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Medical School > Psychiatry > Flashcards

Psychiatry Flashcards

1
Q

MSE - A + B + S

  1. Stand for
  2. Looking for (A+B)
  3. S - parts (3)
A
  1. Appearance, behaviour, speech
  2. Age / ethinicity, clothes/accessories, self care/hygiene, evidence of self harm, eye contact, posture, facial expression, rapport or not, psychomotor (retardation, agitation)
  3. Rate, volume, tone
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2
Q

MSE - Affect + mood

  1. . Affect (observe) - definition
  2. Mood (enquire about) - definition
  3. Mood - types
  4. Affect - parts (3) + examples
A
  1. Immediately expressed and observed emotion (e.g. the patient’s facial expression or overall demeanour)
  2. Sustained emotion present long-term that can alter an individual’s perception of the world
  3. Depressed, anxious, angry/irritable, apathetic, elated
  4. Quality (e.g. sad, hostile, happy), range (restricted, normal, expansive), intensity (normal, blunted, flat), labile
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3
Q

MSE - Thought form

  1. Parts (2) + examples
  2. Linear vs incoherent
  3. Circumstantial
  4. Tangiental
  5. Flight of ideas
  6. Perseveration
A
  1. Speed (accelerated/retarded), flow/coherence (linear, incoherent, circumstantial, tangiental, flight of ideas, perseveration)
  2. In logical order vs makes no sense
  3. Lots of irrelevant/unnecessary details (not to the point)
  4. Moves from one thought to other (relate in some way but never get to point)
  5. Increased number of ideas, produced at a rapid pace
  6. Repetition of particular response without stimulus
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4
Q

MSE - Thought content + possession

  1. Content - what to look out for (5)
  2. Abnormal possession - types (4) + description
A 
1. Delusions (false reasoning) / abnormal beliefs
Obsessions
Over valued ideas
Suicidal thoughts
Homicidal / violent thoughts
  1. Thought insertion – thoughts put into own mind
    Thought withdrawal – thoughts removed from own mind
    Thought broadcasting – others can hear thoughts
    Thought echo
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5
Q

MSE - Perception

  1. Abnormal perception - types (3) + description
  2. Hallucinations - types (5)
  3. Types of auditory + examples (2)
A
  1. Hallucinations - false sensory perception without any relevant external stimulation, patient believes IS real (e.g. hears voices but no sound present)
    Pseudo-hallucations - patient aware not real
    Illusions - misinterpreted perception such as mistaking a shadow for a person
  2. Auditory, visual, tactile, olfactory, gustatory
  3. Secondary (voices talking at them), tertiary (about them)
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6
Q

MSE - Cognition

  1. Abnormal cognition - basic testing (4 parts)
  2. Detailed testing - how to do
  3. What to test in orientation (3)
A
  1. Orientation, attention, concentration, short-term memory
  2. Mini-mental state exam
  3. Time, place, person
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7
Q

MSE - Insight + judgement

  1. Insight - what it is
  2. Judgement - how to test
A
  1. Able to recognise problem / abnormal experience, if not what do they think is the cause, do they want help
  2. Problem-solving
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8
Q

MSE - assessing risk

  1. Components (3)
  2. How to quantify (3)
  3. Long-term assessment - components to consider
A
  1. Harm to self, harm to others, vulnerability
  2. How imminent, how likely, severity
  3. Biological (drugs / alcohol / medication), social situation, psychological state (+ how to support)
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9
Q

Psychiatric history

  1. Screening questions
  2. Important PMH (3)
A
  1. Low mood, elevated mood/increased energy, delusions, hallucinations, anxiety, obsessions/compulsions
  2. Head injury / surgery, neurological conditions, endocrine abnormalities
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10
Q

