Psychiatry Flashcards
Define nihilistic delusion
Delusion of almost nothingness (e.g. nothing in bank account, insides rotting)
Define grandiose delusion
Inflated self-importance (I am God)
Define hypochondriacal delusion
Firm belief they have a disease
Define De Clerambaults (ertomanic) delusion
Man of higher social standing/everyone in love with her
Define Orthello delusion
Sexual partner being unfaithful
Define Capgras delusion
Close relative has been replaced by imposter
Define cotard delusion
Patient believes they are dead or non-existent
Define Folie a deux delusion
Shared delusion with someone else
Define Ekboms delusion
Delusion of infestation
Define loosening of association
Lack of logical association between thoughts giving rise to incoherent speech
Define circumstantiality
Slow, rambling, convoluted but goal direct thinking
Define confabulation
Give false account to fill gap in memory (Korsakoffs)
Define tangeliality
Wandering off topics
Define flight of ideas
Rapid skipping from one thought to distantly related idea, often tentative relation
Define clang associations
Ideas that are linked by rhyme or similarity of words alone
Define Munchausen’s syndrome
Factitious disorder, intentional production of physical or psychological symptoms of illness
Define malingering
Fraudulent simulation or exaggeration of symptoms with the intention of financial or other gain
Define pharmacokinetics
What the body does to the drug
Absorption
Distribution
Elimination
Define pharmacodynamics
What the drug does to the body
Name 1st generation/typical antipsychotics
Haloperidol
Chlorpromazine
Extra pyramidal side effects from 1st generation antipsychotics
Acute dystonic reaction (hours) - muscle spasm, acute torticolis, ocular gyrate crisis
Parkinsonism (4 weeks) - tremor, bradykinesia
Akasthesia (6-60 days) - inner restlessness, pacing + agitated
Tardive dyskinesia (months - years i.e. long term use) - grimacing, tongue protrusion, lip smacking
Treatment for Acute dystonia and Parkinsonism
Procycladine
Treatment for akasthesia
Propanolol +/- cyproheptadine
Treatment for Tardive dyskinesia
Tetrabenazine
Name atypical/new antipsychotics
Olanzapine Risperidone Quetiapine Aripiprazole Clozapine
Side effects of atypical/new antipsychotics
Weight gain
Diabetes Mellitus
Stroke
Most with olanzapine and clozapine
Lowest with aripiprazole
Side effects of clozapine
Agranulocytosis (loss of granulocytes (baso, eoso, neutrophils) Reduced seizure threshold Constipation Myocarditis Cardiomyopathy Arrhythmias Severely reduced consciousness Phaeochromocytoma Parkinson's disease Metabolic syndrome
Name Selective Serotonin reuptake inhibitors (SSRI)
Sertraline
Citalopram
Fluoxetine
Paroxetine
Name Serotonin noradrenaline reuptake inhibitors (SNRI)
Venlafaxine
Duloxetine
Name tricyclics
Amytriptyline
Clomipramine
Side effects of anti-cholinergics/muscarinics
Tachycardia Dry mouth Blurred vision Constipation Urinary retention Drowsiness
Name tetracyclic/NaSSA (noradrenergic and specific seritonergic antidepressant)
Mirtazepine
Side effect of Mirtazepine
Drowsiness
Weight gain
Side effects of Lithium
Fine tremor Impaired renal function Hypothyroidism Cardiac - T wave flattening/inversion Thirst, polydipsia, polyuria (nephrogenic DI) Weight gain Oedema Leucocytosis Teratogenicity
Side effects of Lithium toxicity
Course tremor Ataxia Muscle weakness Seizures Heart block
What should you check in someone who has had a lithium overdose?
U&E’s and TSH
Thyro and nephrotoxic
What is Neuroleptic Malignant Syndrome (NMS)?
Caused by antipsychotic medication -> can be caused by withdrawal of dopaminergic drugs as well
Usually in first 10 days of treatment
Symptoms of Neuroleptic Malignant Syndrome (NMS)
Reduced activity
‘Lead pipe’ rigidity
Stiff pharyngeal and thoracic muscles - leads to dysphagia and dyspnoea
Investigations in Neuroleptic Malignant Syndrome (NMS)
Elevated creatine kinase
Elevated WCC
Deranged LFTs
Metabolic acidosis
Treatment for Neuroleptic Malignant Syndrome (NMS)
Bromocriptine - to reduce dopamine blockade (dopamine agonist)
Dantrolene - to reduce muscle spasms
What causes Serotonin Syndrome?
SSRI
MAOIs
Ecstasy
Symptoms of Serotonin Syndrome
Increased activity Clonus/myoclonus Hyperreflexia Tremor Muscular rigidity Dilated pupils Autonomic dysfunction - tachycardia, unstable BP
Investigations in Serotonin Syndrome
Elevated creatine kinase
Elevated WCC
Deranged LFTs
Metabolic acidosis
Treatment for Serotonin Syndrome
Cyproheptadine
Causes of delirium
PINCH ME
Pain
Infection - UTI, pneumonia, meningitis, sepsis, encephalitis
Nutrition - B12/folate deficiency
Constipation
Hypoxia
Medications - Benzodiazepines, anticholinergics, anticonvulsants
Environment
Other: Endocrine - hypo/hyperthyroid, Cushings. Vascular - stroke, HF, SAH, vasculitis, migraines. Head trauma
Clinical features of delirium
Acute/subacute presentation Fluctuating course Inattention Clouding of consciousness Disorientation in time, place and person Anterograde amnesia Visual hallucinations/illusions Paranoid delusions
Hypoactive features of delirium
Apathy
Withdrawal
Quiet confusion
Hyperactive features of delirium
Agitation
Lack of co-operation
Delusions
Disorientation
Differential diagnosis for delirium
Dementia Alcohol/drug withdrawal Mania Post-ictal Psychosis Anxiety
Investigations for delirium
Bloods - FBC - anaemia, WCC infection, MCV U&E LFT Glucose TFT Blood cultures Blood gases ECG CT/LP Chest X-ray
Management for delirium
Treat precipitating cause + exacerbating factors Environmental and supportive measures Adequate lighting Hearing aids Glasses Clocks/calendars Side room Sleep hygiene Consider haloperidol
Define generalised anxiety disorder
‘Excessive worry’ and feelings of apprehension about every day events/problems, with symptoms of muscle/psychic tension
Anxiety that is ‘generalised + persistent’
How long must symptoms last for to diagnose generalised anxiety disorder
At least six months history of excessive anxiety and worry
Symptoms for generalised anxiety disorder
At least three of: Restlessness Easily fatigued Difficulty concentrating Irritability Muscle tension Sleep disturbance
At least four of: Palpitations, sweating, tachycardia, dry mouth
Difficulty breathing, chest pain, nausea/vomiting
Hot flushes, numbness, restlessness, lump in throat
Dizziness/faint, losing control, fear of dying
Sleep disturbance, irritability
Risk factors for generalised anxiety disorder
35-54 years old Female Divorced/separated Live alone Unemployed
Management for generalised anxiety disorder
Education Stop smoking and alcohol Exercise Psychological support CBT SSRI's Benzodiazepines (lorazepam, diazepam)
Define panic attack
Period of intense fear characterised by group of symptoms that develop rapidly, reach peak at 10 mins, and don’t last longer than 20-30 mins
Define panic disorder
Recurrent panic attacks
Symptoms of panic disorder
Palpitations Chest pain Choking Dyspnoea Dry mouth Dizziness Blurred vision Sweating Feeling of impending doom Fear of dying Fear of losing control Depersonalisation
Management for panic disorder
SSRI’s - Sertraline
CBT
TCA - Clomipramide
Define agoraphobia
Anxiety and panic symptoms associated with places or situations where escape may be difficult or embarrassing -> leading to avoidance
Management for agoraphobia
Behavioural - exposure techniques, relaxation training
Cognitive - teach about bodily responses associated with anxiety
SSRI’s - Citalopram, escitalopram
Define obsessive compulsive disorder
Obsessions are unwanted intrusive thoughts, images or urges that repeatedly enter the persons mind
Compulsions are repetitive behaviours or mental acts that the person feels drive to perform
Examples of obsessions
Often unpleasant = death/sexual
Repetitive
Intrusive
Irrational
Examples of compulsive acts
Checking Washing Counting Symmetry Repeating certain words/phrases
Treatment for OCD
Psychological = CBT
Exposure + response prevention (ERP)
Pharmacological = SSRI’s = Fluoxetine, sertraline
ECT
Define post-traumatic stress disorder
Severe psychological disturbance following a traumatic event
Characterised by involuntary reexperiencing of elements of the event, with symptoms of hyperarousal, avoidance and emotional numbing
How long must symptoms be present for to diagnose post-traumatic stress disorder
1 month
How long must symptoms arise within of the traumatic event to diagnose post-traumatic stress disorder
Arise within 6 months of traumatic event
Symptoms of post-traumatic stress disorder
Re-experiencing - Flashbacks, nightmares, increased BP, sweating
Avoidance - avoiding people, situations or circumstances
Hyperarousal - sleep problems, irritability, poor concentration
Emotional numbing - lack of ability to experience feelings
Treatment for post-traumatic stress disorder
CBT
Eye movement desensitisation and reprocessing
Stress movement
