Psychiatry (rotation To Come) Flashcards
1
Q
Which drugs can we use to treat PTSD?
A
An SSRI e.g. escitalopram, fluoxetine, or venlafaxine
2
Q
Define psychosis.
A
Loss of connection with reality.
Hallucinations and delusions
3
Q
What is the difference between hallucination and illusion?
A
Illusion = there IS an external stimulus. Hallucination = no external stimulus.
4
Q
Define delusion
A
False unshakeable belief even where there is evidence showing the contrary.
5
Q
Which are the 3 causes of organic psychosis?
A
Drug-induced
Delirium
Dementia
6
Q
What is the cause of a patient with dementia who sees little figures walking around them.
A
Organic psychosis - organic cause is the dementia not neccessarily Psychosis itself.
7
Q
What is schizophrenia?
A
Disorder of thinking, perceiving and motivation.
Male = female
Lifetime prevalence = 1%
8
Q
What causes schizophrenia?
A
Genetic = increased risk in first degree relatives Neuro-chemical = dopamine 'hypothesis', serotonin 'hypothesis'
General findings: reduced brain mass, increased ventricular size - very non specific findings in psychiatry.
9
Q
name three positive symptoms in schizophrenia
A
Delusions
Hallucinations
Sense of being controlled
10
Q
name three negative symptoms of schizophrenia
A
Loss of motivation
Paucity of thought (just pause thinking)
Loosening of association i.e. scattered thoughts.
11
Q
What is the cause of depression?
A
15% genetic prevalence
Neurochemical: Monoamine ‘hypothesis’ = altered function of NA.
12
Q
What is Beck’s triad?
A
Self - the future - experiences
13
Q
What are the core symptoms of depression?
A
Low mood
Low energy
Inability to enjoy oneself (anhedonia)
14
Q
Name some biological symptoms of depression.
A
Poor sleep (can be too little, too much)
Poor appetite (can be too little, too much).
Poor concentration
Poor motivation
15
Q
How likely is it that someone treated with depression will experience an episode again?
A
80%
16
Q
What are the suicide rates in men vs. women with depression?
A
Males = 7% Females = 1%
17
Q
What is bipolar affective disorder?
A
Must have episodes of mania and depression.
same as manic-depressive disorder
18
Q
Name some characteristics of mania
A
Elevated mood Reduced need for sleep Reduced appetite Highly motivated Lots of new interests May have grandiose delusions Increased libido - risky activities
(Often these patients do very well so wouldn’t necessarily seek help immediately).
19
Q
What is somatisation?
A
Process of converting psychological into physical symptoms.
20
Q
What is conversion disorder?
A
Loss of function as a result of extreme psychological distress.
e.g. can lose sensation, movement in a limb.
21
Q
In Obsessive compulsive disorder, what is the difference between obsession and compulsion?
A
Obsession = ruminating, circular throughs. Very intrusive. Recognised as absurd. Compulsion = rituals.
22
Q
What is Personality disorder?
A
Becomes a disorder when behaviours impact on everyday life. Marked difficulties with interpersonal relationships.
23
Q
Define delirium
A
Acute fluctuating confusional state with clouding of consciousness and psychotic symptoms.
(bear in mind can be hypoactive)
24
Q
Differentiate between psychosis and schizophrenia.
A
Schizophrenia is a form of a psychotic disorder.
25
Name the aspects of the mental state exam.
```
Appearance and behaviour
Speech
Mood
Thought content
Cognition
Insight
Perception
```
26
Which are the three core symptoms of depression?
Low mood
Anhedonia
Reduced energy/ fatigue.
27
Which are the two hallmark signs of psychosis?
Halluciantions and/or delusions.
28
What is the ICD-10 criteria for Bipolar affective disorder?
At least two episodes - one of which must be hypomania/ manic or mixed.
29
What is the difference between bipolar affective disorder 1 and 2?
BAD 1 = one episode of mania +/- depression
| BAD 2 = one episode of hypomania +/- depression
30
Define a manic episode
```
Elevated mood, or irritable. Sustained for 1 week
Some signs:
- increased talkativeness
- increased activity
- increased self esteem
- decreased need for sleep
- increased sexual energy
```
31
What is the difference between hypomania and mania?
