word use = using normal words but with inappropriate meaning e.g. the air is allergic

42
Q

What is palilalia

A

repeating the last word of a sentence

43
Q

What is echolalia

A

like a parrot -> patient repeats words heard around them

44
Q

Define primary and secondary delusions

A

Primary - do not occur in response to any previous psychopatholoigcal state

Secondary - delusions occur as consequence of a pre-existing psychopathological state e.g. mood disorder

45
Q

Describe grandiose delusions

A

False belief that one is very powerful/important/has magic powers

46
Q

Describe persecutory delusions

A

False belief that one is being harmed/threatened/cheated on/victim of conspiracy

47
Q

Describe delusions of reference

A

False belief that objects/people/events have personal significance and refer to themself (e.g. that a news story is talking about them)

48
Q

What are nihilistic delusions?

A

False belief that oneself/others/the world is going to end

49
Q

Describe the 3 main delusions of thought control

A

Thought insertion -> believing that thoughts are being put into one’s head by an external agency

Thought withdrawal -> believing one’s thoughts/ideas are being extracted from their head by external agency

Thought broadcasting -> believing that one’s thoughts are being diffused so that others know what they are thinking

50
Q

What is an overvalued idea?

A

Plausible belief that patient becomes preoccupied with to unreasonable extent e.g. believing you will be made CEO of your company

51
Q

List 5 physical symptoms of anxiety

A 
Chest pain
Sweating
Tachypnoea
Diarrhoea
Increase BP
Irritability
Reduced libido
52
Q

List 5 psychological symptoms of anxiety

A 
Feeling 'on edge'
Restlessness
Fear of losing control
Difficulty concentrating
Detached feelings 'depersonalisation'
53
Q

Define an obsession

A

involuntary, recurrent intrusive thoughts which enter the mind against conscious resistance

54
Q

Define a compulsion

A

Ritualistic motor acts which cause distress and interfere with ADL
The patient retains insight that their actions are unreasonable and excessive and tries to resist

55
Q

Define panic attacks and panic disorders

A

Attack = discrete episode of intense fear accompanied by physical symptoms lasting 10-30mins

Disorder = when attacks come unpredictably without stimuli or situation

56
Q

List 5 biological symptoms of depression

A 
Early morning wakening
Difficulty falling asleep
Loss of appetite
Weight loss
Loss of libido
Psychomotor retardation (slow speech, limited facial expression)
57
Q

List 5 cognitive symptoms of depression

A 
Reduced concentration
Reduced memory
Guilt
Hopelessness
Suicide/self-harm
58
Q

Describe management pillars of depression

A

Bio - drugs (anti-depressants/psychotics, mood stabilisers)

Psycho - CBT, counselling

Social - help with debt/housing issues, increased socialisation

59
Q

List 5 biological (physical) symptoms of mania

A 
Decreased need for sleep
Increased energy
Sexual disinhibition
Impaired insight
Impaired judgement
Impaired concentration
60
Q

How does hypomania differ from mania?

A

Hypomania has less severe disruption of work/social situations

61
Q

What is dysthymia

A

Chronically depressed mood, onset in early adulthood
May remain throughout life for many years with variable periods of wellness in between
Mood is seldom severe enough to meet the formal depressive episode criteria

62
Q

What is cyclothymia

A

Characterised by instability of mood resulting in alternating periods of mild elation and mild depression, but none of these episodes are long/severe enough to classify as hypomanic/depressive episodes

63
Q

Describe BPAD

A

A disorder is ‘bipolar’ when a patient suffers from episodes of depressed or elevated mood (which may be punctuated by periods of normal mood), as the mood deviates from normal to wither a depressed or elated pole
When this instability of mood is mild -> cyclothymia

64
Q

Define psychosis

A

A mental state in which reality is grossly distorted resulting in symptoms of:

  • delusions
  • hallucinations
  • thought disorder
65
Q

List 4 differential diagnoses of psychotic symptoms

A

Schizophrenia
Schizoaffective disorder
Mania with psychotic symptoms
Depression with psychosis

66
Q

Describe the ICD-10 criteria for schizophrenia

A

1 or more of:

  • thought echo/insertion/withdrawal/broadcast
  • delusions of control
  • hallucinatory voices
  • bizarre delusions (i.e. something that could never happen in real life)
67
Q

Describe the Stages of Change model which describes how we succeed/fail to make changes

A

1) Pre-contemplation - no intention of changing
2) Contemplation - aware there is a problem but no commitment to action
3) Preparation - intent on taking action
4) Action - active behaviour modification
5) Maintenance - new behaviour replaces old
6) Relapse - fall back into old patterns of behaviour

68
Q

Define dependence and its criteria

A

A syndrome incorporating physiological, psychological and behavioural elements

ICD-10 states 3+ of the following should have been present together at some time in 1 year:

  • Desire/compulsion
  • issues Controlling substance use behaviour
  • Withdrawal state (physically)
  • Tolerance
  • Neglect in other interests
  • Persistence (even though you know it’s harmful)

