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PT prep > Psychiatry > Flashcards

Psychiatry Flashcards

1
Q

Mental State Examination parts

A 
Appearance and behaviour 
Speech- RTV
Mood and affect
Thoughts
Perceptions
Insight
Cognition 
Suicidal ideation
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2
Q

What is a delusion?

A

Firm, fixed false belief in something that is not in-keeping with cultural or societal views

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3
Q

What is an illusion

A

Real stimulus but false perception

Can be normal

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4
Q

Types of thoughts in MSE

A 
Tangential
Circumstantial
Knight's move
Clanging/ punning
Blocking
Perseveration 
Disorganised
Neologism 
Loosened associations
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5
Q

Things to comment about appearance in MSE

A 
Unkempt
Clothing
Behaviour- eye contact, expressions
Motor symptoms- akathisia, depressive
Body habitus
Distracted
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6
Q

Types of hallucination

A 
Auditory
Visual
Gustatory 
Olfactory 
Somatic 
Tactile
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7
Q

One unit of alcohol in grams

A

8g of absolute alcohol

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8
Q

Alcohol detoxification withdrawal symptoms/signs

A

Seizures after around 37 hours
Delirium tremens after around 72 hours

1-4 days 
Nausea and vomiting
Tremor
Sweats 
Anxiety
Disturbed sleep
Hypertension
Tachycardia
2+ days
Confusion
Extreme agitation 
Dehydration
Delirium tremens
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9
Q

Symptoms/signs of delirium tremens

A 
Severe confusion 
Agitated behaviour 
Extreme hyperactivity 
Global dysfunction 
LOC
Hallucinations
Sleep disturbance
Fever
HTN
Tachycardia 
Hyperhidrosis 
Dehydration
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10
Q

Scoring system used in alcohol withdrawal

A

CIWA-Ar
10 or more then diazepam
Three scores less than 10- stop diazepam

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11
Q

ICD-10 definition of dependence syndrome

A

Compulsion to take it and difficulty controlling this
Physiological withdrawal state
Evidence of tolerance
Neglect of alternative pleasures
Continuation of substances despite harming consequences

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12
Q

Drugs for alcohol withdrawal

A

Disulfiram- causes acute insensitivity reaction to ethanol- inhibits acetaldehyde dehydrogenase
Naltrexone- opioid receptor antagonist, reduces cravings and euphoria
Acamprosate- GABA analogue, good for maintenance of alcohol abstinence

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13
Q

Adverse effects of lithium

A

Nausea and vomiting
Diarrhoea
Fine tremor
Nephrotoxic- diabetes insipidus and secondary polyuria
Hypothyroid secondary to thyroid enlargement
IIH
Weight gain
Leucocytosis
Hyperparathyroidism and secondary hypercalcaemia

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14
Q

When should lithium levels be monitored?

A

12 hours post-dose
Weekly after starting or changing dose, until stable levels
Checked every 3 months
Thyroid and renal function assessed every 6 months

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15
Q

Features of lithium toxicity

A 
Coarse tremor 
Hyperreflexia
Acute confusion 
Polyuria 
Seizure
Coma
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16
Q

Lithium toxicity may be precipitated by

A

Dehydration
Renal failure
Diuretics, ACE-i, ARBs, NSAIDs and metronidazole

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17
Q

Lithium toxicity management

A

If low levels then alkalisation of urine may help to excrete more
Fluid resuscitation

If extreme then haemodialysis may be indicated

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18
Q

Side effect of Mirtazapine

A

Increase in appetite

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19
Q

Conversion disorder

A

Typically motor or sensory options

Patient doesn’t consciously feign symptoms or seek material gain

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20
Q

Second generation anti-psychotics

A 
Clozapine
Olanzapine
Risperidone 
Quetiapine 
Amisulpride
Aripiprazole
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21
Q

Monitoring of what with clozapine use is extremely important

A

FBC
Risk of agranulocytosis/ neutropenia
Should only be used in patients resistant to other treatment
Dose adjustment if starting or stopping smoking

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22
Q

What is bulimia nervosa?