Hypomania - 4 days
Mania - 1 week+ consecutive episode
Mania - more severe, longer history.
32
What is Beck's triad?
View of self, future and the world
33
Which person is associated with CBT?
Beck
34
Name two cognitive distortions
Shoulds and Musts
| Mental filter
35
Give 3 biological symptoms of depression.
Loss of libido
Loss of appetite
Early morning awakening
36
How do most antidepressants work?
Aim to increase monoamine neurotransmitters i.e. serotonin, noradrenaline, adrenaline.
37
Which percentage of patients with depression recover with placebo?
30%
38
What is the last consideration of treatment with depression?
Considering the addition of ECT.
39
How many weeks should you wait to see if an SSRI is effective?
2 weeks - increase dose if no improvement by week 4.
| Consider switch after 6 weeks.
40
Name two mood stabilisers.
Lithium and lamotrigine.
41
Name x3 SSRIs
Citalopram, sertraline, fluoxetine.
42
Which drug class is mirtazapine?
NASSA - Noradrenergic and specific serotonergic antidepressants.
43
Name x2 TCAs
Amitriptyline, Clomipramine.
44
Name one SNRI. What is this?
Duloxetine - Serotonin and noradrenaline reuptake inhibitors.
45
Serotonin is also known as which chemical?
5 hydroxytryptamine.
46
Synthesis of serotonin starts with which chemical?
Tryptophan.
47
Which enzyme stops serotonin action?
Monoamine oxidase (MAO).
48
Which form of Monoamine oxidase A has the strongest affinity for serotonin?
MAO-A.
49
Citalopram is which kind of drug?
SSRI.
50
Which are the two main SSRIs?
Citalopram, fluoxetine.
51
Why may we see nausea and vomiting with SSRIs?
There are many serotonin receptors in the gut.
52
Which ECG change can be seen with citalopram?
QTc prolongation (escitalopram has less cardiac interactions).
53
Duloxetine is what type of drug class?
SNRI - serotonin and noradrenaline reuptake inhibitor.
54
What is a key benefit of SNRIs?
Dopamine has a similar chemical affinity to noradrenaline so the noradrenaline reuptake transporter can take it up too.
55
What type of drug class is Mirtazapine?
NASSA
| An alpha 2 receptor antagonist
56
How do TCAs work?
Block the reuptake of noradrenaline via NET inhibition. (noradrenaline reuptake transporter).
57
Give an example of a TCA
amitriptyline.
58
MAO-B is mainly used for which condition?
Parkinson's disease; raises dopamine = raises levodopa
59
What is the cheese reaction?
Tyramine interaction from the diet.
If you are on MAOI = raises too much tyramine = risk of hypertensive crisis. (because tyramine increases the release of noradrenaline).
60
Which antidepressant is most likely to cause withdrawal symptoms?
Paroxetine.
61
What is St John's wort?
Plant - hypericum perforatum
herbal remedy that is actually effective!
Binds to serotonin and noradrenline reuptake transporters.
Disadvantage: MANY side effects e.g. increase risk of bleeding, potent hepatic enzyme inducer (affects metabolism heavily).
62
Generally how long do antidepressants take to work?
2-6 weeks
63
Antidepressants are addictive. True or false.
No; they change dopamine levels in the mesolimbic reward pathway.
64
What is the first line medication in someone with bipolar disorder?
Mood stabilisers NOT antidepressants - as can push into mania.
65
What is the difference between section 2 and section 5(2)?
66
What is the difference between section 2 and 3?
67
Which are the three signs of ADHD?
Inattention
Impulsivity
Hyperactivity
68
The SNAP Questionnaire assesses which mental health condition?
ADHD.
69
What is psychosis?
Disorders of perception, belief and functioning. Hallucinations and delusions.
70
Define hallucination.
Perception in the absence of an external sensory stimulus.
71
Define delusion
Fixed, unshakeable beliefs out of keeping with socio-cultural context.
