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Finals > Psychiatry > Flashcards

Psychiatry Flashcards

1
Q

What is delirium?

A

acute confusional state. Fluctuating and impaired consciousness. Onset is over hours/days with a rapid deterioration in preexisting cognitive function

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2
Q

What are the features of delirium?

A

COGNITIVE - low concentration, confused, disorientated in time and space
PERCEPTION - visual and auditory hallucinations
PHYSICAL - reduced mobility and movement, restuless, agitated, appetite changed - fluctuation in behaviours
SOCIAL - reduced cooperation, withdrawal, delusions

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3
Q

name the 2 types of delirium

A

hyperactive and hypoactive

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4
Q

DD for delirium?

A

drug/alcohol withdrawal, mania, psychosis, anxiety

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5
Q

name some causes for delirium

A

SDH, meningitis, sepisis, stroke, encepalopathy, UE deranged, hypoxia, liver/kidney injury, thiamine/B12/folate deficiency

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6
Q

Ix for delirium?

A

Bloods - FBC, UE, LFT, blood glucose, blood gas, blood culture
urine culture
ECG
CT/CXR/LP

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7
Q

Mx for delirium

A

treat precipitating cause
optimise surroundings
1st line Mx = Haloperidol (monitor BP)

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8
Q

what is dementia?

A

progressive and global intellectual deterioration without impaired consciousness. 1st symptom = memory loss

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9
Q

features of dementia?

A

BEHAVIOUR - repetitive, restless, rigid and fixed routines
PERSONALITY - sexual disinhibition, shoplifting, blunting
SPEECH - dysphasia, mutism
THINKING - slow, muddled, reduced memory, confabulation, no insight
PERCEPTION - illusions, hallucinations
MOOD - irritable, depressed, crying

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10
Q

name the 4 As of alzheimers

A

amnesia, aphasia, agnosia, apraxia

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11
Q

irreversible causes of dementia

A

Alzheimers, vascular, lewy body, frontotemporal

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12
Q

Ix for a patient presenting with dementia symptoms?

A

fully history of function and decline/collateral Hx
BLOODS - FBC, UE, LFT, B12, folate, gGT, Ca, TSH, syphyllis, ESR, HIV
CT/MRI head - SD
cognitive examinations

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13
Q

Name some cognitive exams to do on a dementia investigation?

A 
MMSE/AMSE
MOCA
addenbrooks
AMT
FAB
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14
Q

Name a medication and class that you can use in a patient with dementia to improve symptoms?

A

Rivastigmine - Acetylcholinesterase inhibitor

Memantine - NMDA receptor antagonist

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15
Q

what is ECT used for?

A

severe catatonic depression which is non-responsive to medication

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16
Q

what is schizoaffective disorder?

A

schizophrenia + mood disorder

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17
Q

what is section 2 of the MH law?

A

admission for assessment for <28 days. Requires 2 doctors (1 section 12 approved) and you can appeal within 14 days

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18
Q

what is section 3 of the MH law?

A

admission for treatment for <6 months. must have a diagnosis and appropriate management stated

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19
Q

what is section 4 of the MH law?

A

emergency treatment for <72 hours. Could be converted into a section 2 or a section 3.

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20
Q

What is a section 5(2) in the MH law?

A

detention of a patient already in hospital for <72 hours.

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21
Q

What is a section 5(4) in the MH law?

A

detention of a patient already in hospital by an authorized psych nurse for <6 hours.

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22
Q

what is somatisation disorder?

A

patient presents with multiple physical symptoms over 2 years. they refuse to accept reassurance from negative test results

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23
Q

what is anxiety?

A

maladaptive psych symptoms not due to organic cause, and precipitated by stress. can be a normal response but in anxiety disorder this response is exaggerated and lasts >3 weeks

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24
Q

symptoms of anxiety?

A

COGNITIVE - agitated, impending doom, reduced concentration, insomnia, repetitive thoughts, concern of self image
SOMATIC - tension, trembling, sense of collapse, butterfies, increased HR, headaches, sweating, palpitations
BEHAVIOURS - reassurance seeking, avoidance, dependance on a person
CHILDREN - thumb sucking, nail biting, bed wetting

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25
Q

how do you manage anxiety

A

GENERAL - listen and explain, exercise, meditation, breathing exercises, relaxation techniques
THERAPIES - CBT, hypnosis
MEDICATION - 1st line = SSRI
SYMPTOMATIC - B blocker

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26
Q

what are compulsions and obsessions?