Generalised anxiety disorder

  1. Physical symptoms
  2. Medical causes to exclude
  3. Psychiatric symptoms (in last 2 weeks)
  4. Assessment tool
  5. Needs to last for how long for diagnosis
  6. Management - step 1
  7. Step 2
  8. Step 3
  9. 2nd line drug
  10. Benzodiazepines for how long
  11. If symptoms happen sometimes but can’t control
A
  1. Trembling, sweating,palpitations, SOB, headaches, hot flushes, muscle ache/tension, irritable, fatigue, restless
  2. HTN, hyperthyroid, angina, asthma, excessive caffeine
  3. Nervous/anxious, can’t control worrying, worry too much, can’t relax, restless (can’t sit still), irritable, feeling afraid as if something awful might happen
  4. GAD-7
  5. 6+ months, around a range of events / activities
  6. Education, active monitoring
  7. Low-intensity psychotherapy (self-help)
  8. SSRI (sertraline), higher intensity psychotherapy (CBT)
  9. TCA
  10. 2-4 weeks maximum (short-term management)
  11. Panic disorder (same management)
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11
Q

Depression

  1. Core symptoms (3)
  2. Biological symptoms (5)
  3. Cognitive symptoms (5)
  4. If have psychotic symptoms, they are usually
  5. Minimum duration for diagnosis
  6. Minimum core symptoms for diagnosis
  7. Major depressive disorder diagnosis requirements from DSM-5
  8. ICD-10 scoring - mild/moderate/severe
  9. Other scoring system to assess severity
  10. Neurological conditions causing depression (3)
  11. Endocrine (3)
  12. Infections (2)
  13. Other (2)
  14. Management - mild - 1st line
  15. Moderate-severe - 1st line
  16. Switching antidepressants - guidelines
A
  1. Low mood, loss of interest / pleasure, fatiguability
  2. Sleep change (early morning waking), appetite change, psychomotor retardation/agitation
  3. Reduced concentration / memory, poor self-esteem, suicidal/self-harm thoughts
  4. Mood congruent
  5. 2 weeks (‘over last two weeks, how often’)
  6. 2
  7. > 5 over 2 weeks with low mood/interest/pleasure
  8. Mild - 4, moderate - 5-6, severe - 7+
  9. PHQ-9
  10. MS, Parkinson’s, dementia
  11. Hypothyroidism, Cushing’s, Addison’s
  12. HIV, hepatitis
  13. Chronic fatigue, malignancy
  14. CBT, + follow up within 2 weeks to see if worsening
  15. CBT + SSRIs
  16. If SSRI-SSRI, stop 1st + start 2nd (4-7 gap if fluoxetine 1st), cross-taper if SSRI-TCA
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12
Q

Schizoaffective disorder

  1. Definition
A
  1. Mood symptoms (depression, mania) + schizophrenic symptoms (delusions, hallucinations) in the same episode
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13
Q

Schizophrenia - general

  1. Risk factors
  2. First rank symptoms (4)
  3. Other features
  4. Negative symptoms
  5. Paranoid - features
  6. Hebephrenic
  7. Catatonic
  8. Residual
  9. Management
A
  1. Family history, black, migration, urban, cannabis
  2. Auditory hallucination, thought disorder, passivity phenomena, delusional perception
  3. Impaired insight, neologisms, catatonia
  4. Apathy, absent / blunted / incongruous affect, alogia, social withdrawal, impaired attention, anhedonia, sexual problems, lethargy, avolition
  5. Delusions of persecution, delusions of grandeur
  6. Disorganised; confused, purposeless behaviour
  7. Excitement and stupor phases (unusual movements)
  8. Feel like completely recovered when correctly treated
  9. Antipsychotics, CBT, cardiovascular risk modification
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14
Q

Psychosis

  1. Psychotic psychopathology - aspects (5)
  2. Key differentials
  3. Associated medical conditions
  4. Need to rule out
A
  1. Perception, abnormal beliefs, thought disorder, negative symptoms, psychomotor functions
  2. Schizophrenia/ schizoaffective, secondary to mood disorder / medical condition / psychoactive substance, delirium / dementia, personality disorder, neurodevelopmental
  3. Cerebral neoplasm, stroke, trauma, encephalitis, SLE, endocrine, hyperthyroidism, high calcium
  4. Substance abuse
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15
Q

