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FINALS revision - @medicbotanist > Psychiatry > Flashcards

Psychiatry Flashcards

1
Q

What are the 4 Ps used in psychiatry?

A

Predisposing

Precipitating

Prolonging

Protective

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2
Q

What is measured in a Mental State examination?

A
  1. Appearance and Behaviour
  2. Speech
  3. Thought and Delusions
  4. Perceptions and Hallucinations
  5. Cognition
  6. Insight
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3
Q

Describe what is seen in Tardive Dyskinesia?

A

Chronic condition associated with long time anti-psychotic use.

You will see tongue protrusion, rolling of tongue and sucking and smacking movements

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4
Q

What does the following MH Acts and Laws say?

Section 2 
Section 3 
Section 4 
Section 5(2) 
Section 5(4)
A

Section 2: you need to come into hospital for an assessment and diagnosis. 28 days
Section 3: treatment and 6 months
Section 4: emergency for any patients up to 72 hours
Section 5(2): emergency for INPATIENTS up to 72 hours
Section 5(4): emergency for inpatients by a nurse for max 6 hours

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5
Q

What does the following sections mean?

Section 136

Section 137

A

136: detention from public place ie not their home for up to 72 hours
137: police can force entry into someone’s house.

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6
Q

What two hormones/neurotransmitters does alcohol increase ?

A

GABA and dopamine

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7
Q

What are 5 RF that increase the risk of suicide?

A 
Male 
Age 
Previous suicide attempts 
Substance abuse 
Depression 
Lack of social support 
Single 
Chronic disease
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8
Q

How long do you have to have seasonal affective disorder to get a diagnosis?

A

Need to have had it for at least two years

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9
Q

What is the pathophysiology behind seasonal affective disorder?

A

Happens in the winter. related to an affected circadian rhythm.

You get more nocturnal melatonin production

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10
Q

What are 3 presentations of seasonal affective disorder?

A
  1. Increased eating
  2. Increased sleeping
  3. Symptoms of depression
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11
Q

What is the management of seasonal affective disorder?

A
  1. You need to give Light therapy
  2. CBT
  3. SSRI
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12
Q

How does Lithium work as a medication?

A

It inhibits cAMP production. This means that you get increased monoamines supplies

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13
Q

How do the anti psychotics (1st gen and 2nd gen) work?

A
  1. They block the post synaptic D2 receptor
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14
Q

How do anti epileptics work like sodium valproate?

A

They inhibit the sodium channels. Stabilising the membrane potentials and reducing neuronal excitability

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15
Q

How do benzodiazepines work?

A

They work by enhancing the binding of GABA to the GABA receptor

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16
Q

How does normal pressure hydrocephalus present?

A

Ataxia
Incontience
Dementia

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17
Q

What are two causes of normal pressure hydrocephalus?

A
  1. SAH

2. Trauma

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18
Q

What is the management of a patient who has normal pressure hydrocephalus?

A
  1. Shunt b
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19
Q

Where in the brain does Korsakoff psychosis effect?

A

Mammillary Bodies

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20
Q

What is Cotard’s Syndrome?

A

Nihilistic Beliefs that have associations of delusions of poverty

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21
Q

What is Diogene’s Syndrome?

A

When a previous very eccentric individual becomes increasingly isolated and neglect theirselves.

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22
Q

What are some of the complications of doing ECT ?

A

Memory Loss
Muscle Pain
Confusion
Nausea and Vomiting

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23
Q

How would you describe what happens in an acute dystonic reaction?

How do you treat it?

A

Acute Dystonia?
This is when you get head and neck involvement. You get involuntary muscle contractions. You can get eye involvement. You get tongue protrusion, grimacing etc.

Treatment is the anti cholinergic IM Procyclidine

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24
Q

What is the presentation of neuroleptic malignant syndrome?

How do you treat this?

A

You get
Muscle rigidity
Hyperthermia
Hypotension and incontience and altered mental state

Mx: cool the patient, Benzos, IV fluids and muscle relaxants bromocriptine

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25
Q

How does serotonin syndrome present?

A

Hyper reflexia
Impaired consciousness-> coma
Rigidity, tremor and ataxia
Hyperthermia, tachycardia and dilation of pupils.

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26
Q

What are the 3 core symptoms of depression?

A

Anhedonia
Depressed mood for more than 2 weeks
Affect on sleep / poor fatigue

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27
Q

How long do you have to have depression symptoms for a diagnosis?

A

More than 2 weeks.

28
Q

What assessment tools can you use to judge the severity of the dementia ?

A

PHQ 9

29
Q

Note you can get psychotic symptoms with depression !!

Who is it common in?

A

Old people!

30
Q

What is an example of a MAO-B inhibitor?

A

Phenelzine

31
Q

What are the 6 steps of the state of change model?

A 
Pre contemplative 
Contemplative 
Decision 
Action 
Maintenance 
Relapse
32
Q

What med to you give to someone who is opioid withdrawing?

A

You give them methadone

Then after 7 days give naloxone

33
Q

What 5 symptoms are characteristic of someone suffering from PTSD?

A
  1. Poor memory or gaps in memory from the trigger event
  2. Disengaged or distant
  3. Nightmares/ Flashback dreams
  4. Avoid triggers
  5. Hyper acute responses
34
Q

What are the 3 aetiological causes of OCD?

A

Dysfunctional Beliefs
Biological Factors

Personal Factors

35
Q

How long do you have to have experienced OCD symptoms to get a diagnosis?

A

2 weeks

36
Q

For a diagnosis of OCD what criteria need to be satisfied?

A

The thoughts originate in the head

Negative feelings towards these.

patient tries to resist the thoughts

Repetitive and unpleasant

37
Q

What are the 3 treatment options for someone with OCD?

A

Exposure Response Prevention Therapy

CBT

SSRI

38
Q

How do you treat schizoaffective disorder?

A
  1. Start on an anti psychotic: 1st gen Haloperidol or 2nd gen Risperidone
  2. Mood stabiliser : Lithium
  3. Really bad depression can start on SSRI
39
Q

How long can mania last for ?

A

2 weeks to 6 months

40
Q

What are 5 symptoms of mania?

A

I DIG FAST

Irritability 
Distractibility
Grandiose Delusions 
Flight of Idea 
Activity increased 
Sleep decreased 
Talkative
41
Q

How long do psychotic symptoms need to present in mania for in bipolar for a diagnosis?

A

Typically more than a week. Includes:

  • Grandiose ideas
  • Hallucinations
  • Loss of insight
42
Q

What 3 tests should you monitor before starting a patient on meds for bipolar?

A
  1. U&E
  2. TFTs
  3. ECG
43
Q

Management of bipolar?

A
  1. Lithium

2. Sodium Valproate or Lamotrigone or Carbamazepine

44
Q

What congenital abnormality is associated with Lithium use?

A

Epstein Phenomenon

45
Q

What condition is Lamotrigone associated with?

A

Steven Johnson Syndrome

46
Q

What age do personality disorders typically present?

A

Before the age of 18

They have a significant impact on that patient’s life and interactions

47
Q

Personality Disorders are split into 3 classes. What is the describer of each of these classes?

A

Type A: Odd

Type B: Emotional

Type C: anxious

48
Q

What 4 personality disorders are seen in Group A?

A

Schizoid: emotionally cold. Little social contact. Deep fantasy world

Schizotypal: weird beliefs

Paranoid: conspiracy plots

Dissocial: typically involves prisoners

49
Q

What are the 3 personality disorders that make up Class B?

A

Histrionic

EUPD: borderline you get lots of unstable relationships and self harm. In impulsive you get lots of anger and loss of impulse control

Narcissistic: Grandiose Delusions, Lack empathy and high self importance

50
Q

What 3 personality disorders are sen group C?

A

Anakastic: differentiated to OCD as the patient enjoys it.

Anxious

Dependent

51
Q

What is a useful management plan for someone with gambling issue?

A

Use the 12 step programme

52
Q

What is a somatoform pain disorder?

How do you manage it?

A

This is when you have the main symptom being pain.

However, there is no physical cause to explain the pain.

Mx: CBT, pain control team (TCA, SSRI etc)

53
Q

What is a conversion disorder?

A

This is when you have a functional loss without a multisystem complaint.

I.e one day you wake up and you can no longer move your arm.

54
Q

What is a fictitious disorder?

A

Feigning physical symptoms to assume a sick role

55
Q

What is hypochondriasm ?

A

This is when you have a firm belief you have a particular disorder

56
Q

In a somatisation disorder. What physical conditions do you need to exclude?

A

SLE

RA and other multi system disorders

57
Q

What are the 5 first rank symptoms of schizophrenia?

A
  1. 3rd person auditory hallucinations
  2. Delusional perceptions
  3. Thought Disorder (insertion, withdrawal etc)
  4. Somatic passivity (thoughts and actions controlled by someone else)
  5. Lack of insight
58
Q

What are some other non first rank symptoms of schizophrenia?

A
  1. Catatonia
  2. Delusions
  3. Negative symptoms
  4. Persistent hallucinations
59
Q

What are some negative symptoms of schizophrenia?

A

Paucity of speech

Blunting
Apathy
Social withdrawal
Incongruity of affect

60
Q

How long to need symptoms of schizophrenia to get a diagnosis?

A

Around 6 months

61
Q

How many first rank symptoms or other symptoms do you need for a schizophrenia diagnosis?

A

1st rank = only 1 !

Other symptoms = need two!

62
Q

What are some positive symptoms of schizophrenia?

A

Delusions
Hallucinations
Thought disorders

63
Q

What are the 3 different types of schizophrenia?

A

Paranoid

Catatonic

Hebephrenic

64
Q

What is typically the presentation of someone with paranoid schizophrenia ?

A
  1. Delusions of reference
  2. Delusions of persecution
  3. Delusions of special purpose
  4. Delusions of jealousy
65
Q

What is the typical presentation of Hebephrenic Schizophrenia?

A

Affective change (giddy and giggling)

Incoherent speech

Unpredictable behaviour

Fragmented delusions

66
Q

What is the management of schizophrenia ?

A
  1. Haloperidol or Risperidone
  2. If that doesn’t work start on olanzapine
  3. Treatment resistant = clozapine
67
Q

Give an example of a 3rd gen anti psychotic . Why isn’t it used that much?

A

Not very efficacious

Aripiprazole

FINALS revision - @medicbotanist (20 decks)

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