A

COMPULSION - senseless repeated rituals

OBSESSIONS - purposeless ideas/words, perceived by the patient as intrusive (not like delusions.)

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27
Q

How do you manage OCD?

A

SSRI (e.g. fluoxetine)

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28
Q

What is a phobic disorder?

A

anxiety experienced in a well-defined situation that is not dangerous. This situation is avoided as it causes a lot of distress and impaired function

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29
Q

how do you manage a phobic disorder?

A

need to elicit the stimulus!

CBT + SSRI

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30
Q

what is PTSD?

A

develops after a stressful/life threatening situation

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31
Q

symptoms of PTSD?

A 
re-experiencing the event - vivid nightmareds/flashbacks in which there is raised BP and HR
sleep disturbance
reduced concentration
drug and alcohol misuse
emotional numbing
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32
Q

Mx for PTSD?

A

eye movement desensitization and reprocessing
CBT
SSRI

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33
Q

What are the core symptoms of depression?

A

depressed mood, anhedonia, fatigue

34
Q

more typical symptoms of depression?

A

reduced appetite, insomnia, reduced concentration, psychomotor retardation, reduced libido, feelings of worthlessness and guilt

35
Q

How do you score Mild/Mod/Sev depression

A 
Mild = 2 core + 2 typical
Mod = 3 core + 2 typical
Sev = 4 core + 3 typical

+/- psychosis/manic symptoms

36
Q

name 2 screening tools for depression

A

HAD scale, PHQ9

37
Q

How do you manage depression?

A

GENERAL - sleep hygeine, anxiety management, self help books, computorised CBT
IF MOD = CBT + SSRI
SEVERE = rapid MHA/ECT

38
Q

how do you identify severe depression (SUICIDE)?

A 
suicide plan/self harm
unexplained guilt/worthlessness
impaired function
concentration impaired
impaired appetite
decreased sleep/early waking
energy low
39
Q

What is the order for antidepressant use in depression?

A

1st line = SSRI
2nd line = alternative SSRI
3rd line = NaSSA/SNRI
4th line = TCA

40
Q

Give examples of SSRIs and their side effects

A

Citalopram/Sertriline/Fluoxetine
GI symptoms, hyponatraemia, increased anxiety when beginning, increased weight, sexual dysfunction
prolonged QT with citalopram

41
Q

Give examples of NaSSA and their side effects

A

Mirtazipine

sedation, increased appetite

42
Q

Give examples of SNRIs and their side effects

A

Venlaflaxine

nausea, dry mouth, drowsy, constipation, blurred vision

43
Q

Give examples of TCA and their side effects

A

Amitryptilline

drowsy, dry mouth, blurred vision, constipation, urinary retention

44
Q

what are the signs of mania?

A

MOOD - irritable, euphoric
COGNITION - grandiosity, distractable, flight of ideas, confusion, lack of insight
BEHAVIOUR - rapid speech, hyperactive, reduced sleep, hypersexuality
PSYCHOSIS - delusions, hallucinations

45
Q

Name some causes of mania?

A

Meds - steroids, amphetamines, cocaine, SSRIs

PHYS - infection, stroke, neoplasm, bipolar

46
Q

how do you assess someone who is acutely manic?

A

ASSESS - infections, drug use, CT head/EEG, screen toxins

EXAMINE - cycling speed, psychosis, suicide Rx

47
Q

How do you manage acute mania?

A

Olanzipine

48
Q

What medication do you use as prophylaxis of bipolar disease - what screening do you need to do before

A

Lithium carbonate

UE, T4, ECG

49
Q

what is the therapeutic dose of lithium

A

0.6 - 1.0

50
Q

causes of lithium toxicity?

A

dehydration, renal failure, thiazide diuretics, NSAIDS, metronidazole

51
Q

features of lithium toxicity

A

coarse tremor, hyperreflexia, acute confusion, polyuria, seizure and coma

52
Q

How do you manage lithium toxicity?

A

Mild - 0.9% normal saline

Severe - haemodialysis

53
Q

how does cocaine act on the body?

A

blocks uptake of dopamine, noradrenaline and serotonin

54
Q

effects of cocaine on the body?

A

CVS - MI, increased HR and BP, QT prolongation, aortic dissection
PSYCH - agitation, psychosis, hallucination
NEURO - seizure, mydriasis, hypertonia, hyperreflxive

55
Q

Mx of cocaine toxicity?

