Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Anki 3a exports > psychiatry anki > Flashcards

psychiatry anki Flashcards

1
Q

What is an illusion

A

Misenterpretation of an external stimulus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is a hallucination

A

Perception without an external stimulus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is a pseudo-hallucination?

A

Hallucination where the patient is aware it’s not real

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is an overvalued idea?

A

Solitary, abnormal belief that is not delusional or obsessional but preoccupying to the extent of dominating the persons life

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is a delusion?

A

Fixed, false belief maintained despite contrary evidence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is delusional perception?

A

A true perception to which a patient attributes a false meaning.
E.g. traffic lights turning red means aliens are coming

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is concrete thinking?

A

Literal thinking focused on the physical world

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is meant by loosening of association?

A

AKA derailment, knight’s move thinking
No connection between topics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is cirumstiantiality when describing thought patterns

A

Adds in irrelevent details but eventually returns to topic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is meant by tangential thoughts?

A

Digress from subject with unrelated thoughts but there is a connection between thoughts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is thought blocking?

A

Sudden cessation of thought

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is meant by flight of ideas?

A

Pressured speech with shifts in topic with only a loose connection between ideas

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is perserveration?

A

Repitition of specific response despite removal of stimulus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are neologisms?

A

Made up words, unintelligible

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is meant by word salad?

A

Random string of words with no relation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is meant by confabulation?

A

Generation of a fabricated memory without the intention of deceiving someone else

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is somatic passivity?

A

Experiene of one’s body or bodily sensations being controlled or influencfed by an external force

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is meant by pressure of speech?

A

Person speaks rapidly and continuously, often without pauses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is anhedonia?

A

Inability to enjoy things/experience pleasure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is incongruity of affect?

A

Mismatch between a person’s emotional expression and content of thoughts of speech

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is meant by blunting of affect?

A

Reduction in intensity and range of emotional expression-Limited facial expressions, monotone speech etc

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is meant by the belle indifference?

A

Patient shows indifference/a lack of concern toward their symptoms depsite severity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is meant by depersonalisation?

A

Detatched from own thoughts, feeling or body

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is thought alienation?

A

Group of symptoms where patients feel thoughts are not their own. Includes:
1. Thought insertion
2. Thought withdrawal
3. Though broadcasting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Define thought insertion

A

Belief that thoughts are being placfed into one’s mind by an external source

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What is thought withdrawal?

A

Belief that thoughts are being removed from one’s mind

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What is thought broadcasting?

A

Belief that one’s thoughts are being broadcasted or shared with others

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What is meant by thought echo?

A

Auditory hallucinations of their own thoughts being spoken aloud shortly after thinking them

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What is akathisia?

A

Movement disorer characterised by intense restlessness and inability to stay still.Side effect of antipsychotics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Define catatonia

A

Psychomotor disorder that can affect a person’s ability to move normally

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What is stupor?

A

A symptom of catatonia in which the patient is unresponsive and unable to move, speak or react to external stimuli

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What is psychomotor retardation?

A

Noticeable slowing down of thought processes and physical movements

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What is flight of ideas?

A

Rapid and continuous speech with frequent shifts in topic with only a loose connection between ideas

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What is a formal thought disorder?

A

Disruption in the organisation and expression of thought rather than the content

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Define derealisation

A

Dissociative symptom where a person feels detached from their surroundings

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What is a mannerism in psychiatry?

A

Habitual, often repetitive movement or gesture that appears to have some significance but may be out of context or exaggerated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What is stereotyped behaviour psychiatry?

A

Repetitive non functional motor movements, vocalisations or behaviours-
Often seen un individuals with developmental disorders like ASD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Define obsessions

A

Intrusive, unwnted thought, image or urge that repeatedly enters a person’s mind causing significant anxiety or distress

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Define compulsion

A

Repetitive behaviour or mental act that a patient feels compelled to perform in response to an obsession or according to specific rules

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

What is the criteria for sectioning under the MHA?

A

Must have a MENTAL disorder
Must be a risk to their health/safety or the safety of others
Must be a treatment(including nursing/social care)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

What is the one physial illness a patient could be sectioned and treated for?

A

Anorexia nervosa-> re-feeding is allowed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Who carries out a mental health act assessment?

A

> =2 doctors, 1 of whom must be section 12(2) approved
1 approved mental health professional(AMHP)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Can a patient be considered for sectioning under the mental health act if under the influence of drugs/alcohol?

A

No-under the influence excludes patients from detainment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

What is section 2 of the MHA?

A

Compulsory detention for assessment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

What is the citeria for detention under section 2 of the MHA?

A

Mental disorder AND risk to self/others

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

How long can you hold a patient for under Section 2 of the MHA?

A

Max 28 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Is section 2 of the MHA renewable?

A

No

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Which healthcare professionals are required to detain a patient under Section 2 of the MHA?

A

AMHP or NR+2 doctors(one S12 approved)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Describe section 3 of the MHA

A

Compulsory detention for treatment
Criteria: mental disorder and risk to self/others with treatment available
Lasts max 6 months
Renewable
2 drs(one S12) and AMHP, seen in last 24 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Describe section 4 of the MHA

A

Admission for assessment in emergency
Lasts for max 72 hours then usually switched to Section 2
Single dr and AMHP required

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

What is section 5(2) of the MHA and how long does it last for?

A

Detainment of voluntary inpatient in hospital
Max 72 hours, only 1 dr needed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

What is the difference between section 5(2) and 5(4) of the MHA?

A

Both detainment of voluntary inpatient in hospital5(2) required dr, 5(4) requires registerend nurse and only lasts 6 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

What is section 17 a of the MHA for?

A

Community treatment order-patient on section 3 can leave for treatment in the community

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

Who makes a section 17a of the MHA decision?

A

Responsible clinician and AMHP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

When can a section 17a mof MHA be recalled and if recalled, how long can patients be held?

A

Recalled if non-compliant with treatment and missing appointments
If recalled, can be held for up to 72 hours for assessment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

What is section 135 of the MHA for?

A

Police can enter proerpty to escort someone to a Place of Safety(police station or A&e)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

What is section 136 of the MHA for?

A

Can take someone from a public place to a Place of Safety

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

What is section 131 of the MHA?

A

Informal admission-voluntary

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

What is the criteria for a section 131 admission?

A

Must have capacity
Must consent to admission
Must not resist admissions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

What are the key principles of the Mental capacity act?

A

Assumed to have capacity unless proven otherwise
Steps should be taken to help someone have capacity
Unwise decisions doesn’t mean someone lacks capacity
Any decisions made under the MCA must be in the patient’s best interests
Any decisions made must be the least restrictive to a patient’s rights/freedom

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

How is mental capacity assessed?

A

Impairment of or disturbance of functioning of mind/brain?
Are they unable to:
Understand relevant information
Retain relevant information
Weight up and reach a decision
Communicate that decision

How urgent is the clinical decision?
Do they have LPA, advanced directive/statement
Should a best interest meeting be held

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

What is a Deprivation of Liberty Safeguard(DoLS) and when is it used?

A

Used when necessary to deprive a patient or resident of their liberty as they lack capacity to consent to treatment or care to keep them safe from harm
Common in acute medical/geriatric wards

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

What criteria must be met before considering DoLS for a patient

A

> 18yrs
Patient in hospital/care home with a mental disorder
Considered separately for detention under a MHA
Lacks capacity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

Name some uses for antidepressants besides depression

A

Anxiety
OCD
PTSD
Eating disorders
Menopause
Neuropathic pain
Fibro
Smoking cessation
Sleep
Parkinson’s
Nocturnal enuresis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

What does SSRI stand for?

A

Seelctive serotonin reuptake inhibitors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

What is the MOA of SSRI’s?

A

Inhibit serotonin reuptake to increase availabilty and improve mood regulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

What conditions are SRIS’s typically used to treat?

A

1st line for:
Depression
GAD
OCD
PTSD
Panic disorder and phobias

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

Give some exampples of SSRIS

A

Sertraline
Fluoxetine
Citalopram
Paroxetine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

Which SSRI is mostly only used for PTSD?

A

Paroxetine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

Name some side effects of SSRIs

A

GI upset
Anxiety
Insomnia
Weight gain
Palpitations
HYPOnatraemia
QT prolongation(citalopram)
GI bleed(anti-platelet affect)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

What is a key side effect of citaloparm?

A

QT prolongation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

What is the most important mthing to wathc out for in patients on SSRI’s?

A

Serotonin syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

What should you be cautious of when prescribing SSRIs?

A

Shouldn’t be used in mania
Fine for patients with IHD
In patients aged 18-25: increased risk of suicide->follow up after 1 week

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

What do SNRI’s stand for?

A

Serotonin and noradrenaline reuptake inhibitors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

Describe the MOA of SNRI?

