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Phase 3a > Psychiatry > Flashcards

Psychiatry Flashcards

1
Q

What are the First Rank Symptoms of Schizophrenia?

A
  1. Delusions
  2. Auditory Hallucinations
  3. Thought Disorder
  4. Passivity Experience
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2
Q

What are the features of auditory hallucinations in schizophrenia?

A

Audible thoughts
Voices arguing or discussing (3rd person auditory)
Voices commenting on patient’s actions

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3
Q

What are the features of thought disorder in schizophrenia?

A

Thought withdrawal
Thought insertion
Thought broadcasting

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4
Q

What are the features of passivity experiences in schizophrenia?

A

Somatic passivity
Passivity of affect
Passivity of impulse
Passivity of volition

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5
Q

What are the second rank symptoms of schizophrenia?

A

Mood changes (depression or elation)
Emotional blunting
Perplexity
Sudden delusional ideas

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6
Q

What is a reflex hallucination?

A

When a true sensory stimulus causes hallicunations in another sensory modality

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7
Q

What is poverty of speech?

A

Minimal verbal communication lacking unprompted characteristic of normal speech

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8
Q

What is perseveration?

A

Inability to switch ideas along with social context

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9
Q

What is circumstantiality?

A

An inability to answer a question without diverging into unnecessary and excessive detail

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10
Q

What are the positive symptoms of schizophrenia?

A
  1. Thought echo - (own thoughts out loud)
  2. Thought insertion or withdrawal
  3. Thought broadcasting
  4. 3rd person auditory hallucinations
  5. Delusional perception
  6. Passivity and somatic passivity
  7. Odd behaviour
  8. Thought disorder
  9. Lack of insight
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11
Q

What are the negative symptoms of schizophrenia?

A
  1. Blunted affect
  2. Apathy
  3. Social isolation
  4. Poverty of speech
  5. Poor self-care
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12
Q

Is incongruity of affect an issue of mood or thought?

A

Mood
- Occurs when there is a mismatch between affect and mood

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13
Q

What is delusional perception?

A

An inappropriate association between an everyday experience and an unfounded belief about oneself

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14
Q

True or false - delusional perception is a first rank symptom of schizophrenia

A

True

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15
Q

True or false - delusions of paranoia is a first rank symptom of schizophrenia

A

False

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16
Q

Which diseases are visual hallucinations most common?

A

Delirium
Lewy body dementia

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17
Q

What are the side effects of clozapine?

A

Neutropenia
Agranulocytosis
Constipation
Drowsiness
Weight gain

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18
Q

What are pareidolic illusions?

A

Vivid illusions occurring from indistinct stimuli
- Can occur due to fantasy or visual imagery but can intensify when the patient concentrates

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19
Q

What is torticollis?

A

An acute dystonic reaction causing the muscles of the head to tilt down, commonly occurring due to antipsychotic medications

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20
Q

What is bulimia nervosa?

A

An eating disorder characterised by binge-eating, followed by episodes of purging, wherein ingestion of laxatives or vomiting are undertaken in order to prevent absorption

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21
Q

What are the typical symptoms of BN (Bulimia Nervosa)?

A
  1. Engaging in binge-eating behaviour
  2. Body image distress
  3. Frequent trips to toilet after eating
  4. Uncomfortable eating food in presence of others
  5. Mood disturbances - irritability, depression, suicidal ideation, self-harm behaviour
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22
Q

What are clinical findings in Bulimia Nervosa?

A
  1. Often normal body weight +/- weight fluctuations
  2. Tooth erosion
  3. Swollen salivary glands
  4. Mouth ulcers
  5. Gastro-oesophageal reflux and irritation
  6. Alkalosis - loss of HCl from stomach
  7. Hypokalaemia
  8. Russel’s sign - calluses on the knuckles where they have scraped against the teeth
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23
Q

What is Russell’s Sign?

A

Calluses on the knuckles where they have scraped against teeth - often seen in bulimia nervosa

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24
Q

What is a Belle indifference?

A

When a patient is seemingly unconcerned with symptoms of a conversion disorder

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25
Q

In which condition would it be appropriate to prescribe a mood stabiliser (Lithium/sodium valproate?

A

Treatment-resistant mania

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26
Q

In which patient group is sodium valproate contraindicated?

A

Pregnant women

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27
Q

True or false - citalopram is associated with prolongation of the QT interval

A

True

28
Q

What type of drug is first-line for depression?

A

SSRIs

29
Q

What type of drug is second-line for depression?

A

SNRIs
Mirtazapine (NASSA)

30
Q

What drug class would be inappropriate to prescribe to a patient as first-line treatment for depression

A

TCAs (Amitriptyline, Imipramine)
- Significant toxicity in overdose

31
Q

Which antipsychotics are high-risk for weight gain?

A

Olanzapine
Clozapine

32
Q

Which antipsychotics are medium-risk for weight gain?

A

Risperidone
Quetiapine

33
Q

Which antipsychotics are low-risk for weight gain?

A

Aripiprazole

34
Q

What is a persecutory delusion?

A

Unlikely and false beliefs that a person is being harassed, persecuted or victimised

35
Q

What are the characteristics of EUPD Impulsive type?

A
  1. Tendency to act unexpectedly, without consideration of consequences
  2. Tendency to engage in conflicts with others, especially when impulsive behaviour is criticised
  3. Liability of outbursts of anger with inability to control resulting behaviour
  4. Difficulty in maintaining any course of action that offers no immediate reward
  5. Unstable, capricious mood
36
Q

What are the characteristics of EUPD Borderline type?

A
  1. Disturbances and uncertainty about self-image, aims and internal preferences
  2. Liability to intense and unstable relationships - characterised by emotional crises
  3. Excessive efforts to avoid abandonment
  4. Recurrent threats or acts of self-harm
  5. Chronic feelings of emptiness
37
Q

What is flight of ideas?