72
Name 3 types of schizophrenia
- Paranoid schizophrenia
- Catatonic schizophrenia - hyperkinetic psychomotor disturbance
- Residual schizophrenia - Chronic negative symptoms with poor self care and social performance.
73
Name two positive and two negative symptoms of schizophrenia.
Hallucinations and delusions
| Anhedonia, Alogia (without speech), FTD - formal thought disorder
74
Name some 'first rank symptoms' of schizophrenia.
- Auditory hallucinations (third person commentaries i.e. hearing voices)
- Thought withdrawal - thoughts being taken out of head.
- Delusional perception - I saw a red car and I knew I had 2 souls.
75
Name some negative symptoms in schizophrenia.
Social withdrawal, anhedonia, attention control, apathy
76
What do we mean when we say 'affective' psychosis?
Congruent affect i.e. depressed/elated with emotions - appropriate for that situation.
77
Name the investigations for psychosis
History and mental state examination. Physical examination. Urine drug screen, blood tests, EEG.
78
Which neural pathways are associated with schizophrenia?
Mesocortical and mesolimbic pathways - dopamine
79
What is the likely response in giving schizophrenic patients dopamine?
Hallucinations and psychotic symptoms.
80
How do we first treat schizophrenia?
1st generation antipsychotic: chlorpromazine, haloperidol.
2nd generation include olanzapine.
81
Loss of touch with reality associated with delusions and hallucinations. Definition?
Psychosis
82
Give 3 negative symptoms of psychosis
| Clue: 3As.
Alogia, apathy, avolition
83
Chlorpromazine is what type of drug?
Anti-psychotic
84
What is the dopamine theory of psychosis?
Lowered dopamine = helps with psychosis.
| Dopamine increase in the mesolimbic pathway can cause the positive psychotic symptoms.
85
Positive psychotic symptoms are associated with which pathway?
Mesolimbic pathway
86
Negative psychotic symptoms are associated with which pathway?
Mesocortical pathway
87
What is the nigrostriatal pathway?
Projects from dopaminergic cell bodies in substantia nigra (midbrain) to axons in the basal ganglia.
88
Which main neurotransmitter do anti-psychotics work to block?
Dopamine
89
Name two examples of first generation antipsychotics.
Chlorpromazine and Haloperidol.
90
Aripiprazole and risperidone are examples of which kind of drugs?
2nd generation anti-psychotic medications.
91
Which percentage of dopamine receptors usually need to be blocked to see antipsychotic effect without major side effects?
60-80%
92
Which drugs are most commonly used as rapid tranquilisation?
Haloperidol and Olanzapine.
93
What is the impact on prolactin of antipsychotics?
Hyperprolactinaemia; dopamine antagonists.
94
Why does Aripiprazole not cause QT prolongation?
Does not bind to sodium channels in the heart.
95
Which areas are involved in the extra-pyramidal pathway?
Outside of corticospinal tracts in the medulla pyramids.
| Refers to basal ganglia, cerebellum and motor cortex.
96
Which extra-pyramidal effects can we see as an affect of anti-psychotics?
Dystonia
Akathisia
Parkinsonism
97
Define dystonia
Involuntary muscle spasm/ contraction.
98
Eyes rolling upward into head. Medical term?
Oculogyric crisis
99
What is Akathisia?
Internal restlessness.
100
Those with schizophrenia tend to die how many years prior than the general population?
15-20 years earlier.
101
What are some aspects of the metabolic syndrome associated with antipsychotic use?
Weight gain, dyslipidaemia, insulin sensitivity.
102
Which medications act on the h1 receptor?
'pines' - clozapine, quetiapine, olanzapine.
103
Which is considered the gold standard for psychosis?
Clozapine
Binds to 30+ receptors - actually not the highest affinity for dopamine despite binding.
104
How long is a section 2?
28 days (1 month).
105
How long is a section 3?
6 months
106
Who is required in the room to section a patient?
Approved mental health professional (AMHP)
| 2 doctors
107
What is a benefit of aripiprazole?
Less metabolic side effects i.e. less weight gain.
108
What is the medical term for restlessness?
Akathisia
109
Which drug class is Chlorpromazine?
antipsychotic
110
Which drug class is olanzapine?
anti-psychotic medication
111
What is a main common side effect of antipsychotic medication?
Hyperprolactinaemia.
112
Name x3 side effects of hyperprolactinaemia.
Breast tenderness
Breast enlargement
Lactation
113
Which antipsychotic medication is associated with agranulocytosis?
Clozapine.
114
How is Lithium used in psychiatry?
As a mood-stabiliser in bipolar disorder.
115
When checking lithium levels, when should samples be measured?
12 hours post dose.
116
What is the first line treatment in a patient with PTSD?
CBT.
117
Give two examples of atypical antipsychotics.
| What is the advantage of atypical antipsychotics?
Olanzapine, Clozapine, Risperidone.
| Atypical agents avoid extrapyramidal affects.
118
How many SSRIs should you try and what would offer if neither of these are effective?
SNRI - eg. duloxetine.
119
What is malingering?
An act, not a psychological condition.
120
Give x3 atypical antipsychotics.
Olanzapine
Risperidone
Clozapine.
121
What can cause a rise in clozapine levels within the blood?
Smoking cessation.
122
Give x3 indications of ECT.
Catatonic episodes
Prolonged or severe, manic episode.
Severe, life threatening depression.
123
Define Agoraphobia.
A type of anxiety disorder in which you fear or avoid situations which may cause panic.
124
What are the key presentations of autism?
Repetitive behaviours e.g. repeating phrases, actions
Does not understand social cues
Avoiding eye contact
125
Which disorder will CBT not be effective in?
Personality disorders - DBT - Dialectical behaviour therapy.
126
What is DBT?
Dialectical behavioural therapy.
Based on CBT but focuses more on accepting who you are at the same time as changing behaviours.
More group work.
127
What is adjustment disorder?
Any event - doesn't have to be as stressful as in acute stressful. Disorder gets better as stressful event recedes e.g. relationship ending. Typical time period; 1 month.
128
Name the three core diagnostic symptoms of PTSD.
1. Reliving of event e.g. nightmares.
2. Hyperarousal, vigilence
3. Avoidance due to re-exposure.
129
Which is the first line medication for PTSD?
SSRIs,
| CBT.
130
What is EMDR?
Eye movement desensitisation reprocessing.
keeping a traumatic memory in mind and following doctor's fingers. Working memory is working so hard on trying to focus on event and fingers - the thoughts have less hold and power.
131
Why do we not treat PTSD right away with therapy?
Must be a delay to differentiate away from an acute stress reaction.
132
Are panic attacks part of the diagnostic criteria for PTSD?
No. It is a separate diagnosis.
133
There is a low weight requirement for anorexia nervosa. True or false?
False; no longer a weight loss requirement - more rapid weight loss over short period of time.
134
Which medications used to treat hypertension can cause depression?
Beta blockers
135
Name 3 SSRIs
Escitalopram, sertraline, fluoxetine.
136
Which drug class if moclobemide?
MAO I/ RIMA (reversible inhibitors of monoamine oxidase).
137
What is tardive dyskinesia?
Abnormal involuntary movements e.g. licking lips.
138
What is the term for restlessness, abnormal involuntary movements?
Akathisia.
139
What is the difference between antisocial and avoidant behaviour?
Antisocial behaviour is more associated with aggressive and impulsive behaviour.
140
Define schizoid.
Emotional aloofness and social isolation. Few interests.
141
What is serotonin syndrome and what can it be caused by?
High heart rate, hyperreflexia, sweating.
| Caused by triptans (taken for headaches) + escitalopram.
142
Which medication is most commonly associated with agranulocytosis?
Clozapine
143
What should you remember to refer if you see a patient on clozapine?
Full blood count; Clozapine can cause agranulocytosis/ neutropenia.
144
Which drug class is Venlafaxine?
SNRI - serotonin and noradrenaline reuptake inhibitor.
145
Which type of hallucination is seen as a first rank synotin in Schizophrenia?
Auditory hallucinations (not visual).
146
A manic episode must always be more than 7 days in duration. True or false?
False.
147
What is the FTD we can typically see in manic patients?
Flight of ideas
148
Which is the gold standard mood stabiliser?
Lithium
149
What is a large disadvantage of lithium?
Has a very narrow therapeutic range.
150
Name the common side effects of lithium.
Fine tremor
| Mild GI upset
151
How do we treat acute mania?
1. First line antipsychotic
2. Stop antidepressant first, then offer antipsychotic
3. Benzodiazepine e.g. clonazepam
Longer term = lithium, sodium valproate.
152
What is the difference in timeframe between baby blues and postnatal depression?
Baby blues: upto 10 days
| Post natal depression: peak 3 months
153
How do we treat post natal depression?
Reassurance and CBT
| SSRIs - sertraline, paroxetine - can continue to breastfeed.
154
What are the first rank symptoms in schizophrenia?
Auditory hallucinations, thought disorder (thought insertion, thought withdrawal, thought broadcasting), delusional perceptions (the traffic light is green therefore I am King).
155
How would we assess if THOUGHT (from asetpci) is disordered?
?Thought insertion
?Thought withdrawal
?Thought broadcasting
156
What is a delusional perception?
Two stage process where second intense delusion has no meaning relative to the first.
157
Is schizophrenia characterised by auditory of visual hallucinations as a first rank symptom?
Auditory
158
What is the difference between mania and hypomania?
```
Mania = lasts at least 7 days and impairs functional capacity at work.
Hypomania = lasts typically up to 4 days and does not impair functional capacity at work.
```
159
How would thought present in mania?
Flight of ideas.
160
Which symptoms are mainly diagnostic of depression?
Low mood, anhedonia and fatigue.
161
How do we treat GAD?
1. Educate patient and active monitoring.
2. Low intensity psychological interventions.
3. CBT, drugs first line Sertraline as SSRI.
162
Which is the first line drug treatment for GAD?
Sertraline.
163
How do we define borderline personality disorder?
Unstable self image, recurrent suicidal behaviour, efforts to avoid real or imagined abandonment.
164
What does histrionic mean?
Acting in an inappropriately seductive way to get attention from others. Need to be centre of attention.
165
Give three features of narcissistic behaviour
Grandiose ideas of self.
Lack of empathy
Sense of entitlement
166
Define schizoid behaviour.
Few interests, preference to solitary activities, lack of desire for companionship, loss of libido.
167
What is the difference between affect and mood?
```
Affect = Patient's immediate expression of emotion
Mood = Sustained emotion
```
168
What is schizotypal behaviour?
Few interests, odd and eccentric behaviour, inappropriate affect.
169
What is a neologism?
New made up word which can be made up of a combination of more than one word.
170
What is a clang association?
Ideas which are associated only because they rhyme/ sound similar to one another.
171
Anorexia nervosa is diagnosed by BMI. True or false.
False.
172
What do we diagnose anorexia by?
1. Restrictive eating
2. Intense fear of gaining weight/ becoming fat
3. Body dysmorphia.
173
What is the main difference between typical and atypical antipsychotics?
```
Typical = Dopamine D2 receptor antagonists. Mainly extrapyramidal side effects e.g. parkinsonism, dystonia, akathisia.
Atypical = weight gain, agranulocytosis (clozapine), hyperprolactinaemia. LESS EXTRAPYRAMIDAL.
```
174
What is the main difference between typical and atypical antipsychotics?
Typical = more associated with extrapyramidal
175
Name one typical and atypical antipsychotic.
```
Typical = haloperidol
Atypical = clozapine, olanzapine, risperidone, aripiprazole.
```
176
Name one key side effect that is more seen in atypical antipsychotics than typical?
Atypical = hyperprolactinaemia, agranulocytosis (clozapine).
177
Which are the most preferred SSRIs?
Escitalopram and Fluoxetine.
| Sertraline too especially post MI.
178
Which two treatments have interactions which can cause serotonin syndrome?
SSRIs and triptans
179
Name the most common side effect of ECT.
Retrograde amnesia.
180
When is lithium most commonly used? What type of drug is it? Give 2 specific considerations for Lithium.
Most commonly used for bipolar disorder. A mood stabilising drug.
- Very narrow therapeutic range
- Weekly bloods to check lithium levels and once normal check every 3 months.