A

Increase serotonin and noradrenaline levels, improve mood and reduce anxiety

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

When are SNRI’s commonly used?

A

2nd line after truing SSRIs for depression
Also used for GAD and panic disorder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

Name some examples of SNRI’s

A

Duloxetine
Venlafaxine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

Name some side effects of SNRI’s

A

Nausea
Insomnia
Agitation
Tachycardia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

What should you be cautious about when prescribing SNRI’s?

A

CI in patints with a history of heart disease and hypertension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

Descirbe the MOA of TCA’s

A

Block reuptake of serotonin and noradrenaline(anti-muscarinic)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

When might TCA’s be used as a treatment?

A

Another 2nd line choice ofr depression/anxiety

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

Give some examples of TCAs

A

Amitryptaline
Clomipramine
Imipramine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

What are the side effects of TCA’s?

A

Anti-cholinergic
Can’t see, pee, shit or spit
Urinary retention
Blurred vision
Constipation
Dry mouth
Dizziness
TCA TOXICITY*****

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

When are TCA’s contraindicated?

A

Patients with heart disease, diabetes, urinary retention, long QT syndrome, liver damage, CP450 medications

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

When should TCA’s be prescirbed with caution?

A

In the elderly-risk of falls

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

What are MAO-I’s and what is their mechanism of action?

A

Monoamine Oxidase Inhibitors
Inhibit monoamines which are responsible for metabolism of serotonin and noradrenaline in the presynaptic cleft-> increase serotonin and noradrenaline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

When are MAO-Is used?

A

Sometimes used to treat depression-not first line

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

Give some examples of MAO-I’s?

A

Selegiline
Moclobemide
Phenelzine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
89
Q

Name some side effects of MAO-I’s?

A

Hypertensive reaction with tyramine-containing foods
Marmite, cheese, salami etc

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
90
Q

When are MAO-Is contraindicated?

A

Cerebrovascular disease
Mania in bipolar
Phaeochromocytoma
CVR disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
91
Q

What drug class does mitrazapine belong to?

A

Noradrenergic and specific seretonergic antidepressant(NaSSA’s)
Modulate serotonin and noradrenaline levels in the brain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
92
Q

What are the indications for using mirtazapine as a treatment?

A

2nd line for depression
Especially helpful in patients with sleep and low weight problems

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
93
Q

Name some side effects of mirtazapine

A

Sedation
Increased appetite
Weight gain
Constipation/diarrhoea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
94
Q

What are antipsychotics used to treat?

A

Bipolar
Depression
Delirium
Personality disorders
Eating disorders
Huntington’s
Tic disorders
Intractable hiccups
Nausea and hyperemesis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
95
Q

How do typical/1st gen antipsychotics work?

A

Antagonists to D2 receptors on cholinergic, adrenergic and histaminergic receptors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
96
Q

Give some examples of 1st gen/typical antipsychotics

A

Haloperidol
Chlorpromazine
Flupentixol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
97
Q

What kind of symptoms to typical/1st gen antipsychotics cause?

A

Extra-pyramidal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
98
Q

Name some side effects of 1st gen/typical antipsychotics

A

Dopamine 2 receptor blockade:
Acute dystonia-spasms and involuntary movements
Akathisia: restlessness
Parkinsonism: tremors, rigidity, bradykinesia
Tardive dyskinesia: involuntary repetitive movements, particularly of face, lip smacking etc

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
99
Q

What is acute dystonia?

A

Involuntary muscle contractions/spasms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
100
Q

What is tardive dyskinesia?

A

Involuntary repetitive movements, particulary of face
Lip smacking, tongue movements etc

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
101
Q

What is a side effect of antipsychotics with regards to the histamine 1 receptor blockade?

A

Sedation->drowsiness/sleepiness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
102
Q

What is a side effect of antipsychotics with regards to the alpha 1-adrenergic receptor blockade?

A

Orthostatic hypotension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
103
Q

What is a side effect of antipsychotics with regards to the muscarinic receptor blockade?

A

Anticholinergic effect:
Can’t pee, see,shit or spit
Dry mouth
Constipation
Blurred vision
Urinary retention

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
104
Q

What is 1st line for psychosis?

A

2nd gen/atypical antipsychotics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
105
Q

Why are 2nd gen antipsychotics now preferred to 1st gen?

A

Fewer extrapyramidal side effects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
106
Q

What is a disadvantage of using 2nd gen antipsychotics compared to 1st gen

A

Increased metabolic side effects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
107
Q

How do 2nd gen/atypical antipsychotics work?

A

D2, D3, D5 and HT2A antagonists

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
108
Q

Give some examples of 2nd gen/atypical antipsychotics

A

Risperidone
Quetiapine
Olanzapine
Aripiprazole
Clozapine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
109
Q

What are some of the metabolic side effects of 2nd gen/atypical antipsychotics?

A

Weight gain
Impaired glucose metabolism/diabetes
Increase levels of lipids
Increased levels of prolactin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
110
Q

What are some general side effects of 2nd generation/atypical antipsychotics?

A

Increased weight
Hyperprolactinaemia
Clozapine-agranulocytosis
Increase VTE and stroke risk in elderly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
111
Q

What monitoring should be done in patients on 2nd gen/atypical antispychotics?

A

Weight
Blood glucose
HbA1c
Lipids
BP
ECG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
112
Q

When is clozapine used as a treatment?

A

Treatment resistant schizophrenia once 2 others have failed-treats both positive and negative symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
113
Q

What are the side effects of clozapine?

A

CLOZAPINE
Constipation
LOwered seizure threshold
Zedation
Agranulocytosis
Phat(increased weight)
Increased salivation
Neutropenia
ECG: Myocarditis

Agranulocytosis key

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
114
Q

What monitoring should be done for patients on clozapine?

A

Weekly FBC looking at WCC for first 18 weeks, then fortnightly
Bloods
Lipids
Weight
Fasting blood glucose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
115
Q

Name some common mood stabilisers

A

Lithium
Sodium valproate
Carbamazepine
Lamotrigine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
116
Q

What is lithium used to treat?

A

Bipolar disorder and mania
Depression
Aggression/self harm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
117
Q

When is lithium contraindicated?

A

Addison’s disease
Arrhythmias
Brugada
Hypothryoidism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
118
Q

Name some side effects of lithium

A

LITHIM
Leukocytosis
Diabetes insipidus-nephrotoxicity
Tremor(fine)
Hypothyroidism, hypercalcaemia, hyperparathyroidism
Increased weight
Metallic taste

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
119
Q

What should be given to women of childearing age who are on lithium and why?

A

Contraception
Causes cardiac malformations in the 1st trimester

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
120
Q

What monitoring should be done for patients on lithium

A

Start:
U&E’s
ECG
TFTs
BMI
FBC

Throughout:
Electrolytes
eGFR
TFT’s
BMI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
121
Q

Name some side effects of sodium valproate

A

Nausea
Gastric irritation
Diarrhoea
Weight gain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
122
Q

What are carbamazepine and sodium valproate used for in psychiatry?

A

Mood stabilisers:Both used for bipolar disorder prophylaxis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
123
Q

What is lamotrigine used for in psychiatry?

A

Mood stabiliser
Useful in preventing depressive episodes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
124
Q

Name some side effects of lamotrigine

A

Steven Johnson syndrome
Dizziness
Rashes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
125
Q

What is important to remember about prescribing mood stabilisers to women of child bearing age?

A

Teratogenic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
126
Q

Describe some symptoms of TCA toxicity

A

Drowsiness
Confusion
Arrhythmia
Seizures
Vomiting
Headache
Flushing
Dilated pupils

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
127
Q

What investigations should be done to diagnose and assess TCA toxicity?

A

FBC
U&E
CRP
LFT’S
VBG
ECG-QT prolongation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
128
Q

How is TCA toxicity treated

A

Generally supportive care and management
Consider activated charcoal within 2-4 hours of OD and intensive care review if severe
IV soidum bicarbonate for arrhythmia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
129
Q

What is neuroloeptic malignant syndrome?

A

Rare, life threatening reaction to antipsychotics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
130
Q

When does neuroleptic malignant condition occur?

A

After the introduction of or increase in neuroleptic medications (antipsychotics)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
131
Q

How do patients with neuroleptic malignany syndrome present?

A

FEVER
Fever
Encephalopathy
Vital signs(tachypnoeic/cardic/hypertensive)
Elevated CK-rhabdomyolisis
Rigidity-lead pipe

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
132
Q

Name some differentials for neuroleptic malignant syndrome

A

Malignant hyperthermia
Serotonin syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
133
Q

What are some investigations to investigate neuroleptic malignant syndrome?

A

Creatine kinase!
FBC
Renal and liver function

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
134
Q

What is the treatment for neuroleptic malignant syndrome?