A

A person’s stream of thought being faster than usual
- Direction or purpose of thinking may be lacking, but successive thoughts appear to be connected

38
Q

Which second-line antidepressant is associated with weight gain?

A

Mirtazapine

39
Q

What is first-line, short-term management for mild depression?

A

Low-intensity psychosocial interventions:
- Computerised CBT
- Individualised CBT or individual guided self-help based on CBT
- Structured group physical activity programme

40
Q

When would it be appropriate to use biological therapy in the short-term management of mild-depression?

A

Exceptional cases:
- Past history of moderate or severe depression
- Presence of mild depression present > 2 years
- Presence of mild depressive symptoms after other interventions

41
Q

What is the long-term management of mild depression?

A
  1. Risk assessment
  2. Ongoing review - response to treatment, compliance, symptoms
  3. Measurement scales to assess response to treatment and QoL
  4. Relapse prevention plan
  5. Assess for social support and previous issues flagged up during consultations
  6. Review antidepressants compliance, use, side effects, adjust dose if required
42
Q

What is the short-term management of moderate or severe depression?

A
  • Combination of biological treatment and high intensity psychosocial treatment
43
Q

What is the long-term management of moderate or severe depression?

A
  1. Risk assessment
  2. Review their response to high-intensity psychosocial intervention compliance and symptoms
  3. Review response to antidepressant therapy, compliance, side effects and adjust doses if appropriate
  4. Measurement scales to assess response to treatment and quality of life
  5. Relapse prevention plan
  6. Assess social support and previous issues flagged up during consultation
44
Q

What is thought echo?

A

An auditory hallucination wherein people can hear their own thoughts as if spoken aloud to them

45
Q

Which TCA may be used as a first-line treatment of OCD?

A

Clomipramine

46
Q

What is coprolalia and which condition is it characteristic of?

A

Uncontrollable outbursts of obscenities or swear words in socially inappropriate settings
Common in Tourette’s Syndrome

47
Q

In which drugs are acute dystonic reactions most common?

A

First-class antipsychotics e.g. Haloperidol

48
Q

What causes acute dystonia (Extrapyramidal side effects) in antipsychotic use?

A

D2-recepter antagonism in the tuberofundibular pathway

49
Q

What are the common symptoms of PTSD?

A
  1. Re-experiencing
  2. Avoidance
  3. Emotional numbing
  4. Hyperarousal
50
Q

What is the first-line option for therapy in treatment of PTSD?

A

CBT

51
Q

What is the management for TCA overdose?

A
  1. ABC
  2. Examine for clinical features - Low K, acidosis, QRS>0.16s
  3. Consider gastric lavage if within one hour of potentially fatal overdose
  4. Give 50g of charcoal within 1 hour of ingestion
  5. Give sodium bicarbonate (50ml of 8.4%) if pH<7.1, RS >0.16s, arrhythmias or hypotension present
  6. Avoid antiarrhythmics - correct hypoxia, hypotension, acidosis, hypokalaemia, give sodium bicarbonate
  7. Hypotension - IV fluids, consider inotropes
  8. Monitoring - minimum of 12 hours
52
Q

What is lanugo hair?

A

Soft, downy hair on the face, back and arms which grows as a result of anorexia nervosa

53
Q

What are obsessional thoughts?

A

Unpleasant or distressing thoughts, ideas or images that are unwanted, despite the person recognising them as their own

54
Q

What is Mindfulness-based cognitive therapy (MBCT)?

A

Psychotherapy which incorporates elements of CBT and mindfulness
Delivered in group setting on a weekly basis for eight weeks

55
Q

What intervention is recommended by NICE after three or more depressive episodes?

A

Mindfulness-based cognitive therapy (MBCT)

56
Q

What are the signs and symptoms of neuroleptic malignant syndrome?

A

Muscle rigidity
Fever
Altered mental status
Autonomic dysfunction

57
Q

What is the management of neuroleptic malignant syndrome?

A

Individualised and based on clinical need - commonly:
Admission to ITU
Antipsychotics stopped immediately
Aggressive hydration - IV fluids and
Cooling methods to treat hyperthermia
Treated with dantrolene and benzodiazepines
Bromocriptine mesylate is useful in severe cases to reverse the hypodopaminergic state

58
Q

Which drug class may cause lithium toxicity?

A

Thiazine diuretics - e.g. Bendroflumethiazide

59
Q

What are the clinical features of lithium toxicity?

A

Anorexia, D+V
Drowsiness, restlessness
Dysarthria
Dizziness, ataxia, incoordination, muscle twitching, coarse tremor
Hyperreflexia, convulsions
Acute renal failure
Collapse, coma

60
Q

What are the core symptoms of depression?

A
  1. Low mood
  2. Lethargy
  3. Anhedonia
61
Q

What are signs of obsessive-compulsive personality disorder?

A
  • Rigidity with respect to morals, ethics, values
  • Reluctant to surrender work to others
  • Preoccupation with details, rules, lists and orders
  • Perfectionism impairing ability to complete tasks
62
Q

What are the poor prognostic indicators in schizophrenia?

A

Strong family history
Gradual onset
Low IQ
Prodromal phase of social withdrawal
Lack of obvious precipitant

63
Q

How long should a patient remain on antidepressants after remission?

A

6 months

64
Q

How long should an SSRI dose be reduced?

A

Gradually reduce over 4 weeks

65
Q

What are the symptoms of SSRI discontinuation syndrome?

A

Increased mood change
Restlessness
Difficulty sleeping
Unsteadiness
Sweating
Gastrointestinal symptoms: pain, cramping, diarrhoea, Vomiting
Paraesthesia

Phase 3a (6 decks)

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