Neuroleptic malignant syndrome

  1. When does it occur
  2. Presentation
  3. Abnormal bloods
  4. Complications
  5. Management
A
  1. Hours-days after starting new antipsychotic (1st or 2nd generation)
  2. Pyrexia, increased muscle tone/rigidity, autonomic lability (HTN, high HR/RR), agitated delirium/confusion
  3. Raised CK, leukocytosis
  4. AKI from rhabdomyolysis
  5. Stop antipsychotic, IV fluids, dopamine agonist (bromocriptine), dantrolene, medical ward
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16
Q

Substance dependence

  1. Alcohol - units calculation
  2. CAGE questionnaire to test dependence - Qs (4)
  3. Post-withdrawal - how long before initial symptoms
  4. Seizures
  5. Delirium tremens (+ 1st line management)
  6. Wernicke’s encephalopathy - features (3)
  7. Management
A
  1. ABV x Vol
  2. Thought about cutting down, annoyed by criticism of drink, any guilt, eye opener
  3. 6-12 hours
  4. 36 hours
  5. 72 hours (chlordiazepoxide)
  6. Delirium, opthalmopelgia, ataxia
  7. Parenteral thiamine
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17
Q

Personality disorder

  1. History - key points (3)
  2. Management - medical (3 types used)
  3. Preferred psychological therapy

Cluster A (‘suspicious’)

  1. Paranoid
  2. Schizoid
  3. Schizotypal
A
  1. Source of distress, co-morbid mental illness, specific impairment
  2. SSRIs, mood stabilisers, benzodiazepines
  3. Direct behavioural therapy
  4. Sensitive/unforgiving if offended, no trust, conspiracy
  5. Indifference to praise/criticism, solitary, no interest in sex/relationships, emotionally cold, few interests
  6. Ideas of reference (differ from delusions in that some insight is retained), odd beliefs, perceptual disturbance, paranoid ideation/suspiciousness, eccentric behaviour, inappropriate affect, odd (but coherent) speech
18
Q

Dementia - general

  1. Reversible causes to rule out
  2. Blood screen to do so
  3. Suspected dementia - refer where
  4. Average life expectancy from diagnosis

Management

  1. Drug to maintain cognitive function (+ 3 examples)
  2. Use ^ at what MMSE score
  3. Drug to use in mod-severe/if 1st line not tolerated
  4. Anxiolytics - which to use, which to avoid
A
  1. Deficiency (vit B12/folate), TSH, calcium, Cushing’s, Addison’s
  2. TFT, B12, folate, BM, U+E, LFT, infection, autoimmune, CT head
  3. Memory clinic
  4. 4 years
  5. Cholinesterase inhibitors (donepezil, rivastigmine, galantamine)
  6. 10+
  7. NMDA receptor antagonists (memantine)
  8. Use trazdone, avoid benzodiazepines
19
Q

Lewy-Body dementia

  1. Features
  2. Classic pathological feature, in which locations (3)
  3. Imaging if suspected
  4. Management - medical
  5. Which drug completely contraindicated
  6. Why
A
  1. Progressive cognitive impairment, parkinsonism, hallucinations (mostly visual), sometimes delusions, marked fluctuations throughout day, sleep disrupted
  2. Alpha-synuclein cytoplasmic inclusions (LBs) in substantia nigra, paralimbic and neocortical areas
  3. DaTscan (single photon emission CT)
  4. AChE inhibitors, memantine
  5. Antipsychotics (neuroleptics)
  6. 50% have catastrophic results, potentially irreversible Parkinsonism, impaired consciousness, severe autonomic symptoms, 2-3x increase in mortality
20
Q

Dementia - general

  1. Types (3) + examples
  2. Age to be classified as early onset
  3. Symptoms suggesting depression over dementia in memory loss
A
  1. Cortical (Alzheimer’s, frontotemporal),
    subcorticical (Parkinson’s, Lewy-body, Huntington’s, HIV related), mixed (vascular, infection-induced)
  2. <65
  3. Short history, rapid onset, biological symptoms, worried about memory, reluctant to take test, variable MMSE, global memory loss
21
Q