A

benzodiazepene

56
Q

what are the features of dependance on a substance?

A

strong compulsions/cravings
difficulty controlling substance levels of use
withdrawal
tolerance
neglect of other hobbies
persisting using despite harmful consequences

57
Q

signs of opioid use?

A

rhinorrhea, needle tracks, pinpoint pupils, drowsy, yawning

58
Q

complications of opioid addiction

A 
HIV/Hep B and C
infective endocarditis and sepsis
DVT
respiratory depression
social - prostitution and crime
59
Q

how can we reduce harm to opioid addicts?

A

needle exchange programmes
HIV and Hep B and C testing
Methodone and buprenorphine

60
Q

how does Naloxone work?

A

opioid antagonist - blocks euphoria in relapse

61
Q

How do you screen for alcohol overuse?

A

CAGE

  • ever felt you should cut down?
  • have people been annoyed by your drinking?
  • ever felt guilty about drinking?
  • ever had an eye opener drink?
62
Q

signs of delerium tremens?

A

72 hours after stopping drinking alcohol

high heart rate, BP drops, tremor, fits, tactile or visual hallucinations

63
Q

how do you manage delerium tremens?

A

monitor BP

give chlordiazepoxide

64
Q

list support and 2 medications to help with alcohol abstinence?

A 
treat coexisting depression
refer to specialists
AA
Disulfiram - nasty reaction when relapse
Naltrexone - reduces the pleasure when drinking (opioid antagonist)
65
Q

Long term side effects of alcohol abuse?

A

LIVER - fatty liver, cirrhosis, hepatitis
CNS - memory and cognition, cerebellar atrophy, wernicke and korsakoff
GI - D&V, ulcers, varices, pancreatitis
CVS - arrhythmia, increased BP

66
Q

what causes wernickes encepalopathy?

A

longstanding thiamine deficiency (B1)

67
Q

triad of wernickes encepalopathy?

A

confusion, wide gait ataxia, ophtalmoplegia (nystagmus and conjugate gaze)

68
Q

Mx for wernickes encepalopathy?

A

IM thiamine

69
Q

what is Korsakoff syndrome?

A

hypothalamic damage and cerebral atrophy due to longstanding thiamine deficiency

70
Q

features of korsakoff syndrome?

A

unable to form new memories (confabulation)

no insight and apathy

71
Q

Name the first rank symptoms of schizophrenia

A

auditory hallucinations - thought echo, 3rd person, 2 people discussing in 3rd person

thought disorder - thought insertion/withdrawal/broadcast

passivity phenomena - body sensations externally controlled

delusional perception - object normal but leads to a delusion (traffic light green, therefore I am a god)

72
Q

what is required for the diagnosis of schizophrenia?

A

a clear 1st rank symptom lasting >6 months, with all other causes ruled out

73
Q

DD for schizophrenia?

A

head injury, tumour, bipolar, drugs, alcohol

74
Q

Main RF for schizophrenia?

A

genetics

75
Q

Name some psych interventions for patients with schizophrenia?

A

CBT - target hallucinations/delusions
Work with family
Social support
Early interventions service - supports people in their first psychotic episode (reduce time of untreated pschosis, quick effective care, increase return to education/employment, maintain life trajectory)

76
Q

What advice/monitoring do you do before starting an antipsychotic?

A

Hx/Fam Hx of diabetes/HTN/CVD
advice on diet/exercise/weight control
MONITOR: BP/weight/BG/lipids/FBC/ECG for clozapine

77
Q

how do first generation antipsychotics work? name a few and the side effects

A

D2 antagonists
e.g. Haloperidol
SE = EPSE - tremor, slurred speech, akathesia, dystonia, tardive dyskinesia

78
Q

how do you manage dystonia and tardive dyskinesia?

A

Dystonia - Procyclidine

Tardive dyskinesia - tetrabenazine

79
Q

How do second generation antipsychotics work? name a few and the SE

A

5HT2A and D2 antagonist
e.g. Risperidone/Olanzapine/Quetiapine
SE = hyperprolactinaemia, sexual dysfunction, increased weight, DM, CVS SE, daytime drowsiness

80
Q

Name SE of clozapine - what additional baseline Ix are needed

A

Agranulocytosis and myocarditis

FBC and ECG

81
Q

Different personality disorders - discuss the clusters and types

A

look in notes

Finals (21 decks)

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