A

Characterised by episodes of uncontrollable binge eating followed by purgative behaviours to prevent weight gain (such as self-induced vomiting, laxative use, diuretics, exercise)

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23
Q

First generation antipsychotics and their side effects

A

Haloperidol, chlorpromazine

Extrapyramidal side effects and hyperprolactinaemia are common

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24
Q

Examples of typical antipsychotic extra-pyramidal side effects

A

Parkinsonism
Acute dystonia- sustained muscle contraction (managed with procyclidine)
Akathisia
Tardive dyskinesia

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25
Q

Best SSRI post-MI

A

Sertraline

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26
Q

Which SSRI is most likely to cause a prolonged QT?

A

Citalopram

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27
Q

SSRI side effects

A

Most common is GI
Increased risk of GI bleed (PPI if also on NSAID)
Hyponatraemia

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28
Q

Management of Generalised Anxiety Disorder

A

Education about GAD and active monitoring
Low intensity psychological interventions- self help or psychoeducational groups
CBT or drug treatment
Specialist input

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29
Q

PTSD management (symptoms for 4 weeks)

A

Watchful waiting if <4 weeks
Trauma-focused CBT or Eye Movement Desensitisation and Reprocessing
Venlafaxine or SSRI if pharmacological is necessary

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30
Q

Anti-muscarinic side effects of TCAs

A 
Blurred vision
Dry mouth
Drowsiness
Constipation
Urinary retention
QT lengthening
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31
Q

Schneider’s first rank symptoms of Schizophrenia

A

Auditory hallucinations- thought echo, two or more voices discussing in the third person, voices commenting on patients behaviour (running commentary)

Thought disorder- Insertion, withdrawal, broadcasting

Passivity phenomena- body activities being controlled externally, experiences are imposed on the individual- eg actions, impulses or feelings

Delusional perceptions- a two stage process- delusional insight from a normal stimulus

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32
Q

How long should SSRIs be prescribed for minimum

A

6 months- prevents relapse into depression

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33
Q

Indications for ECT

A

Severe depression, catatonic schizophrenia and severe mania

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34
Q

Side effects of ECT

A

Headache, nausea, memory impairment and arrhythmias

Very few long term effects noted

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35
Q

Definition of hypomania

A

Decreased or increased function for 4 days

Elevated mood or irritability

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36
Q

Definition of mania

A

Severe functional impairment or psychotic symptoms (delusions of grandeur or hallucinations) for 7 days or more

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37
Q

Definition of chronic insomnia

A

Trouble falling asleep or staying asleep at least 3 nights a week for at least 3 months

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38
Q

What should be measured and observed in people starting an SSRI?

A

U&Es- risk of hyponatraemia

39
Q

Indications for ECT

A

Treatment resistant depression
Manic episodes
Catatonia (life threatening)
Episode of moderate depression known to respond to ECT in the past

40
Q

Somatisation disorder

A

Unexplained symptoms persisting for at least 2 years, refusal to accept negative results

41
Q

Erotomania

A

Delusional disorder that involves the belief that a famous person is in love with you, absence of any other psychotic features

42
Q

Diagnosis of anorexia nervosa

A

Restriction of energy intake relative to requirements leading to a low body weight
Intense fear of gaining weight, getting fat, even though underweight
Disturbance in the way one’s body shape or weight is experienced, denial of the seriousness of underweight, undue influence of body weight on self-image

43
Q

Management of anorexia nervosa

A

Anorexia focused family therapy first line in children and young people
CBT 2nd line

44
Q

Side effects of ECT

A

Immediate- drowsiness, confusion, headache, nausea, aching muscles, anorexia, cardiac arrhythmia, retrograde memory loss, short term memory impairment
Long term- apathy, anhedonia, difficulty concentrating, loss of emotional responses, difficulty learning new information

45
Q

Factors associated with a poorer prognosis in schizophrenia

A 
Low IQ
Strong FH
Social withdrawal prodrome 
Gradual onset
Lack of obvious precipitant
46
Q

What is an oculogyric crisis?