Alzheimer’s dementia

  1. Risk factors (4)
  2. Autosomal dominant form - protein mutations (3)
  3. Pathological changes - macroscopic
  4. Microscopic (+ 2 proteins involved)
  5. Biochemical - deficiency in what
A
  1. Genetic, vascular, head injury, less education
  2. Amyloid precursor protein (chromosome 21), presenilin 1 (C 14), presenilin 2 (C 1)
  3. Widespread cerebral atrophy, cortex + hippocampus
  4. Cortical plaques (type A beta-amyloid protein), intraneuronal neurofibrillary tangles (excessively phosphorylated tau protein)
  5. Acetylcholine
22
Q

Vascular dementia

  1. Pathophysiology
  2. Risk factors + their secondary prevention
  3. Type of deterioration
  4. Features
  5. Drug management only if
A
  1. Neuron death due to blood flow disruption
  2. Smoking, T2DM, HTN, cholesterol (aspirin/clopidogrel)
  3. Stepwise
  4. Confusion, restless, agitation, can’t organise thoughts, speech/language issues, unsteady/falls, incontinence
  5. Co-existing Alzheimer’s / Lewy Body dementia
23
Q

Mental Health Act

  1. Section 2
  2. Section 3
  3. To put section 2/3 in place, need 2 doctors, 1 must be
  4. Section 4
  5. Section 17
  6. Which do police use
A
  1. Admission for assessment - 28 days
  2. Admission for treatment - 6 months
  3. Section 12 approved
  4. Emergency admission for assessment - 72 hours (if not time to wait for section 2)
  5. Community treatment order (supervised, must obey conditions or may be recalled as liable to section 3)
  6. 136
24
Q

Bipolar disorder

  1. Types (2)
  2. Mania - definition
  3. Hypomania - definition
  4. Long-term management - 1st line mood stabiliser
  5. 2nd line
  6. Long-term - 1st line for depressive symptoms

Acute mania - management

  1. If already on mood stabiliser + antidepressant
  2. If not on mood stabiliser/antipsychotic
  3. If that (or alternative) not tolerated
A
  1. Type I (mania + depression); Type II (hypomania + D)
  2. Severe impaired function / psychotic symptoms for 7+ days
  3. Decreased or increased function for 4+ days
  4. Lithium
  5. Sodium valproate
  6. Fluoxetine
  7. Stop AD, increase MS dose, add AP
  8. Haloperidol, olanzapine, quetiapine or risperidone
  9. Lithium / valproate
25
Q

Frontotemporal dementia (Pick’s disease)

  1. Features
  2. What remains relatively intact
  3. Imaging if FTD suspected
  4. Diagnostic finding
  5. Microscopic changes (4)
  6. Management - do not use what
  7. Semantic dementia - features
  8. Progressive non fluent (chronic progressive) aphasia
A
  1. Insidious onset, <65yo, personality change, hyperorality, disinhibition, increased appetite
  2. Memory and visuospatial skills
  3. FDG-PET or perfusion SPECT
  4. Focal gyral atrophy with knife-blade appearance (frontal + temporal lobes)
  5. Pick bodies - spherical Tau aggregations (silver-staining), gliosis neurofibrillary tangles, senile plaques
  6. AChE inhibitors, NMDA antagonists (memantine)
  7. Fluent progressive aphasia (conveys little meaning), recent memory better than long time ago
  8. Non fluent speech (agrammatic short uttering), comprehension preserved
26
Q

Cognitive function - general

  1. Different tests (3)
  2. MMSE - parts (6)
  3. If considering delirium, use what
A
  1. MMSE, MoCa, ACE-R
  2. Orientation, registration, attention, recall, language, copying
  3. Confusion assessment method (CAM)
27
Q