A

Stop causative agent
Cooling blankets and IV fluids to prevent renal failure and hyperthermia
Benzodiazepines for muscle rigidity
Dantrolene in severe cases
Intensive monitoring
Bromocriptine(dopamine agonist)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
135
Q

What is serotonin syndrome?

A

Life threatening emergency characterised by an increase in serotonergic activity in the CNS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
136
Q

When does serotonin syndrome occur?

A

Typically first few months after starting an SSRI/increasing the dose
Can also happen with SNRI’s, MAO-I’s, TCA’s, MDMA/cocaine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
137
Q

Describe the presentation of a patient with serotonin syndrome

A

Neuromuscular:
Hyperreflexia
Myoclonus
Rigidity

Autonomic:
Tachycardia
Sweating
Hyperthermia

Altered mental state: confusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
138
Q

Name some differentials for serotonin syndrome

A

Neuroleptic malignant syndrome
Malignant hyperthermia
Anti-cholinergic toxicity->decreased bowel sounds, urinary retention

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
139
Q

How can serotonin syndrome and neuroleptic malignant syndrome be differentiated?

A

Neuroleptic malignant syndrome: slower onset, longer duration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
140
Q

How is serotonin syndrome diagnosed?

A

Mostly based on clinical exam and history
Bloods to monitor organ function

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
141
Q

How is serotonin syndrome managed?

A

Stop causative agent
Supportive care and symptom management
In severe cases: antidotes like cyproheptadine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
142
Q

What are the features of addiction?

A

Tolerance
Withdrawal
Persistent desire/unsuccessful attempts to stop
Substance taken in large amounts/used for longer periods then intended
Vocational/social/recreational activities given up or reduced because of substance use
More time spent seeking/recovering from effects of substance
Repeated use despite awareness of damage from substance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
143
Q

Which pathway is addiction medicated by?

A

Dopamine reward pathway

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
144
Q

Describe the stages of change model

A

Pre-contemplation-> contemplation-> preparation-> action-> maintenance-> relapse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
145
Q

153a8a3d8b7e436597a59035d3809f0f-oa-3

A

Stages of change model

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
146
Q

Descirbe the general management of addiction

A

Maintainence vs abstinence
Treat co-morbidities(mental and physical)
Psychological interventions(CBT, motivational interviewing, AA)
Pharmacological intervention(manage detox, maintainence etc)
Social intervention(work, housing, family)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
147
Q

Descirbe the symptoms of acute alcohol intoxication

A

Ataxia
Nausea and vomiting
Decreased GCS
Respiratory depression
Impaired judgment
Anterograde amnesia
Dysarthria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
148
Q

When does alcohol withdrawal typically occur?

A

12 hours after the last drink

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
149
Q

What scoring system is used to monitor signs of alcohol withdrawal and guide treatment?

A

CIWA score
Clinical institute withdrawal assessment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
150
Q

Describe the symptoms of alcohol withdrawal with time frames

A

6-12 hours: tremor, sweating, tachycardia, anxiety
seizures at 36 hours
Delirium tremens is at 48-72 hours: coarse tremor, confusion, delusions, auditory and visual hallucinations, fever, tachycardia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
151
Q

How many hours after the last drink is a patient going through alcohol withdrawal most at risk of seizures or status epilepticus?

A

7-48 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
152
Q

Descirbe the pharmacological management of alcohol withdrawal

A

Short acting benzodiazepines
Chlordiazepoxide reducing regine (20-40mg qds reducing to 0 over 1 week)
Pabrinex-prevent Wernicke-Korsakoff’s syndrome
Oxazepam if evidence of liver injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
153
Q

Describe the supportive management of alcohol withdrawal

A

Fluids
Anti-emetic
Referral to local drug and alcohol liasion teams

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
154
Q

What is delirium tremens?

A

Life threatening emergency characterised by extreme autonomic hyperactivity and neuropsychiatric symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
155
Q

How long after alcohol cessation is delirium tremens most likely to set in?

A

About 72 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
156
Q

What are the triggers for developing delirium tremens

A

Cessation of alcohol
Can be precipitated by infeciton, trauma or illness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
157
Q

Describe the symptoms of delirium tremens

A

Confusion and disorientation
Hallucinations (visual or tactile, formication)
Autonomic hyperactivity-> sweating, hypertension
Rarely seizures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
158
Q

When do symptoms of delirium tremens typically peak?

A

Between 4th and 5th day post withdrawal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
159
Q

Give some differentials for delirium tremens

A

Alcohol withdrawal(no hallucinations)
Wernicke-korsakoff(no autonomic instability)
Encephalitis/meningitis(no focal neurological signs)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
160
Q

Describe the management of delirium tremens

A

1st line: lorazepam
If symptoms persist: parenteral lorazepam or haloperidol
Maintainence therapy of alcohol withdrawal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
161
Q

What is Wernicke’s encephalopathy?

A

Acute neurological syndrome from a thiamine(B1) deficiency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
162
Q

Name some causes of Wernicke’s encephalopathy

A

Most common: chornic alcohol abuse
Malabsorption, eating disorders

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
163
Q

What are the 3 core symptoms of Wernicke’s encephalopathy?

A

Confusion
Ataxia
Ophthalmoplegia/nystagmus
Don;t need all 3 to make a diagnosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
164
Q

How is Wernicke’s encephalopathy investigated?

A

Thiamine level testing
Bloods-FBC’s, U&E’s, liver and bone profile, magensium, clotting
Neuroimaging->MRI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
165
Q

How is Wernicke’s encephalopathy managed?

A

Treat underlying cause
Thiamine supplementation->pabrinex

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
166
Q

What is Korsakoff’s syndrome?

A

Chronic memory disorder that arises as a late complication og untreated Wernicke’s

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
167
Q

What is the main complication of Wernicke’s encephalopathy?

A

Korsakoff’s syndrome(becomes permanent)
Also coma, death

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
168
Q

What is the aetiology of Korsakoff’s syndrome?

A

Degeneration of mamillary bodies(part of circuit of papez involved in memory formation) due to thiamine deficiency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
169
Q

What are the symptoms of a patient with Korsakoff’s syndrome?

A

Profound anterograde amnesia
Limited retrograde amnesia
Confabulation(fabricate memories to mask deficit)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
170
Q

How is Korsakoff’s syndrome treated?

A

Ongoing thiamine supplementation
Cognitive rehabilitation
Treat underlying cause(like alcoholism)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
171
Q

What are some symptoms of opiate intoxication?

A

Drowsiness
Confusion
Constricted pupils
Bradypnoea
Bradycardia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
172
Q

How many hours after the last dose might opiate withdrawal symptoms begin, and when does it peak?

A

Can begin as early as 6 hours after last dose
Symptoms peak at 36-72 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
173
Q

Is opiate withdrawal typically life threatening?

A

No

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
174
Q

Describe the symptoms of opiate withdrawal

A

Agitation
Chills
Cramps
Sweating
Increased salivation
Insomnia
GI disturbance
Dilated pupils
Piloerection
Tachycardia and hypertension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
175
Q

How is opiate withdrawal managed acutely?

A

Methadone(can cause prolonged QT syndrome)
Lofexedine(alpha 2 receptor agonist)
Loperamide(for diarrhoea)
Anti-emetics(nausea)
Benzodiazepines(only for agitation, should be avoided)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
176
Q

What is used in opiate detox programmes?

A

Methadone and bupernorphine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
177
Q

What is used as opiate addiction relapse prevention?

A

Neltrexone once detox done

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
178
Q

What is an opiate overdose treated with?

A

Naloxone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
179
Q

Give some examples of stimulants

A

Cocaine
meth
MDMA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
180
Q

What are some symptoms of stimulant intoxication?

A

Euphoria
Hypertensive crisis
Tachycardia
Dilate pupils
Pyrexia
Agitation
Psychosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
181
Q

What are some potential consequences of stimulant intoxication?

A

Rhabdomyolysis
SIADH and water overload
Cocaine->Ischaemic events due to vasospasm
Death

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
182
Q

What causes death in patients with stimulant intoxication?

A

Hyperpyrexia
Hypertension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
183
Q

How is stimulant intoxication managed?

A

Deaths due to hyperpyrexia and hypertension so:
Cooling
Antihypertensives like nitroprusside or GTN
Benzodiazepines

184
Q

What is the criteria for an ADHD diagnosis?

A

Neurodevelopmental disorder-symptoms affect daily functioning in >1 setting and symptoms last for >6 months
Symptoms present before age of 12 years

185
Q

What are the cardinal features of ADHD?

A

Inattention
Impulsivity
Hyperactivity

186
Q

Describe the aetiology of ADHD

A

Decreased activity in the frontal lobe->impaired executive function

187
Q

How might inattention manifest in a patient with ADHD

A

Difficult sustaining attention to tasks that aren’t rewarding or stimulating or require sustained mental effort
Easily distracted by external stimuli
Loses things

188
Q

How might hyperactivity/impulsivity manifest in a patient with ADHD?