A

Spasmodic movements of eyeballs into fixed positions, typically upward deviation

47
Q

Core features of major depressive episode and other features

A 
Depressed mood, anhedonia and/or anergia 
Weight loss or gain
Anorexia or increase in appetite 
Insomnia or hypersomnia
Psychomotor agitation or retardation 
Fatigue
Feelings of worthlessness or guilt
Loss of concentration 
Suicidal ideation
48
Q

Main features of a manic episode

A

Mood- inappropriate, elevated, excited, irritable
Motor activity/ volition- productive, increased energy, reduced sleep, poor concentration, increased libido
Increased cognition- rapid speech, flight of thoughts, clang associations, rhyming, grandiose ideas

49
Q

Bipolar type 1

A

At least one manic episode for at least one week

Significant impairment of functioning

50
Q

Bipolar type 2

A

Milder episode of hypomania
No severe impairment
Duration of 4 days

51
Q

Management of bipolar affective disorder

A

Admission
Antipsychotic drugs and lithium
Prophylactic mood stabilisers- lithium, anticonvulsants, atypical anti-psychotics
Psychosocial support

52
Q

Average number of ECT shocks to achieve remission

A

8

53
Q

Contraindications of ECT

A

Brain tumour
Increased ICP
Recent MI
Brain aneurysm

54
Q

Memory loss from ECT

A

Uncommon to have autobiographical memory loss
Increased cognitive testing 4-14 days post-test
Metanalysis shows no cumulative cognitive deficits from successive treatment

55
Q

What is psychosis

A

‘Loss of contact with reality’

Inability to pick out salient information

56
Q

What is a delusion

A

Fixed, firm, unshakeable belief in something that is held against the evidence and the social and cultural norms

57
Q

Environmental factors that increase likelihood of developing schizophrenia

Though FH- genetic is greatest risk!

A 
Fetal infection and malnutrition
Chronic cannabis consumption 
Urbanicity 
Social class
Social isolation 
Immigrant status
58
Q

What is the PANSS scoring system?

A

Positive and negative syndrome scale

59
Q

Positive symptoms of schizophrenia

A

Symptoms of psychosis
Delusional perception
Hallucinations (auditory most common)

60
Q

Negative symptoms of schizophrenia

A 
Blunted affect
Alogia
Avolition
Anhedonia
Asociality
61
Q

Management of schizophrenia

A

Biopsychosocial approach
Anti-psychotic medication- assess which will be best
Initial benzodiazepines acutely
Psychological- psychoeducation, CBT and/or family therapy
Social- housing and benefits, substance misuse, occupation and employment, lifestyle- smoking, exercise, diet

62
Q

Tests to perform before beginning anti-psychotic medication

A

Weight and waist circumference
Pulse and BP
Fasting blood glucose, HbA1c, lipid profile and prolactin levels
Assessment of any mood disorders
Nutritional status, diet and level of physical activity

63
Q

Treatment resistant schizophrenia and management

A

Attempted two different antipsychotics at an adequate dose for an adequate amount of time (6-8 weeks), one has to be a second generation antipsychotic

Clozapine

64
Q

Side effects of clozapine

A

AGRANULOCYTOSIS
Anti-dopaminergic- tardive dyskinesia, tremor, movement disorders, apathic facial expressions
Anti-cholinergic- constipation, dry mouth
Anti-histamine- weight gain, dizziness, drowsines
Anti-adrenergic- hypotension
Neuroleptic malignant syndrome
Withdrawal
Seizures

65
Q

Section 135

A

Police can enter your home and remove an individual to a place of safety for assessment by approved mental health care professionals

66
Q

Section 136

A

Police can detain individuals in a safe place from a public place (usually kept in station or hospital)

67
Q

Section 5(2)

A

Doctors have the ability to detain an inpatient for up to 72 hours but CAN’T force treatment

68
Q

Section 5(4)

A

Nurses can detain inpatients for up to 6 hours

69
Q

Section 2 of the mental health act

A 
Assessment of mental health disorder 
Up to 28 days
Require 2 senior doctors and another health or social worker (AMP)
Can treat
Can be appealed after 14 days
70
Q

Section 3 of the mental health act

A

Long term section for treatment

Up to 6 months with various appeal processes

71
Q

What class is Mirtazipine?

A

NaSSA

Noradrenaline and specific serotonin antidepressant

72
Q

Risk assessment of a failed suicide

A 
4Ps to assess degree of intent and seriousness
Planning vs impulsivity 
Precautions to remain hidden
Preparations prior to act
Public/ in isolation 
Regret
Future planning
Current MSE
Past Hx and background
Coping mechanisms
Protective factors
73
Q

Schizoid personality

A

Introspective, asociality, emotionally cold, asexual, lack of close relationships

74
Q

Paranoid personality

A

Bears grudges, possessive, suspicious, combative, excessive self importance

75
Q

Schizotypal personality

A

Ideas of reference , strange beliefs and thinking, abnormal perceptual experiences, paranoia and social anxiety, inappropriate affect, strange behaviour or appearance

76
Q

Antisocial personality

A

Impulsive, aggressive, irritable, tendency or violence and aggression, short lived relationships

77
Q

Emotionally unstable personality

A

Intense unstable relationships, boredom/emptiness, uncertain about identity, fear of abandonment, unstable mood, impulsive

78
Q

Histrionic personality

A

Dramatic, excessive, exaggerated, shallow, centre of attention, inappropriate, manipulative

79
Q

Narcissistic personality

A

Need to be admired, egocentric, entitled, lack of empathy, grandiosity

80
Q

Anankastic/ obsessive- compulsive personality

A

Rigid, requires order, adherence to rules, perfectionist, exclusion of pleasure, intrusive thoughts

81
Q

Anxious personality

A

Social withdrawal, fear of rejection, low self esteem, inferiority, embarrassment

82
Q

Dependent personality

A

Requires reassurance, fear of abandonment, insecure, clingy, indecisive

83
Q

Clinical features of ADHD

A

Inattention
Over activity
Impulsivity

84
Q

Management of ADHD

A

Bio- medication- methylphenidate or dexamphetamine
Psych- Parenting training programmes, CBT/behavioural therapy
Social- Structure and routine, educational support/ school liaison

85
Q

Side effects of methylphenidate/ dexamphetamine

A

Headaches, insomnia, anorexia, dizziness, anxiety

Growth suppression

86
Q

Autism spectrum disorder clinical features

A

Triad of
Social impairment
Communication impairment
Restrictive/ repetitive behaviours and interests

87
Q

Management of autism

A

Bio- risperidone, SSRI
Psych- SALT, social skills training, behavioural modification programmes, parental training courses
Social- appropriate educational setting

88
Q

What is a learning disability?

A

Significant sub-average intellectual functioning
Deficits in adaptive or social functioning
Onset within developmental period

89
Q

Investigating confusion in the elderly

A 
Bloods and blood culture
ABG
CXR
MMSE/AMT
Urine and culture
ECG
CT head/ LP/EEG if indicated
90
Q

Puerperal psychosis recovery time

A

Usually 6-8 weeks

91
Q

Management of puerperal psychosis

A

As per condition outside pregnancy
Bio- benzos, antipsychotics, mood stabilisers, antidepressants, ECT
Psych- CBT, family therapy, psychoeducation
Social- Support for the family, housing, employment, protection of the children

92
Q

Suicide risk assessment questions

A 
Current episode
BEFORE
Precipitant 
Planned or impulsive
Precautions against discovery 
Alcohol 
DURING
Method, alone, where, what was going through their mind, did they mean to end their life, what did they do straight after
AFTER
Who were they found by, how did they feel when help arrived, do they regret it, current mood, still feeling suicidal, what would they do if they went home today
93
Q

Specific questions to ask about overdose

A 
What medication(s) did they take?
Where did they get it
How much of them?
What did they take it with?
How long had they been planning and what made them decide?
What did they do after?
How did they get here?

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