SSRIs

  1. Action
  2. Timeline
  3. How to take
  4. Length of treatment
  5. Effects - how long before seen
  6. Tests
  7. Important side effects
  8. Cautions / Contraindications
  9. Supplementary
  10. Which antidepressant if recently had MI
  11. Specifically interact with (+ why)
  12. Normal starting dose
  13. Acute withdrawal (sudden stop) - symptoms
A
  1. Stop neuronal serotonin uptake, altering brain chemical balance, thought to help mood/physical symptoms
  2. Once a day
  3. Tablet
  4. Stop 6 months after symptoms improve (slow taper)
  5. 4-6 weeks (ideally try for 4+ weeks before changing)
  6. -
  7. GI (N+V, loss of appetite, diarrhoea), anxiety (early but wears off), insomnia, sweating, low Na+ (elderly)
  8. Caution in epilepsy (lower seizure threshold), young, peptic ulcer, hepatic impairment, suicide risk (need to refer)
    Contraindication in mania phase of bipolar
  9. Mind
  10. Sertraline
  11. MAOIs e.g. selegiline, rasagiline (inhibit serotonin metabolism, higher risk of serotonin syndrome)
  12. 20mg PO OD
  13. GI upset, flu like withdrawal symptoms, insomnia
28
Q

Eating disorders

  1. Anorexia nervosa - features
  2. Abnormal bloods (low, high)
  3. Diagnosis (DSM 5)
  4. Bulimia nervosa - features
  5. Abnormal bloods
  6. Diagnosis
  7. Management
  8. Prescribing caution
A
  1. Reduced BMI, bradycardia, hypotension, amenorrhoea, ‘lanugo’ hair on body, hypothermia
  2. Low K+, low LH/ FSH/oestrogen/testosterone, low T3
    High cortisol, GH, cholesterol, carotin, impaired GTT
  3. Restriction of intake, fear of gaining weight, body dysmorphia/denial of seriousness
  4. Binge eating then purging (vomiting, laxatives), swollen salivary glands, ‘Russel’s sign’ (knuckle calluses)
  5. Alkalosis (vomiting up stomach HCl), low K+
  6. Recurrent binge, lack of control, abnormal compensatory behaviour, at least 1x a week for 3 months
  7. Individual eating disorder CBT, family therapy (kids)
  8. Medications causing long QT + arrhythmias can cause more of a problem due to electrolyte abnormalities
29
Q

Suicide risk

  1. Score
A
  1. SADPERSONs score
30
Q

Serotonin syndrome

  1. Drug causes
  2. Features
  3. Management - mild-moderate
  4. Addition if severe
A
  1. SSRIs, MAOIs, ecstasy, amphetamines
  2. Neuromuscular excitation (hyperreflexia, myoclonus, rigidity), autonomic NS excitation (hyperthermia), altered mental state
  3. Supportive IV fluids, benzodiazepines
  4. Serotonin antagonists (cyproheptadine, chlorpromazine)
31
Q

Antipsychotics - general

  1. Target which symptoms of psychosis
  2. Mechanism of action
  3. 1st generation - examples
  4. 2nd generation - examples
  5. Why 2nd generation better
  6. Caution in what diseases
  7. Contraindicated if (2)
  8. Monitoring - at start
  9. At 3 months
  10. At six months
  11. Yearly
A
  1. Positive
  2. Dopamine (D2 receptor) antagonist
  3. Chlor/levopromazine, haloperidol
  4. Olanz/Cloz/Quetiapine, risperidone, amisulpiride
  5. Better at treating treatment-resistant schizophrenia and negative symptoms, and lower risk of extra-pyramidal side effects
  6. Any CV disease
  7. Severe IHD, PMH of neutropaenia
  8. FBC, U+E, LFT, lipids, weight, fasting BM, prolactin, ECG, BP (+ frequently during dose titration)
  9. Lipids, weight
  10. Fasting BM, prolactin
  11. FBC, U+E, LFT, lipids, weight, fasting BM, prolactin, CV risk assessment
32
Q