(Drugs Can Work Together on New People)

69
Q

Define withdrawal

A

A substance specific syndrome which occurs on reduction/cessation of the psychoactive substance which has been used repeatedly over long period of time in high doses

70
Q

Define hazardous vs harmful use

A

Hazardous -> quantity/pattern of substance use that puts the user at risk of adverse consequences without dependence
Harmful -> quantity/pattern of substance use that causes adverse consequences without dependence

71
Q

Describe an emergency detention certificate (EDC)

A
  • for pts with a mental disorder/suspected mental disorder
  • allows them to be kept in hospital/brought in for assessment
  • any FULLY registered doctor can complete
  • lasts 72hrs
  • not essential, but MHO should consent if possible
  • cannot be appealed
  • senior psychiatrist can then revoke or convert to STDO
72
Q

Describe a STDO

A

Short term detention order

  • a Section 22 approved practitioner + MHO must set it
  • allows patients with suspected/confirmed mental disorder to be detained in hospital for up to 28 days
  • patients have right to appeal
  • can be revoked or changed to CTO with appropriate application
73
Q

Describe a CTO

A

Compulsory treatment order

  • Requires 2 written medical recommendations, one from AMP (approved medical practitioner) and also GP
  • Taken to court
  • lasts 6 months
74
Q

Describe the pathophysiology underlying Alzheimer’s disease

A

B-amyloid proteins deposited in blood vessels and neurotoxic tau proteins accumulate

75
Q

Name RFx for Alzheimer’s disease

A 
CVD
Hyperlipidemia
FHx
Age
Down's syndrome
76
Q

List 5 symptoms of Alzheimer’s disease

A 
Poor completion of ADL's
Mood changes
Memory loss
Disorientation
Nominal dysphasia (unable to recall the names of objects/people)
77
Q

List RFx for vascular dementia

A 
Hypertension
Obesity
Hyperlipidaemia
Smoking
Age
78
Q

List 5 symptoms of vascular dementia

A 
Poor concentration
Disinhibition
Previous strokes/TIA's
Slow information processing
Difficulty problem solving
79
Q

Describe the pathophysiology of LB dementia

A

Alpha synuclein protein accumulates -> forms lewy bodies -> these accumulate in the dopaminergic system

80
Q

Name the common triad of symptoms seen in LB dementia

A

Hallucinations
Dementia
Parkinsonism (bradykinesia, rigidity, tremor, shuffling gait, postural instability)

(also REM sleep disturbance and cognitive fluctuations)

81
Q

Describe features of fronto-temporal dementia

A

Changes in personality and social conduct

Peak onset in 50’s

82
Q

Compare dementia and delirium in terms of 1. onset, 2. consciousness, 3. course, 4. attention and 5. behaviour

A
  1. Delirium = sudden, dementia = gradual
  2. Delirium = impaired, dementia = normal
  3. Delirium = short lived, dementia = long
  4. Delirium = impaired, dementia = normally intact
  5. Delirium = hypo/hyperactive, dementia = normal
83
Q

List 5 organic causes of depression

A 
Hypothyroidism
Chronic steroid use/Cushing's syndrome
Intoxication
Anaemia
Uraemia
84
Q

What is serotonin syndrome?

A

Occurs due to an XS of serotonin in the body
Usually from XS SSRI or use of mix of antidepressant drugs
Triad of symptoms:
- altered mental status (agitated, anxious, restless)
- neuromuscular (tremor, clonus, hyperreflexia, +ve babinski)
- autonomic hyperactivity (HTN)

85
Q

Describe the components of the SADPERSONS score for assessing suicide risk

A 
Sex (?male)
Age (<20, >44)
Depressed
Previous suicide attempt
Ethanol abuse
Rational thinking loss (psychosis)
Social support lacking
Organised suicide plan
No spouse (divorced, separated, widowed, single)
Sickness (presence of chronic/debilitating illness)
86
Q

What are the 5 criteria for detaining someone using the mental health act?

A
  1. Suspected/confirmed mental disorder
  2. Treatment available
  3. Risk to self/others (if no treatment is given)
  4. Impaired decision making (due to the mental disorder)
  5. Detention/use of compulsory powers is necessary
87
Q

What are the classical type of hallucinations in schizophrenia?

A

Auditory
3rd person
Voices anticipate/echo/broadcast the patients thoughts

88
Q

What classic hallucinations are found in psychotic depression?

A

Auditory
2nd person
Derogatory comments made ‘to’ the patient by another voice, which are accepted by the patient as true

89
Q

Name 5 side effects of TCA’s e.g. amytryptiline

A 
Drowsiness
Sedation
Dry mouth
Constipation
Urinary retention
Postural hypotension
90
Q

List 4 side effects of SSRI’s

A

Dyspepsia
Insomnia
Hyponatremia
Suicidal behaviour

91
Q

List 3 side effects of ECT

A

Memory loss (anterograde or retrograde)
Headache
Muscle aches

Year 4 (28 decks)

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