A

Excessive motor activity
Difficult engaging in activities quietly
Blurts out answers in school/work
Tendency to act in response to immediate stimuli without deliberation or consideration of risk/consequence

189
Q

How is ADHD diagnosed?

A

According to the DSM-5 clinical criteria
Behavioural observation
Comprehensive history and physical exam
Teacher and parent reports
Neuropsychological testing

190
Q

How is ADHD treated?

A

Conservative-> behavioural therapy, CBT, psychoeducation, social skills training
Medical-stimulants-> methylphenidate, amphetamines

191
Q

How do stimulants work to treat patients wth ADHD?

A

Act on frontal lobe to increase executive function and attention and decrease impulsivity

192
Q

What should be monitored in children on methylphenidate?

A

Growth

193
Q

Define autism spectrum disorders

A

Set of complex neurodevelopmental disorders resulting in social, language and behavioural deficits

194
Q

How does ASD present?

A

Social interaction-> plays alone, no eye contact, struggle to perceive others
Language and communication-speech and langiage delay, monotonous voice, interpret speech literally
Behavioural traits; narrow interests, rituilistic behaviours, routines, stereotyped movements
Other conditions; Learning difficulties, genetics, seizures

195
Q

Name some differentials for ASD

A

Intellectual disability(no social deficits)
ADHD(no social/language deficits)
Specific language impairment
Childhood schizophrenia(hallucinations/delusions)
Asperger’s- milder social features and near normal speech development

196
Q

How is ASD diagnosed?

A

MDT assessment
Psychological evaluation
Speech and language assessment
Cognitive assessment

197
Q

How is ASD managed?

A

MDT approach
Behavioural-applied behavioural analysis(encourage positive behaviours, ignore negative)
Family and social support

198
Q

How is ASD different to asperger’s?

A

Asperger’s has milder social features and near normal speech development

199
Q

What are the key features of learning disabilities?

A

Decreased intellectual ability
Difficulty with everyday activities

200
Q

Name some potential causes of learning disabilities

A

Inherited
Early childhood illness/brain injury
Problems during pregnancy/birth
Smoking/alcohol in pregnancy

201
Q

What causes Down’s syndrome?

A

Trisomy 21

202
Q

Name some risk factors for having Down’s syndrome

A

High maternal age
Family history

203
Q

Descirbe the typical facial features of a patient with Down’s syndrome

A

Flat occiput
Oblique palpebral fissures
Small mouth
High arched palate
Broad hands
Single, transverse palmar crease

204
Q

What medical conditions are associated with Down’s syndrome?

A

Complete AV septal defect
Hypothyroidism
Increased risk of Alzheimer’s by age of 50
Learning disability
Autistic traits

205
Q

What is generalised anxiety disorder?

A

Chronic and pervasive condition characterised by excessive, uncontrollable worry extending across various life domains

206
Q

What are the ICD10 criteria for GAD?

A

6 month history of tension, worry and axiety about everyday issues
Increase in symptoms(autonomic, chest/abdo, brain, tension)
Doesn’t met criteria for panic disorder, hypochondriasis and OCD
Can’t be explained by a physical condition or medication

207
Q

Describe the epidemiology of GAD

A

More common in females, associated with depression, substance misuse and personality disorders

208
Q

Name some risk factors for developing GAD

A

Low socioeconomic status
Unemployment
Divorce
ack of education

209
Q

Describe the symptoms of GAD

A

Psychological: worries, decreased concentration, insomnia, derealisation
Motor: restlessness, feeling on edge
Neuromuscular: tremor, tension headache, muscle aches, dizziness
GI: dry mouth, nausea, indigestion, vomiting
CVR: chest pain, palpitations
Resp: dyspnoea, tight chest, breathlessness
GU: urinary frequency, erectile dysfunction, amenorrhoea

210
Q

How is GAD diagnosed?

A

Full history and exam(rule out organic causes)
Questionnaires liked GAD-2/7
Sucide risk assessment

211
Q

Name some differentials for GAD

A

Hyperthyroidism
Cardiac causes
Too much caffeine
Substance abuse
Depression
Medication induced anxiety
Anxious/avoidant personality disorder
Early stage dementia/schizophrenia

212
Q

Describe the management of GAD

A
  1. Individualised non-facilitated help, guided self-help, psychoeducational groups, interactive CBT
  2. CBT, applied relaxation
    Medical SSRI(sertraline)
    Symptomatic: propanolol
213
Q

What is panic disorder?

A

Occurence of recurrent unexpected panic attacks, each marked by intense fear/discomoft resulting in avoidant behaviours

214
Q

What is the criteria for a panic attack disorder diagnosis?

A

Recurrent unexpected panic attacks
Persistent concern about future attacks
Behavioural changes resulting in avoidance of associated situations

215
Q

Describe the epidemiology of panic disorder

A

Bimodial incidence, peaks and 20yrs and 50 yrs
Concurrent agoraphobia in 30-50% of cases
Increased risk of attempted suicide with comorbid epression/substance abuse

216
Q

Describe the clinical features of panic disorder

A

Breathing difficulties, chest pain, palpitations, shaking, sweating
Hyperventilation-> hypocalcaemia, carpopedal spasm
Depersonalisation/derealistation
Agoraphobia

217
Q

Name some differentials for panic disorder

A

Other anxiety disorders(GAD, agoraphobia)
Depression(takes precedence), alcohol/drug withdrawal
Organic: CVR/resp, hypoglycaemia, hyperthyroidism, phaeocromocytoma

218
Q

How is panic disorder managed?

A

CBT(80-100% successful)
Psychoeducation and ‘fear of fear’ cycles
Interoceptive exposure and techniques secondary agoraphobia exposure techniques
SSRI’s
Clomipramine(TCA)
Propanolol for symptomatic management

219
Q

What are phobias?

A

Excessive and irrational fears, restricted to highly specific situations

220
Q

What are the clinical features of a phobia?

A

Usually apparent in early childhood
Leads to avoidance behaviours
Results in bradycardia or hypotension
Rule out depression

221
Q

What is agoraphobia?

A

Fear of open spaces and associated factors like the presence of crowds or difficulty of immediate escape

222
Q

At what age does agoraphobia typically start?

A

20’s or mid 30’s

223
Q

What is social anxiety disorder?

A

AKA social phobia
Fear of scrutiny by others in small groups(5-6 people)
Can be specific(public speaking) or generalised

224
Q

What are the symptoms of social phobia

A

BLUSHING(characteristic)
Palpitations
Sweating
Trembling

225
Q

What can precipitate the development of social phobia?

A

Stressful/humiliating experiences
Parental death
Separation
Chronic stress

226
Q

What are come complications of social phobia?

A

Depression
Alcohol/drug abuse

227
Q

How are phobias managed?

A

CBT
Exposure techniques->systematic desensitization
Flooding
Modelling
2. SRRI’s
Propanolol if somatic symptoms dominate

228
Q

What is an acute stress reaction?

A

Immediate and intense psychological response following exposure to a traumatic event

229
Q

How is acute stress reaction differentiated from PTSD?

A

Sx for <1 month: acute stress reaction
>1 month: PTSD

230
Q

What is the criteria needed to diagnose an acute stress reaction?

A

Exposure: direct/indirect exposure to traumatic event
Symptoms: Dissociation, low mood, arousal, avoidance
Duration: 3 days-1 months post event

231
Q

Name some clinical features of acute stress reaction

A

Intrusive memories, dissociation, hyperarousal, avoidance, low mood
Emotional: anxiety, sense of unreality
Physiological: palpitations, hypervigilance
Behavioural: effort to escape reality and reminders

232
Q

Name some differentials for an acute stress reaction

A

Adjustment disorders
PTSD(>1 month)

233
Q

How is acute stress reaction managed?

A

Trauma focused CBT
Medications if severe: benzodiazepines

234
Q

What is adjustment disorder?

A

Significant emotional distress and disturbance that interferes with social functioning

235
Q

When does adjustment disorder typically arise?

A

During a period o adaptation to a major life change/stress

236
Q

How is adjustment disorder different to an acute stress reaction?

A

Adjustment disorder: stressor doesn’t need ot be severe or life-threatening(e.g., being fired)
Acute stress reaction: Severe stressor

237
Q

Describe the clinical features of adjustment disorder

A

Mood: depression/amxiety
Behavioural: marked irritability, imapired work/social function
Interpersonal disruptions and avoidance behaviours
Cognitive alterations: persistent negative outlook, precoccupations with the stressor

238
Q

Name some differentials for adjustment disorder

A

Acute stress reaction
PTSD

239
Q

How is adjustment disorder managed?

A

Psychotherapy(CBT, group, family)
Medications(anti-anxiety/antidepressants)
Self care strategies(stress management, activity, social support)
Treatment usually short term, symptoms improve once stressor is removed or indivdual learns how to cope

240
Q

What criteria is needed to diagnose PTSD?