Antipsychotics - side effects

  1. 2nd generation - higher risk of
  2. Clozapine - serious side effects (3)
  3. 1st generation - nigrostriatal pathway (EP) side effects
  4. Management of EPSEs
  5. Other side effects - antimuscarinic
  6. High prolactin (as usually inhibited by dopamine)
  7. Arrhythmia (+ most commonly caused by)
  8. Alpha adrenergic receptor blockade - effect
  9. Histamine blockade - effects (2)
  10. Effect if epileptic
A
  1. Metabolic syndrome - weight gain, DM, lipid changes
  2. Agranulocytosis, myositis, cardiomyopathy
  3. Parkinsonian symptom, acute dystonia, akathisia, NMS
  4. Procyclidine
  5. Dry mouth, constipation, urinary retention, blurred vision
  6. Galactorrhoea, amenorrhoea, sexual dysfunction
  7. Prolonged QT (haloperidol)
  8. Postural hypotension
  9. Sedation, weight gain
  10. Lowers seizure threshold
33
Q

Tricyclic antidepressants

  1. Action
  2. Timeline
  3. How to take
  4. Length of treatment
  5. Effects - how long before seen
  6. Important side effects - receptors blocked (4)
  7. Complications - cardiovascular (2)
  8. Neurological
  9. Sudden withdrawal
  10. Contraindications - do not prescribe with
A
  1. Inhibit serotonin and noradrenaline uptake at synapse
  2. Daily
  3. Tablet/oral solution
  4. Long-term - at least 6 months after symptoms improve
  5. 2 weeks
  6. H1 (sedation), muscarinic (dry mouth, blurred vision, urinary retention, constipation), dopamine (sexual dysfunction, breast changes), alpha
  7. Arrhythmias, other ECG changes
  8. Convulsions, hallucinations, mania
  9. GI upset, flu symptoms, neuro symptoms, sleep change
  10. MAOIs
34
Q

Atypical antipsychotics - counselling

  1. Action
  2. Timeline
  3. How to take
  4. Length of treatment
  5. Effects - how long before seen
  6. Tests
  7. Important side effects
  8. Complications / Contraindications
A
  1. Blocks receptors in brain that allow overactive chemical message transmission between nerve cells, causing schizophrenia
  2. Daily PO (bedtime) / slow IM (depot) every 2-4 weeks
  3. Start small dose, build up over 1-2 weeks, adjust
  4. Long term (keeps symptoms at bay)
  5. Several days / weeks
  6. Olanzapine (occasional LFTs), clozapine (WCC for neutropaenia weekly for 18 weeks, every 2 weeks from 18-52 weeks, monthly from 1 year), yearly health screen
  7. Anti dopamine, histamine, cholinergic, adrenergic
  8. Complication (NMS, agranulocytosis, withdrawal), contraindicated in liver failure, caution if epilepsy, pregnant, DM, CVD
35
Q

Lithium - counselling

  1. Action
  2. Timeline
  3. How to take
  4. Length of treatment
  5. Effects - how long before seen
  6. Tests - before starting
  7. Tests - lithium levels
  8. Tests - every 6 months
  9. Important side effects
  10. Side effects - toxicity
  11. Complications
  12. Contraindications
  13. Other advice - lifestyle
A
  1. Mood stabiliser
  2. 1-2 times daily
  3. Tablet, capsule or syrup
  4. Lifelong, with regular psychiatric reviews
  5. 1-2 weeks, 6-12 months for full effects
  6. FBC, U+E, TFT, bHCG, ECG, weight, BP, pulse
  7. At 12 hours, 5 days, then weekly until 4 weeks stable, then every 3 months
  8. TFT, U+E, Ca2+
  9. GI (abdominal pain, nausea), metallic taste, fine tremor
    Water symptoms (thirst, polyuria, impaired urinary concentration, weight gain, oedema)
  10. GI (anorexia, diarrhoea, vomiting)
    Neuromuscular (speak, dizzy, ataxia, twitch, big tremor)
    Other (drowsy, restless, apathy)
  11. Renal failure, nephrogenic DI, hypothyroid
  12. 1st trimester pregnancy, breastfeeding, big CV/renal disease, Addison’s, low Na+, untreated hypothyroid
  13. Alcohol - max 1-2 units/day
36
Q

Mood stabiliser - general

  1. Indications (4)
  2. Check for what in neck before starting
  3. Drug interactions (4)
  4. Important point when prescribing
A
  1. Prophylaxis for bipolar / schizoaffective disorder, recurrent depression, manic episode management
  2. Goitre
  3. ACE-i, diuretics, NSAIDs, SSRIs
  4. Prescribe by BRAND
37
Q

Sodium valproate - 2nd line MS

  1. Pre-questions
  2. Taken when
  3. Number of doses per day
  4. Avoid what (2)
  5. Length of treatment
  6. Side effects (8)
  7. Monitoring
A
  1. Pregnant / trying for a baby / breast feeding, liver/kidney problems
  2. After meals
  3. 2-3
  4. Alcohol, aspirin
  5. Usually lifelong
  6. Nausea, stomach pain, diarrhoea, headache, increased appetite/weight gain, fatigue, hair thinning
  7. Regular LFTs
38
Q

DVLA

  1. Must not drive, must inform DVLA during
  2. May be able to drive, must inform DVLA
A
  1. Severe anxiety/depression, acute psychosis, acute mania/hypomania, acute schizophrenia
  2. ADHD, dementia, mild learning disability, personality disorder
39
Q

Post-traumatic stress disorder (PTSD)

  1. Symptoms - re-experiencing
  2. Hyper-arousal
  3. Emotional
  4. Other
  5. Management - therapy
  6. If medication necessary, use what
A
  1. Flashbacks, nightmares, repetitive and distressing intrusive images)
  2. Hypervigilance for threat, exaggerated startle response, sleep problems, irritability and difficulty concentrating
  3. Emotional numbing, depression, anger
  4. Avoidance of things that could remind them, substance misuse, unexplained physical symptoms
  5. Watchful waiting to see if symptoms resolve within 4 weeks of event, then trauma-focussed CBT, eye movement desensitisation and reprocessing (EMDR) therapy
  6. Venlafaxine, SSRI (sertraline), risperidone if severe
40
Q

Attention deficit hyperactivity disorder (ADHD)

  1. Definition
  2. Diagnosis - DSM-5
  3. Following presentation, do what
  4. Drug therapy - from what age
  5. 1st line medication (6 week trial in children) + SEs
  6. Monitoring requirements in children
  7. 2nd and 3rd line
A
  1. Persistent inattentive + hyperactive/impulsive behaviour, with element of developmental delay
  2. 6 features up to age 16, 5 from 17+ years old
  3. 10 week ‘watch and wait’, then refer to secondary care if symptoms persist
  4. Last resort, from 5+ years old
  5. Methylphenidate (dopamine/norepinephrine reuptake inhibitor); abdominal pain, nausea, dyspepsia
  6. ECG at start (potentially cardiotoxic), weight and height every 6 months in children
  7. Lisdexamfetamine; dexamfetamine if L not tolerated
41
Q

Personality disorder - cluster B ‘(emotional/impulsive’)

  1. Antisocial - features
  2. Borderline (EUPD)
  3. Histrionic
  4. Narcissistic
A
  1. Against law, commoner in men, deception, impulsive, aggressive, irresponsible, lack of remorse
  2. Unstable relationships/self image, impulsive, suicidal, anger, avoid abandonment
  3. Inappropriate seductiveness, centre of attention, shifting shallow emotions, attention seeking, dramatic
  4. Grandiose self-importance, feel entitled, fantasies about success, takes advantage, no empathy, envy
42
Q

Personality disorder - cluster C (‘anxious’)

  1. Avoidant
  2. Dependent
  3. Obsessive-compulsive
A
  1. Fear of criticism/rejection, feels inferior, social isolation
  2. Can’t make decisions, lack of initiative, always need support, feel can’t care for themselves
  3. Details/rules/ perfectionist, dedicated, hoarder

Medical School (28 decks)

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