181
Define personality disorder
Cannot be explained by social or cultural factors
Causes distress to personal, family, social, educational and other important areas of functioning.
Important to see there is disruption in OVERALL functioning rather than in a specific area.
182
Which are the three clusters of personality disorders?
Cluster A - odd and eccentric
B - dramatic, emotional
C - Anxious, obsessive
183
Define schizoid personality disorder
Perceived as emotionally cold
Preference to be by themselves
Limited capacity to express feelings and experience pleasure.
184
Which condition is commonly seen in patients whereby they may think they have bipolar
Borderline personality disorder - mood changes will happen more frequently in a day (not so quick in bipolar)
Intense and unstable personal relationships.
Absolute glorification/ demonisation of people in personal relationships.
Difficulty managing emotions and behaviour.
Very much black and white behaviour.
185
Name one typical antipsychotic - which are the main side effects of typical antipsychotics?
Haloperidol.
| Extra-pyramidal side effects e.g. parkinsonism, muscle contraction, akathisia (severe restlessness).
186
Is akathisia associated with typical or atypical antipsychotics?
Typical e.g. haloperidol; extra-pyramidal effects.
187
Name one atypical antipsychotic - which are the main side effects of atypical antipsychotics?
Olanzapine, clozapine, risperidone. Hyperprolactinaemia
Clozapine - agranulocytosis.
Weight gain.
188
Which drugs do SSRIs interact with?
NSAIDs - must give SSRIs with a proton pump inhibitor if patient is on NSAIDs.
Triptans - risk of serotonin syndrome.
189
Name 3 discontinuation symptoms of SSRIs.
Increased mood change, restlessness, sweating, unsteadiness, GI symptoms e.g. pain.
190
What is the most common side effect of ECT?
Retrograde amnesia.
191
Which cardiac medication can cause depression?
Beta blockers
192
Which are the two medications of choice in treating bipolar disorder?
Lithium and sodium valproate.
| but sodium valproate not to be used in women of child bearing age so first line: lithium.
193
Which remedy do we use for benzodiazepine overdose?
Flumazenil
194
Which remedy do we use for zopiclone overdose?
Flumazenil
195
When may we use naloxone?
Opiate overdose
196
Which remedy do we use for paracetamol overdose?
N-acetylcysteine.
197
Which side effect may be seen with lithium?
Ebstein's anomaly = tricuspid valve is displaced in the neonate.
198
Lithium toxicity occurs above which level?
Above 1.5mmol/L.
199
Which are the three main symptoms of Wernicke's encephalopathy?
Confusion, ataxia and nystagmus.
200
What is the name of the condition which can present 72 hours within withdrawal of alcohol if a patient is experiencing hallucinations?
Delirium Tremens
201
Which diagnosis can follow Wernicke's encephalopathy where there can be amnesia, apathy and loss of insight?
Korsakoff's psychosis.
202
AUDIT PC and FAST are questionnaire tools for screening for which condition?
Assessing alcohol use
203
What treatment do we give for alcohol withdrawal?
Treat cause e.g. thiamine if Wernicke's encephalopathy.
| Often use benzodiazepines e.g. diazepam or chlordiazepoxide = reduce symptoms.
204
Toby has had to drink more alcohol recently in order to ‘relax’ describes what behavior?
Tolerance
205
Define one unit of alcohol in terms of mg and ml?
One unit of alcohol is defined as “amount of alcohol that an adult can metabolise in 1 hour which is equivalent to about 10 ml of pure ethanol or 8g of pure ethanol.”
206
Which two of the following neurotransmitters are believed to play a role in CNS effects of alcohol?
GABA and NMDA
207
Alcohol Withdrawal Syndrome occurs 24 hours after the last drink. True or false?
Within 4-12 hours
208
Which medication is the first line prescription for alcohol withdrawal?
Benzodiazepines.
209
What is methadone used for?
Treatment for opiate dependence.
| It is a long acting synthetic opiate.
210
What is the treatment for opiate overdose?
Naloxone
211
Name two signs of opiate overdose
Pin point pupils and respiratory depression.
212
Flumazenil is used to treat what?
Benzodiazepine overdose.
213
What is disulfiram used for?
Disulfiram is used as an adjunct in management of alcohol dependence, it gives extremely unpleasant systemic reaction due to accumulation of acetaldhehyde. Interferes with metabolism of acetaldehyde.
214
Which is the psychoactive ingredient in 'mushrooms'?
Psilocybin
215
Which plant is heroin extracted from?
The opium poppy = Papaver Somniferum
216
Give 3 symptoms/ signs of alcohol withdrawal?
Dilated pupils, raised blood pressure, yawning, cool, clammy skin.
217
Which medication can cause cogwheel rigidity as a side effect?
Haloperidol; typical antipsychotic.
218
Which medication can cause loss of outer eyebrow as a side effect?
Lithium.
219
Hypertensive crisis can be a side effect of which medication?
Moclobamide
220
Anxiety can be a side effect of which medication?
Escitalopram - can cause patients to get worse for first few weeks before feeling better.
221
Akathisia can be a side effect of which medication?
Risperidone.
222
Give examples of tardive dyskinesia.
Lip smacking, grimacing
223
What is delusional parasitosis?
Delusional disorder where convinced they have infestation of parasites, worms and flees.
- More common in older women
224
What is formication?
Experience where people are itching and they feel like they have insects on their skin - specifically related to drug use and drug withdrawal.
225
Do we want bipolar patients to stop lithium treatment during pregnancy?
no; risk of relapse during pregnancy if discontinued is worse than risk of birth defects.
226
Is mania associated more with elevated mood or irritability?
Irritability!
227
Which medication cause hyponatraemia as a side effect?
SSRIs e.g. Escitalopram
228
Which are the main side effects of mirtazepine?
Sedation and increased appetite.
229
Fine tremor is a key side effect of which medication?
Lithium.
230
What are two common effects of acute stress reaction?
Depersonalisation and derealisation
231
What is somatisation disorder?
Excessivelt worried about symptom
| - hypochrondriasis is worried about diagnosis
232
Which drug do we use to manage short term alcohol abuse vs. long term alcohol abuse?
Short term alcohol withdrawal = Short-acting benzodiazepines. e.g. lorazepam
Long term alcohol withdrawal = Long-acting benzodiazepines e.g. chlordiazepoxide, diazepam
233
What is the difference between Type 1 and Type 2 bipolar affective disorder?
Type 1 bipolar affective disorder =x1 episode of major depression and x1 episode of mania
Type 2 bipolar affective disorder = x1 episode of major depression and x1 episode of hypomania.
234
How do we treat GAD - generalised anxiety disorder?
SSRIs and CBT
235
Acetylcysteine is used in the treatment of what?
Paracetamol overdose
236
Which medication do we use to treat delirium or alcohol withdrawal?
Chlordiazepoxide.
237
Which enzyme is raised in alcoholics?
GGT - gamme glutamyl transferase
238
What is the first treatment for OCD?
Exposure and response prevention
239
How do we differentiate between hypomania and mania?
Auditory hallucinations
240
What are the most common side effects of TCAs?
Dry mouth and blurred vision
241
Which is the antidepressant which increases appetite the most?
Mirtazapine
242
What is Korsakoff's syndrome?
Often a complication of Wernicke's - confusion, ataxia and opthalmoplegia.
243
Dizziness, electric shock sensations and anxiety are symptoms of discontinuing which drug?
SSRIs e.g. fluoxetine, paroxetine
| - mainly think SSRI discontinuation with 'electric shock'.
244
Which medication is associated with hyponatraemia?
SSRIs. e.g. sertraline
245
What is the risk of using SSRIs during pregnancy?
Pulmonary hypertension
246
Which antidepressant increases appetite?
Mirtazapine
247
What type of therapy is used for borderline personality disorder. Disorders where people experience emotions very intensely?
DBT - Dialectical behaviour therapy
248
A young woman complains of feeling lonely. She has stopped seeing her old friends as she is worried about not being liked or criticised. What is the diagnosis?
Avoidant personality disorder - not agoraphobia; s a disorder characterised by anxiety surrounding places or situations that might not be 'safe'