A

Direct/indirect exposure to a traumatic event(actual threatened death, serious injury or sexual violence)
Symptoms:intrusion, avoidance, negative alterations in cognition and mood, arousal and reactivity
Duration: >1 months(DSM-5) or >6 months(ICD-11)

241
Q

How long do symptoms need to have been present for to make a PTSD diagnosis?

A

ICD 11: >6 months
DSM 5: >1 months

242
Q

How common is PTSD?

A

Lifetime rates: 7-9%

243
Q

Describe the clinical features of PTSD

A

Intrusions: recurrent distressing memories/nightmares/flashbacks
Avoidance
Mood and cognition: distorted blame, negative emotions and beliefs
Arousal and activity: Increased vigilance, concentration and sleep troubles, increased startle response

244
Q

How is PTSD classified?

A

Mild: Manageable, limited impact on social/ocupational function
Moderate: Mild-severe distress and impact on function, no significant risk of suicide, self harm or risk to others
Severe: Unmanageable distress, high risk of self-harm/suicide

245
Q

How is PTSD managed?

A

Moderate-severe; secondary care referral
Trauma focussed CBT and EMDR
Veterans priority scheme
Risk assessment for suicide/self-harm
Medications: SSRI’s(start with sertraline, paroxetine) or SNRI(venlefaxine)

246
Q

What is the criteria for a diagnosis of OCD?

A

Presence of obsessions, compulsions or both
Time-consuming (>11hr/day), OR cause significant impairment
Not attributable to another medical/mental disorder

247
Q

How common is OCD?

A

1-3% of the population

248
Q

At what age does OCD typically present?

A

Adolescence/early adulthood

249
Q

How do patients with OCD present?

A

Obsessions; intrusive, unwanted distressing thoughts/imagesCompulsions: Repetitive behaviours aimed at decreasing anxiety

250
Q

What scoring system is used to assess severeity of OCD?

A

Yales-Brown OC scale
Mild: 8-15
Moderate: 16-23
Severe: 24-31
Extremely severe: 32-40

251
Q

Name some differentials for OCD

A

GAD
Major depressive disorder
Body dysmorphic disorder
Social anxiety disorder
Hoarding disorder
Trichotillomania
PTSD
ASD

252
Q

How is OCD managed?

A

Mild: low intensity CBT
Exposure and repsonse prevention: ERP
Moderate: Intensive CBT or SSR
IFluoxetine, citalopram, paroxetine, sertraline
Clomipramine as alternative
Severe:Intensive CBT and SSRI

253
Q

If a patient is on a medication for OCD, how long should they continue taking it for?

A

If effective: continue for at least 12 months, then review

254
Q

What is the criteria for a diagnosis of major depressive disorder?

A

Presence of a major depressive episode lasting over 2 weeks

255
Q

What is dysthymia?

A

Persistent depressive disorder-chronic form of depression lasting more than 2 years

256
Q

What are the 9 DSM 5 depression symptoms?

A

Depressed mood/irritability(can be subjective or objective)
Anhedonia
Weight/appetite changes
Sleep changes
Activity changes-pscyhomotor agitation/retardation
Fatigue/loss og energy
Guilt and feelings of worthlessness
Cognitive issues
Suicidality(thoughts or formulation of a plan

257
Q

What is the DSM-5 criteria for a depression diagnosis?

A

5/9 symptoms for at least 2 weeks

258
Q

Name 2 additional features that might be seen in severe depression

A

Psychosis->delusions and/or hallucinations
Depressive stupor-> immobility, mutism, refusal to eat/drink->ECT

259
Q

What investigations should be done to make a diagnosis of depression?

A

FBC
U&E’s
TFT’S
LFT
Glucose
cortisol
B12/folate
Toxicology screen
CNS imaging in some cases
Questionnares: HAD scale and PHQ-9

260
Q

What questionnaires are used to assess depression?

A

HAD scale
PHQ-9

261
Q

Name some differential diagnoses for depression

A

Organic:
Neurological: Parkinson’s, dementia, MS
Endocrine: thryoid, hyoer/hypo-adrenalism
Chronic conditions: diabetes, obstructive sleep apnoea, mono
Neoplasms and cancer
Substance use/medication side effect

262
Q

Describe the management of depression:

A

Secondary care referral: high risk for suicide, psychosis/bipolar
Mild /moderate: self help, CBT(low intensity psychological interventions), consider SSRI/SNRI
Recurrent: antidepressant/lithium
Continue for at least 4-6 months post-remission then taper
Severe: ECT

263
Q

Name some side effects of ECT

A

Headaches
Muscle aches
Memory loss
Confusion
Death

264
Q

Why should antidepressants be used with caution for depression?

A

High risk of suicide

265
Q

What are the most common ways in which patients self harm?

A

Cutting
Self-poisoning
Burning
Hitting
Hair pulling

266
Q

What groups is self harm most common in?

A

Young people
More common in females

267
Q

Name some risk factors for self-harming

A

Mental illness
Alcohol/substance misuse
social disadvantage/lack of social support
Childhood adversity
Personality characteristis(impulsivity, poor problem solving, interpersonal difficulties)
Life events-predisporing/precipitating factors(especially relationship problems

268
Q

Give some reasons behind why a patient would self-harm

A

Expression of personal distress
May/may not be with lethal intent
Attempt to communicate/seek help/care
Way of obtaining relief from a difficult and otherwise overwhelming situation

269
Q

Name some of the most common methods by which patients committ suicide

A

Hanging-most common
Self-poisoning
Jumping
Drowning
Cutting/stabbing
Firearms

270
Q

Name some risk factors for committing suicide

A

SADPERSON
Sex: male
Age
Depression
Psychiatric hx
Excessive drug use
Rational thinking absent
Single
Organised attempt/previous attempt
No support/living alone

Others:
Poverty and unemployment
Prisoners
Marginalised groups
FHX mental illness/suicide
childhood adversity and bullying
physical illness

271
Q

What are some red flags and important things to assess when carrying out a suicide risk assessment?

A

Level of intent/hopelessness, agitation, lack of sleep
Prior attempts/plans/notes
Giving away possessions etc
Typical: young male/late life white divorced male living alone, social withdrawal

272
Q

What are the different kinds of overdose using paracetemol?

A

Acute: Excessive amounts in <1 hour
Staggered: Excessive amount ingested in >1 hour
Therapeutic excess: Too much taken- to treat pain/fever without self harm intent

273
Q

How much paracetemol counts as an overdose?

A

>75mg/kg/24 hours

274
Q

How does a paracetemol overdose cause problems/

A

Normally: NAPQ1 inactivated by glutathione
OD: glutathione depleted, so massive excess of NAPQ1 which builds up and causes liver and kidney damage

275
Q

How do patients who have OD’s on paracetemol present?

A

N+V
Haematuria and proteinuria
Jaundice
Loin pain
Abdominal pain
Coma/unconscious

276
Q

What investigations should be done for a patient who has overdosed on paracetemol?

A

fbc
u&e
amp;elfts
clotting screen
VBG-severe metabolic acidosis
Paracetemol levels

277
Q

What kind of imbalance can a paracetemol overdose cause?

A

Metabolic acidosis

278
Q

Describe the management of a paracetemol overdose

A

<1 hr and dose >150mg/kg: activated charcoal
1-4 hrs: wait, check at 4 hrs then N-acetylcysteine
4-24 hrs/staggered OD: N-acetylcysteine
>24hrs: N N-acetylcysteine if liver failure or high paracetemol levels
Last line: liver transplant

279
Q

When would a patient who has overdosed on paracetemol be considered for an urgent transplant?

A

Arterial pH<7.3 OR
Serum creatinine >300micromol/litre
Prothrombin time >100 seconds
Grade 3/4 encephalopathy

280
Q

Which patients are at higher risk of complications after a paracetemol overdose?

A

HIV
Mlanutrition
Eating disorders
Pre-existing liver disease
Regular alcohol excess

281
Q

Which blood test results indicate a poor prognosis following a paracetemol overdose?

A

Bilirubin >300micromol
INR>6.5

282
Q

What is post partum depression?

A

Significant mood disorder that develops within 1 year post birth

283
Q

How is postpartum depression different to the baby blues?

A

Baby blues: Less than 2 weeks post birth, resolve spontaneously
Postpartum depression: significant mood disorder up to 1 year post birth

284
Q

Name some risk factors for developing postpartum depression

A

Deprivation
History of mental health disorders
Lack of support

285
Q

Describe the aetiology of postpartum depression

A

Biological: hormonal fluctuations(lower progesterone, oestrogens etc, changes in melatonin, cortisol, immune and inflammatory processes)
Psychological: stress from transition to motherhood
Social: lack of support, life stressors, low socioeconomic status

286
Q

What symptoms might a patient with postpartum depression present with?

