Quizzes Flashcards
Psychotropic that can cause severe epigastric pain that radiates to the back, with associated vomiting.
Sodium valproate, pancreatitis
Mood stabilizer that can cause hypercalcemia
Lithium
*barbiturates, VA, carbamazepine, and haloperidol cause HYPOcalcemia
CASE: bipolar I disorder pregnant patient on lithium during 3rd trimester, serum level of 0.75mmol/L + no plans of breastfeeding. Course of management.
> Suspend lithium 24-48 hours before planned CS or induction, and at the onset of labour.
Lithium levels should be measured 12h after last dose
If within therapeutic range, restart lithium day 1 postnatal
Check serum levels after 1 week
*During pregnancy, due to the increase in total body water, lithium dose should be increased to maintain therapeutic range. However, requirements return to pre-pregnancy levels immediately after delivery.
ICD-11 trait domain specifiers
Borderline pattern
Anankastia
Detachment
Dissociality
Disinhibition
Negative affectivity
Likelihood of an individual completing suicide within two years following an initial act of DSH
1%
CASE: adolescent with mild depression. Course of management.
First line: 4 weeks - watchful waiting, with maintained contact with the family
If it persists: 2-3mos of individual non-directive supportive therapy, group CBT, guided self-help
CASE: adolescent with moderate to severe depression
First line: 3mos CBT, IPT or family therapy
Pattern of acts of assault, threats, humiliation, intimidation, or abuse that is used to harm, punish, or frighten a victim.
Coercive control
Risk of having another child with Down syndrome if a parents has balanced translocation (asymptomatic carriers with 45 chromosomes - enough genetic material but in the wrong location)
15%
Dementia with Capgras syndrome like delusion
Dementia with Lewy bodies
Only licensed treatment for moderate to severed TD in the UK
Tetrabenazine
Medication management of psychosis in Parkinson’s disease
> Consider reducing or stopping anticholinergics and dopamine agonists
Consider to give atypical antipsychotic (low dose quetiapine)
Consideration for cholinesterase inhibitor
Trial of clozapine
DBT treatment stages
Pre-treatment phase: assessment, orientation to therapy, commitment to therapeutic contract
Stage 1: reducing life threatening behaviour, behaviour that may interfere with progress and with quality of life
Stage 2: emotional processing of previous traumatic experiences, target post-traumatic stress-related symptoms
Stage 3: develop self-esteem, establish future goals
Stages of Cognitive analytic therapy
Reformulation - identification of patterns
Recognition - develop ways to recognise unhelpful patterns
Revision - interventions or alternatives to identified patterns
Drug of choice for the prevention and treatment of antipsychotic-induced weight gain
Metformin
First choice medication for akathisia
Low dose propanolol
*no contraindications: asthma, bradycardia, hypotension
Treatment for antipsychotic induced hypersalivation
Antimuscarinic agents: propantheline, diphenhydramine
Personality trait domains shared by ICD-11 and DSM-5
Detachment
Disinhibition
Dissociality/ antagonism
Negative affectivity
*5th domain: anankastic (ICD-11) & psychoticism (DSM-5)
NICE guidelines: youngest age that a child may be considered for antidepressant treatment for depression
5yo
McNemar test is particularly suitable when dealing with what kind of data
paired categorical data
> before-and-after studies
> repeated measures of proportions
> matched case control studies
Pre-requisite for providing a psychiatric report in clinical proceedings
Receiving instructions
Neuroimaging finding most commonly found in individuals with both Down syndrome and Alzheimer’s dementia
Cortical thinning
Progression rate of MCI to dementia in 1 year
10%
Heritability in frontotemporal dementia is accounted for by what type of mutation
Autosomal dominant
Among the SGAs, what are the top 3 highest incidence of orthostatic hypotension
Quetiapine 27% → Clozapine 24% → Iloperidone 19.5.