A

Persistent low mood, anhedonia, low energy
Decreased appetitie, disturbed sleep patterns, insidious onset
Concerns about bonding with baby and caring for it
Potential thoughts of harm

287
Q

Name some differentials for postpartum depression

A

Baby blues
Postpartum psychosis
Adjustment disorders

288
Q

What investigations should be done to diagnose postpartum depression?

A

Edinburgh postnatal depression scale(EPDS)
Detailed psychiatric history, physical exam and rule out organic causes

289
Q

How is postpartum depression treated?

A

Self-help and psychological therapies
(CBT and IPT(interpersonal))
Antidepressants(sertraline/paroxetine-safer for breastfeeding)
Admission to mother-baby mental health uni

290
Q

Which SSRI’s are safest for breastfeeding mothers?

A

Sertraline
Paroxetine

291
Q

What is the treatment for baby blues?

A

Reassurance and support
Regular health visits to check in on mum and baby

292
Q

What is post partum psychosis and when does it typically occur?

A

Serious psychiatric condition
Typically under 2 weeks post birth

293
Q

Name some risk factors for developing post partum psychosis

A

Prior history of psychosis
Family history

294
Q

Describe the aetiology of post-partum psychosis

A

Unknown, combination of:
Genetic susceptibility
Hormonal changes post birth
Psychosocial stressors
Increases risk if history of severe mental illness

295
Q

How do patients with post-partum psychosis present?

A

Paranoia
Hallucinations
Manic epsiodes
Despressive episodes
Confusion
Delusions(especially capgras-baby replaced by imposter)

296
Q

What investigations should be done in a patient with post partum psychosis?

A

Clinical diagnosis
Rule out organic causes-> sepsis, thyroid issues etc

297
Q

How is post partum psychosis managed?

A

Antipsychotics: olanzapine and quetiapine(safe for breastfeeding)
Mood stabilisers for some
High risk: referral to specialist mother and baby inpatient mental health unit

298
Q

When should a referral be made to a specialist mother and baby inpatient mental health unit in patients with post partum psychosis?

A

If high risk, especially if comman hallucinations and delusions about baby
Command->kill baby/not your baby, imposter etc

299
Q

What are eponymous syndromes?

A

Unique and rare manifestations of distorted thinking

300
Q

Capgras delusion?

A

Either oneself or another person has been replaced by an exact clone

301
Q

What causes capgras delusion?

A

Psychotic illness
Brain trauma

302
Q

What is Ekbom’s syndrome?

A

Patient feels infested with parasites-‘crawling’ inside skin

303
Q

What causes Ekbom’s syndrome?

A

Psychosis
B12 deficiency
Hypothyroidism
Neurological disorders

304
Q

What is cotard delusion?

A

Patient is dead, non-existing or rotten

305
Q

What causes cotard delusion?

A

Psychosis
Parietal lobe lesions

306
Q

What is othello syndrome?

A

Spouse/partner is unfaithful with little ot no proof

307
Q

What causes othello syndrome?

A

Alcohol abuse
Psychosis
Frontal lobe damage

308
Q

What is freigoli syndrome?

A

Persecutory beliefs->strangers are persecutors in disguise

309
Q

What is folie a deux?

A

Delusions shared by 2 or more people
One has psychosis, the other is submissive

310
Q

What is de clerembault’s syndrome?

A

Delusion of being the object of love’erotomania’

311
Q

Name some psychiatric conditions that can cause delusions

A

Schizophrenia
Bipolar disorder
Psychotic depression

312
Q

What are the different classifications of delusions?

A

Bizarre-very unusual
Non-bizarre-plausible but not correct
Mood congruent
Mood neutral

313
Q

What is a nihilistic delusion?

A

Typicallyh congruent with depressed mood
Believes they are dead, world is ending etc(cotard)

314
Q

What are grandiose delusions?

A

Patient believes they possess extraordinary traits/power

315
Q

Whne are grandiose delusions most commonly seen?

A

Manic phase of bipolar disorder

316
Q

What are delusions of control?

A

External entity controlling thoughts/actions

317
Q

Whare are persecutory delsuions and when are they most commonly seen?

A

Patient feels conspired against
Schizophrenia-paranoid delusions

318
Q

What are somatic delusions?

A

Convinced they have a physical, medical, biological problem despite no medical evidence

319
Q

What are delusional perceptions?

A

Delusions from an a real perception
Like seeing a certain flower means aliens are landing

320
Q

What are delusions of reference?

A

Things that are mundane (like words in a newspaper) mean something special to the patient

321
Q

Give some differentials for delusions

A

Mood disorders with psychotic features
Neurocognitive disorders->Alzheimer’s/Parkinson’s
Substance induced psychosis

322
Q

How are delusions managed?

A

Pharmacological->antipsychotics(treat underlying disorder)
Psychotherapy-> CBT to challenge irrational beliefs
Psychoeducation

323
Q

What is schizophrenia?

A

Chronic or relapsing/remitting form of psychosis

324
Q

What is the DSM 5 criteria for a schizophrenia diagnosis?

A

Symptoms for at least 6 months
At least 1 month of ‘active phase’ symptoms(1 ‘ABCD’ symptom)

325
Q

What are the different subtypes of schizophrenia?

A

Paranoid
Catatonic
Hebephrenic
Residual
Simple

326
Q

Describe the features of paranoid schizophrenia?

A

Delusions and hallucinations, often with a persecutory theme

327
Q

Describe the features of catatonic schizophrenia

A

Motor disturbances and way felxibility

328
Q

Describe the features of hebephrenic schizophrenia

A

Disorganised thinking, emotions and bheaviour

329
Q

Describe the features of residual schizophrenia

A

Symptoms persist after a major episode

330
Q

Describe the features of simple schizophrenia

A

Gradual decline in functioning without prominent positive symptoms

331
Q

Describe the aetiology of schizophrenia

A

Huge genetic component
Environmental

332
Q

Name some environemntal risk factors for developing schizophrenia

A

Childhood trauma/birth trauma
Urban living and immigration to more developed countries
Heavy cannabis use in childhood

333
Q

What are the positive symptoms of schizophrenia?

A

ABCD
Auditory hallucinations(3rd person auditory)
Thought Broadcasting
Control issues
Delusional perceptions

334
Q

What are the negative sympotms of schizophrenia?

A

Alogia
Anhedonia
Affective incongruity/blunting
Avolition

335
Q

What are some risk indicators in patients with schizophrenia?

A

Harm to self/others
Command hallucinations
Hisotyr of self harm or suicidal ideation
Fixation on specific individuals

336
Q

What investigations might be done when making a schizophrenia diagnosis?

A

Brain imaging
Drug screening
Test to exclude infection(HIV, syphilis) or metabolic (thyroid) causes

337
Q

Name some differentials for schizophrenia

A

Substance induced psychotic disorder
Organic psychosis-> infection
brain injury,
Wilson’s,
encephalitis
Depression and dementia
Schizoaffective disorder(mood episodes independent of psychosis)

338
Q

Describe the acute management of schizophrenia

A

Sedatives: to manage dangerous behaviour
Lorazepam
Haloperidol
Promethazine
IM/oral atypical antipsychotics:RisperidoneOlanzapine

339
Q

Describe the long term management of schizophrenia

A

Psychiatric referral and psychotherapy
Maintainence therapy with atypical antipsychotics(risperidone, olanzapine)
Treatment resistant: clozapine

340
Q

How many antipsychotics need to be trialled to consider schizphrenia treatment resistant?

A

At least 2

341
Q

Describe the prognosis of schizophrenia?

A

Rule of quarter:
25% never have another episode
25% improve significantly with treatment
25% show some improvement
25% are resistant to treatment

342
Q

Name some factors associated with a good prognosis in patients with schizophrenia

A

High IQ/high education
Sudden onset
Precipitating factor
Strong support network
Mostly positive symptoms

343
Q

What are the features of mania/hypomania?

A

High mood
Increased irritability
Excessive energy
Little sleep

344
Q

How is hypomania different to mania?

A

Hypomania>=4 days, no psychotic symptoms, limited impairment
Mania >;=7 days, severe functional impairment and presence of psychosis

345
Q

What criteria is needed for a diagnosis of bipolar affective disorder?

A

> =2 episodes
Including one episode of mania/hypomania

346
Q

What are the different type of BPAD?

A

Type 1 and type 2

347
Q

What is the criteria for BPAD type 1?

A

>=1 depressive episode and >=1 manic episode

348
Q

What is the criteria for BPAD type 2?

A

Recurrent major depressive episodes and hypomania

349
Q

How long does a depressive episode need to last for it to count towards a bipolar diagnosis?

A

At least 2 weeks

350
Q

Describe the presentation of patients with BPAD

A

Depressive: low mood, , worthlessness, suicidal ideation
manic: high mood, inflated self esteem, little sleep, psychosis, impulsivity, rapid speech
Others: risk taking behaviour, violence, money spending, sexual disinhibition

351
Q

Name some differentials for BPAD

A

Major depressive disorder(no mania/hypomania)
Cyclothymic disorder
Schizoaffective disorder

352
Q

What is cyclothymic disorder?

A

Mood fluctuations over 2 years

353
Q

When are patients with suspected BPAD refffered to CMHT?

A

Hypomania: routine CMHT referral
Mania/depression: urgent CMHT referral

354
Q

Describe the management of new/acute BPAD in a patient presenting with mania/hypomania

A

Stop SSRI
Mania+agitation: IM benzo/neuroleptic
Main: oral antipsychotics(haloperidol, olanzapine
2nd line: different antipsychotic
3rd: Lithium
4th: ECT

355
Q

Describe the management of new/acute BPAD in a patient presenting with depression

A

Mood stabiliser
Consider SSRI/atypical antipsychotic

356
Q

When is BPAD considered chronic and maintainence therapy started?

A

4 weeks post resolution of acute episode

357
Q

How is chronic BPAD managed?

A

Maintainence therapy: mood stabilisers-lithium
High intensity psychological therapy(CBGT, interpersonal therapy)

358
Q

What are the broad features of class a personality disorders

A

Odd/eccentric cluster

359
Q

What age do you need to be to be diagnosed with a personality disorder?

A

At leasy 18 years

360
Q

What are the Class A personality disorders?

A

Paranoid personality disorder
Schizoid personality disorder
Schizotypal personality disorder

361
Q

What are the features of paranoid personality disorder?

A

Pervasive and enduring irrational suspicion and mistrust of others
Hypersensitivity to criticism
Reluctance to confide in others for fear of it being used against them
Often preoccupied with unfounded beliefs about conspiracies against them

362
Q

What are the features of schizoid personality disorder?

A

Detachemnt of social relationships, lack of interest/desire for interpersonal relationships
Prefer solitary activites
Few, if any close relationships outside of immediate family
Emotional coldness, detachment, flattened affect

363
Q

What are the features of schizotypal personality disorder?

A

Impaired social interacitons, distorted cognitions and perceptionsInappropriate/constricted afdect, eccentric behaviour
Odd thinking and speech, magical thinking, peculiar ideas
Paranoid ideation and belief in influence of external forces

364
Q

How is schizotypal personality disorder different to schizophrenia?

A

Both have cognitive/perceptual distortions
Schizotypal personality disorder patients have a better grasp on reality

365
Q

How are class A personality disorders managed?

A

Psychotherapy like CBT
Medication mangement for associated symptoms

366
Q

What are the broad features of class B personality disorders?

A

Dramatic/emotional/impulsive cluster

367
Q

What are the disorders included in the clas B personality disorder cluster?

A

Antisocial personality disorder
Borderline personality disorder/EUPD
Histrionic personality disorder
Narcissistic personality disorder

368
Q

What are the features of antisocial personality deisorder?

A

Disregard for and violation of the rights of others
Exhibit a lack of empathy, engage in manipulative and impulsive actions
Unremorseful behaviour
Failure to obey social norms and laws

369
Q

What condition in childhood increases the risk of developing antisocial personality disorder in adulthood, and how can this risk be diminished?

A

Conduct disorder
CBT treatment

370
Q

What are the features of BPD/EUPD?

A

Abrupt mood swings, unstable relationships, poor self esteemInability to contro. temper and manage responses effectively
History of trauma and higher propensity for self harm
Splitting-relationships idealised or devalued

371
Q

How is BPD managed?

A

Dialectical behavioural therapy (DBT)

372
Q

Describe the features of histrionic personality disorder

A

Attention seeking behaviours and increased displays of emotion
Many display innapropriate sexual behavior
Shallow, dramatic and exaggerated emotional expressions
Distorted perception of interpersonal boundaries

373
Q

Describe the features of narcissistic personality disorder

A

Persistent pattern on grandiosity, lack of empathy and need for admiration from others
Sense of entitlement->exploit other to fulfil own desires
Arrogant and preoccupied with personal fantasies and desires, even at the cost of others’ feelings and needs

374
Q

What are the broad features of class C personality disorders

A

Anxious/fearful cluster

375
Q

What personality disorders are included in class C personality disorders?

A

Avoidant personality disorder
Dependent personality disorder
Obsessive-compulsive personality disorder

376
Q

Describe the features of avoidant personality disorder

A

Intense feelings of social inadequacy, fear of rejection and increased sensitivity to criticism
Patients often self impose isolation to avoid strong potential criticism, depsite strong desire for social acceptance and interaction

377
Q

Describe the features of dependent personality disorder

A

Pervasive and excessive need ot be taken care of, leading to submissive and clingy bhevaiour
Often lack self-confidence and initiative, relying excessively on others for deciison making
Patients may seek new relationships as a source of care and support when existing ones end

378
Q

Descirbe the features of obssessive compulsive personality disorder

A

Excessive preoccupation with orderliness, perfectionism and control
Strict adherence to tasks and perfectionism
Reluctance to delegate

379
Q

How is obsessive compulsive personality disorder different to OCD?

A

Obsessive compulsive personality disorder has no recurrent intrusive thoughts or rituals
Ego-syntonic-patient perceives their symptoms as rational unlike OCD

380
Q

What are medically unexplained symptoms?

A

Persistent bodily complaints for which adequate investigations don’t reveal sufficient explanatory pathology

381
Q

What are the features of somatoform disorder

A

Unconscious process
Common presentations:
GI sx, fatigue, weakness, MSK symptoms
Can lead to loss of function

382
Q

Describe the features of conversion disorder

A

Neurological symptoms without an underlying neurological cause
Commonly: paralysis, pseudoseizures, sensory changes
Linked to emotional stress
Unconscious process

383
Q

Describe the features of hypochondriasis

A

Excessive concern they will develop a serious illness despite a lack of evidence
Typically have no/very few symptoms
Patients tend to demand lots of investigations which further anxiety

384
Q

Describe the features of Munchausen’s syndorme

A

Fictitious disorder where patients intentionally fake symptoms to gain attention and play a patient role
No insight into motivation

385
Q

WHat is malingering?

A

Patients intentionally fake/induce illness for a secondary gain
Secondary gain: drug seeking, benefits, avoiding prison/work

386
Q

How are medically unexplained symptoms managed?

A

Screen for underlying health problems
Psychological support and therapy like CBT

387
Q

What is delirium?

A

Acute confusional state, mostly in the elderly, usually reversible

388
Q

What are the general symptoms of delirium?

A

Fluctuating attention and cognition
Change in consciousness

389
Q

What are the different types of delirium?

A

Hyperactive
Hypoactive
Mixed

390
Q

What are the features of hyperactive delirium?

A

Increased psychomotor activity
Restlessness
Hallucinations

391
Q

WHta are the symptoms of hypoactive delirium?

A

Lethargy
Decreased responsiveness
Withdrawal

392
Q

Describe the aetiology of delirium?

A

DELIRIUM
Drugs and alcohol
Eyes, ears and emotional disturbances
Low output state(MIR, ARDS, PE, CHF, COPD)
Infection
Retention(of stool/urine)
Ictal(related to seizure activity)
Under hydration/malnutrition
Metabolic disorders (Wilson’s, thyroid, electrolyte imbalances)
Subdural haematoma, sleep deprivation

393
Q

Give some examples of metabolic disorders that can cause delirium

A

Wilson’s
Thyroid problems
Electrolyte imbalances

394
Q

Give some examples of drug classess that can cause delirium

A

Anti-cholinergics
Anti-convulsants

395
Q

Describe the typical presentation of a patient with delirium?

A

DisorientationHallucinations(visual or auditory)InattentionMemory problemsChange in mood or personalitySundowningDisturbed sleep 

396
Q

What is sundowning?

A

Increased agitation/confusion later on in the day

397
Q

What are some differentials for delirium?

A

Dementia: gradual onset and stable consciousness level
Psychosis: Usually preserved orientation and memory
Depression: stable consciousness, pervasive low mood
Stroke: focal neurological signs

398
Q

What investigations should be done for a patient to diagnose delirium?

A

Tools: 4AT, CAM for delirium assessment
Comprehensive physical exam and infection screen
Bedside: bladder scan, medication review, ECG, urine MC&S
Bloods: FBC, U&Es, LFTs, TFTs, cultures
Imaging: abdo US, CXRCT/MRI if no identifiable cause found

399
Q

How is delirium managed?

A

Treat underlying cause
Non pharamcological strategies:
Environment with good lighting
Maintaining a regular sleep-wake cycle
Regular orientation and reassurance
Ensuring glassess and hearing aids are used

If very agitated, low dose lorazepam/haloperidol

400
Q

What is dementia?