Lowest: Lurasidone & Asenapine (<2%)
The only 2 drugs licensed in the UK for the management of non-cognitive symptoms associated with dementia
Haloperidol
Risperidone
> drug of choice for geriatric population due to haloperidol’s adverse effects
> optimal dose for dementia 1mg BID
> specifically indicated for short term (6 weeks) treatment for persistent aggression
> drug review 4-6w → 3mos → q6mos
Case: opioid dependent patient wanting quick detox within a couple of weeks
Lofexidine
> 10-day course, withdrawn over 2-4 days
*other meds that can ameliorate symptoms - loperamide, metoclopromide, ibuprofen
Case: opioid dependent pregnant patient who is in her first trimester and also currently breastfeeding that wants to quit
Methadone
*Buprenorphine - contraindicated due to risk of withdrawal in the foetus
*Suboxone - avoid during pregnancy
*still breastfeed even if they continue opioids
Neuroimaging: CT/MRI ventricular dilation of temporal horns + thinning cortex
NPH
Neuroimaging: SPECT temporal and posterior parietal hypoperfusion
Alzheimer’s disease
Neuroimaging: CT/MRI relative sparing of medial temporal lobes; frequent periventricular lucencies on MRI
DLB
Neuroimaging: CT/MRI atrophy of basal ganglia, with boxing of caudate and dilation of ventricles
Huntington’s disease
Neuroimaging: PET asymmetrically decreased dopamine activity in the basal ganglia
Parkinson’s disease
Tetrad of narcolepsy
Sleep paralysis
Cataplexy
Hypnagogic hallucinations
Excessive sleepiness
[SCHEep]
Peak onset of schizophrenia in children and adolescent
> 15yo
Susser’s Triad of Causal Properties
Direction
Association
Time order
Most common BPSD seen in Alzheimer’s dementia
Apathy
Interventions in ID: others mirror his BODY LANGUAGE and pleasantly imitate his vocalizations
Intensive interactions
Interventions in ID: changes in daily routine via visual displays
Now and next cards
ECG tracings: 19yo with eating disorder and induced vomiting (hypokalemia)
ST segment depression with U waves
*severe hypokalemia can casuse U waves
ECG tracings: Clozapine initiation + chest pain (myocarditis)
diffuse ST elevation
ECG tracings: adult woman Citalopram 40mg OD + recent intake of diphenhydramine
QTc proloongation
ECG tracings: elderly Alzheimer’s patient on donepezil
Sinus bradycardia
Opioid effect that do not show any tolerance
Constipation and miosis
Adjunct to aid formerly opiate dependent patients who want to remain abstinent
Natlrexone
*must have been abstinent for 7-10 days to prevent precipitating withdrawals
CASE: alcohol dependence, no physical sequelae, seeking pharmacological intervention to reduce alcohol cravings
Acamprosate + behavioral couple therapy
Paradoxical injunction is originally used in which family therapy technique
Systemic family therapy
Empty chair technique is usually used by which therapy technique
Gestalt therapy
NICE guidelines: for bipolar individuals with a manic episode, what should be offered in the first instance
Haloperidol, olanzapine, quetiapine, risperidone
Baseline likelihood of having a child with ASD
1.5%
* if already with 1 child with ASD = 15%
* if already with 2 children with ASD = 30%
NICE Guidelines: person developing moderate or severe bipolar depression, not taking any drug to treat the bipolar depression
fluoxetine + olanzapine
quetiapine
Symptomatic relief of cannabis withdrawal, especially agitation, impulsivity, and irritability
Benzodiazepines
Increased need for handling in babies is seen in withdrawal of which drug
Nicotine
Benzodiazepines for those with hepatic impairment
alt/ast TOL
Temazepam
Oxazepam
Lorazepam
*short half-lives with no active metabolites
Treatment guidelines for ADHD
Mild-mod - 1st line: behavior therapy and psychoeducation. No medications.
Severe - Medication treatment
> 1st line: Methylphenidate & dexamfetamine (70% of children improve), atomoxetine (it is an alternative 1st line, NOT second line)
Imprinting of chromosome 15 is seen in…
Angelman syndrome - loss of maternal contribution
Prader-Willi - loss of paternal contribution
Core features of Ganser syndrome
Clouding of consciousness
Pseudo visual hallucinations
Approximate answers
Somatic conversion symptoms
CASE: 45yo bipolar disorder, currently compliant with lithium therapy only. Recently complained of hypomanic symptoms. Lithium dose was increased to max but no effect. Most appropriate medication to add to prevent relapse of mania.
Sodium valproate
*NICE Guidelines:
> acute mania - Optimise lithium monotherapy. If still not effective, add olanzapine, risperidone, or quetiapine
> for maintenance phase - adding VA is the first recommendation when lithium is ineffective