A

Syndorme of chronic/progressive nature which involves the impairment of multiple higher cortical functions

401
Q

What quesitonnaire can be useful for assessing dementia?

A

Mini mental state exam(MMSE)

402
Q

Describe the MMSE results for dementia

A

<24/30: dementia
20-24: mild dementia
13-20: moderate
<12: severe

403
Q

How can demential be classified?

A

Primary
Secondary(caused by something else)

404
Q

Name some primary causes of dementia

A

Alzheimer’s
Fronto-temporal
Lewy body
Parkinson’s
Huntington’s
Vascular

405
Q

Name some secondary causes of dementia

A

Infection
Trauma
Post-ictal
Toxic
Autoimmune
Metabolic
Neoplastic
Congential
Endocirne
Functional

406
Q

How do patients with dementia present

A

Memory loss
Language problems
Disorientation
Difficulty with ADL’s
Poor judgement
Mood/behaviour/personality changes
Withdrawal from society
Decrease in consciousness

407
Q

What investigations should be done in a patient with suspected dementia?

A

Functional history(including collateral and risk assessment)
Cognitive assessments: MMSE, MOCA, IO-CS, MIS, TYM
Brain imaging: CT/MRI
Bloods=confusion screen

408
Q

What bloods are including in the ‘confusion screen’?

A

FBC
U&Es
LFTs
CRP/ESR
Calcium
TFTs
B12 and folate
Syphilis and HIV screen

409
Q

Describe the general management of dementia

A

HOWSAFE
HOme safety
Wandering
Self-neglect
Abuse
Falls
Eating
Lifestyle-encourage activity
Social-include OT assessment
Psychological-group stimulation therapy
Pharmacological

410
Q

What is the most common cause of dementia?

A

Alzheimer’s disease

411
Q

Descirbe the pathophysiology of alzheimer’s disease

A

Build up of amyloid plaques and neurofibrially tangles within the brain

412
Q

Name one risk factor for Alzheimer’s disease

A

Down’s syndrome

413
Q

Describe the features of alzheimer’s disease

A

4A’s:
Amnesia (most recent memories lost first)
Aphasia (word finding problems, muddled speech)
Agnosia (recognition problem)
Apraxia (inability to carry out skilled tasks despite intact motor)

414
Q

What is the treatment for dementia?

A

Mild-moderate: cholinesterase inhibitors(rivastigmine, galantamine, donezepil)
Severe: NMDA inhibitor: memantine

415
Q

What is the 2nd most common cause of dementia?

A

Vascular dementia

416
Q

Descirbe the pathophysiology of vascular dementia

A

Impaired blood flow to areas of the brain due to vascular damage

417
Q

What is the key symptoms of vascualr dementia?

A

‘Step-wise’ cognitive decline due to progressive infarcts

418
Q

How is vascular dementia diagnosed?

A

Clinical
Neuro-imaging can show evidence of significant small vessel disease

419
Q

How is vascular dementia treated?

A

Manage underlying vascular risk factors, e.g. statins

420
Q

What is the 3rd most common cause of ementia?

A

Lewy body dementia

421
Q

Describe the aetiology of lewy body dementia

A

Lewy bodies(alpha synuclein) deposits in cells as inclusions

422
Q

What are the key symptoms of lewy body dementia

A

Cogniitive decline and Parkinsonism(rigidity, tremor, bradykinesia)
Associated with liliputian hallucinations

423
Q

Desribe the timing of symptom onset in patients with lewy body dementia

A

Dementia, then movement problems both begin within a year of each other

424
Q

Why does dementia present before parkinsonisn in lewy body dementia?

A

Inclusions affect paralimbic and neocortical areas first, then progress to the substantia nigra

425
Q

How can lewy body dementia be distinguished from dementia due to parkinson’s?

A

Lewy body: dementia first and parkinsonism begin within a year of each other
Parkinson’s: Parkisonism first then dementia, develops a year apart

426
Q

Which medications might be used to treat lewy body dementia?

A

Rivastigmine
Neuroleptics(haloperidol) can help with hallucinations but worsen rigidity
Dopaminergics(amantadine) help rigidity but worsen hallucinations

427
Q

Describe the pathophysiology of fronto-temporal dementia

A

Atrophy of frontal and temporal lobes 

428
Q

What are the key symptoms of fronto-temporal dementia?

A

Behavioural changes
Disinhibition
Cognitive impairment

429
Q

What age is fronto temporal dementia usually diagnosed?

A

Age 45-65
Most other types of demenita affect those >65 years

430
Q

Describe the subtypes of frontotemporal dementia

A

Behavioural(60%): loss of social skills, personal conduct awareness, disinhibition and repetitive behaviour
Semantic(20%): Inability to remember words for things
Progressive non-fluent aphasia(20%0: patients can’t verbalise
Pick’s disease: diagnosed post-mortem

431
Q

What is Pick’s disease?

A

Type of fronto temporal dementia where tau proteins that damage frontal and temporal lobes
Diagnosed post mortem

432
Q

How is fronto temporal dementia diagnosed?

A

SPECT imaging: decreased metabolic function in frontal lobe
MRI: increased T2 signal in frontal lobe

433
Q

What is anorexia nervosa?

A

Self imposed starvation and relentless pursuit if extreme thinnes
Distorted body image

434
Q

What are the subtypes of anorexia nervosa?

A

Restrictive: minimal food intake and excessive exercise
Bulimic: Episodic binge eating then behaviours like induce vomiting/laxative use

435
Q

What is the criteria for an anorexia nervosa diagnosis?

A

Restrictive energy/food intake
Distorted body image
Intense fear of gaining weight
ICD-11 ONLY: low BMI

436
Q

Describe the epidemiology of anorexia nervosa

A

Mostly adolescents and young adults
F>M
Associated with other psychiatric disorders

437
Q

How is anorexia nervosa diagnosed?

A

Full physical exam and history(including collateral)
Bloods

438
Q

What bloods might be different in patients with anorexia nervosa?

A

Deranged electrolyes: low calcium, magnesium, postassium and phosphate
Low FSH, LH oestrogen and testosterone
Leukopenia
Increased GH, and cortisol
High cholesterol
Metabolic alkalosis

439
Q

What might you see when taking a history of a patient with anorexia nervosa?

A

Preoccupation with food and calories
Starvation via restricting intake, purging or excessive exercise
Poor insight, calories in mind regardless of physical health

440
Q

What might you seen on a physical exam in a patient with anorexia nervosa?

A

BMI <17.5kg/m2
Hypotension
Bradycardia
Enlarged salivary glands
Lanugo hair
Amenorrhoea
Pitted teeth
Parotid swelling
Russel’s sign
Failed SUSS test

441
Q

What is Russel’s sign?

A

Lesions on hand from inducing vomiting

442
Q

How might an examination of someone with anorexia nervosa be different to one with bulimia nervosa?

A

Anorexia: BMI<17.5kg/m2
Bulimia: might have normal BMI

443
Q

Describe the management of anorexia nervosa?

A

CBT-EDSSCMMANTRA(maudsley model of AN treatment for adults
Family therapy if underage
Admission under MHA for structured re-feeding
MARSIPAN checklist

444
Q

What symptoms might promt inpatient treatment when it comes to anorexia nervosa?

A

Severe/rapid weight loss
Suicide risk
Failed SUSS test

445
Q

What is the SUSS test anorexia?

A

Sit up squat stand test
Assesses proximal muscle weakness which might hint at respiratory muscle weakness

446
Q

Name some complications of anorexia

A

Re-feeding syndrome
Arrhythmias
Osteoporosis

447
Q

What arrhythmias might you see as a result of anorexia nervosa?

A

Bradycardia
Prolonged QTc

448
Q

What is refeeding syndrome?

A

Rapid increase in insulin shifts potassium, magnesium and phosphate into cells leading to oedema, tachycradia and confusion

449
Q

How can re-feeding syndrome be prevented?

A

Pabrinex
Pre-feeding
Monitor and replensih electrolyes
Build caloric intake gradually

450
Q

What are Capgras delusions?

A

Misidentification syndrome characterised by belief that the closest person is replaced by an imposter who look physically the same

451
Q

Describe the therapeutic dose symptoms of lithium

A

Fine tremor
Dry mouth
GI disturbance
Increased thirst and urination

452
Q

Describe the symptoms of lithium toxicity

A

Coarse tremor
CNS dysfunction: seizures, impaired co-ordination, dysarthria
Arrhythmias
Visual disturbance

453
Q

How can lithium toxicity be diagnosed?

A

Serum lithium levels
Assessment: electrolytes, LFTs, U&Es, ECG

454
Q

How is lithium toxicity managed?

A

Supportive
Maintain electrolytes
Monitor renal function
IV fluids

455
Q
A

Anki 3a exports (11 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions