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Random psych Flashcards

1
Q

Organic causes of psychosis

A

Vascular -cerebrovascular accident
Infection- encephalitis, meningitis, neurosyphilis
Traumtic brain injury
Autoimmune encephalitis (anti-NMDA, anti-VGKC)
Metabolic- B12 deficiency, pellagra (vit B3 deficiency), acute intermittent porphrya, wilsons
Iatrogenic- steroids,
Neoplasms- brain tumor
Endocrine- thyrotoxicosis, cushings
Neurodegenerative disease- Alzheimers, Lewy-body, Parkinsons, huntingtons

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2
Q

what is schizoaffective disorder

A

schizophrina + bipolar disorder(mood disorder)

random episodes of psychosis within mood fluctuations

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3
Q

what prescribed medications can cause psychosis?

A

steroids
anticholinergics eg. TCAs
dopaminergics eg. bromocriptine
thyroxine
antimalarials

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4
Q

what illicit substances are most likely to cause psychosis

A
  1. high THC containing cannabinoids- esp synthetic weed (spice)
  2. amphatamines
  3. hallucinogens (LSD, PCP, psilocybin)
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5
Q

key question to ask with someone presenting with auditory hallucinations

A

do you hear the voices through your ear or inside your head?

(true psychotic pts will try to find an explanation for the auditory hallucinations and put them down to an external stimuli as to not sound as crazy. Pts who want to appear psychotic will say thet hear voices in their head)

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6
Q

according to ICD-11, how long does someone need to have symptoms to be diagnosed with schizoprenia?

A

1 month

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7
Q

what is the first line psychological treatment for borderline personality disorder

A

dialectal behavioural therapy (DBT)

remember its pretty much the only condition where CBT isnt the first line

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8
Q

What are the different personality disorders in cluster A personality type

A

Paranoid
schizoid
schizotypal

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9
Q

What are the different personality disorders in cluster B personality type

A

Antisocial
narcissistic
Histrionic
Borderline

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10
Q

Features of anorexia nervosa

A
  • morbid fear of fatness (overvalued idea)
    -BMI <17.5
  • deliberate measures to lose weight eg. food restriction, excessive exercise
  • endocrine disturbances eg. amenorrhoea in women,
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11
Q

Physical disturbances in anorexia nervosa

A
  • low BMI <17.5
  • bradycardia
  • hypotension
  • lenugo hair
  • cold extremities
  • hypothermia
  • constipation
  • amenorrhoea
  • severe: long QTc
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12
Q

What is refeeding syndrome

A

Happens when there is a significant reintroduction of food after the person has had a substantial period of malnourishment

When glucose is reintroduced, there is a surge in insulin, which draws already depleted K, Mg and phosphate into cells leading to major hypokalaemia, hypomagnesmaeia and hypophosphataemia

clinical features:
nausea
muscle weakness
confusion/ coma
arrhythmias- torsades de pointes
ECG changes- T wave flattening and U waves

+thiamine deficiency –> wernickes encephalopathy

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13
Q

features of bulimia nervosa

A
  • characterised by repeated bouts of binging, feeling of regret followed by purging
    eg. vomiting, laxatives, diuretics
  • excessive preocupation of controlling body weight
  • episodes must happen at least 1/week for 3 months to fit diagnostic criteria

may not be underwight like in anorexia

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14
Q

Physical/ clinical signs in bulimia nervosa

A

signs of excessive vomiting:
erosion of teeth

Russels sign- calluses on the knuckles due to self induced vomiting

swelling of parotid glands

hallitosis- bad breath

mallory weiss tear- haematemesis, pain

electrolyte disturbances- low Na, Cl, Mg, Phos and K
arrhythmias
metabolic alkalosis
dehydration
hypostnsion
tachycardia

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15
Q

what is the PHQ-9 questionnaire and what are the questions

A

assessment of the severity of depression

in the past 2 weeks how often…
1. have you had little interest or pleasure doing things
2. trouble sleeping or sleeping too much
3. loss of appetite or eating too much
4. feeling down, depressed or hopeless
5. lacked energy to do things
6. felt like youve let people around you down
7. trouble concentrating
8. changes in speech
9. had thoughts that youd be better off dead

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16
Q

how to interpret the PHQ-9 score

A

0-4: normal
5-9: mild depressiom
10-14: moderate
15-19: moderately severe
20-27: severe

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17
Q

management of acute mania

A
  1. risk assess and consider section 5(2)
    - Urine drug screen
    - monitor fluid status
  2. if first presentation:
    • short acting benzo (lorazepam)
      - antipsychotic: olanzepine
  3. if already on medication
    - optimise dose
    - check for any interactions
    - consider adding antipsychotic
  4. ECT if unresponsive to Rx

After:
-check compliance
- enquire for any trigger (eg. drugs, antidepressant)
- prev episodes of depression?

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18
Q

Key questions to ask in a history of a manic pt

A

why do they think they are here?

whats been going on?

MOOD: How do they feel in themselves
Have you ever had something like this before?
Have you ever had a period of time where you felt the complete opposite?

THOUGHT: probs will just come out

PERCEPTION: have you been hearing things when it seems like no one is around?

Do you hear through your ear or in your head

INSIGHT: Do you know why you are seeing a psychiatrist? Do you think there is a problem with your mental health

RISK: have you had any thoughts about harming/ killing yourself. Any thoughts of harming others
Do you feel safe?
been spending more money than usual?

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19
Q

what is the managament of adjustment disorders

A
  • spectrum of reactions as a response to ill health

health psychology
antidepressents
commmunication
counselling
symptom control of medical issues
CBT

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20
Q

Medical emergencies related to psychiatric medication

A

neuroleptic malignant syndrome (anti psychotics)
serotonin syndrome (antidepressants)
long QTc –> torsades de pointes (citalopram)

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21
Q

psychiatric problems from medications

A

Roaccutane (acne) –> depression increased suicidality
steroids –> psychosis, delerium, mania, depression

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22
Q

max dose of lorazepam

A

4mg in 24 hrs

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23
Q

Tests to perform in a GP setting for addiction

A

urine drug screen

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24
Q

GABA-A targeting drugs

A
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25
Q

MOA of benzodiazepines

A

potentiates the affects of GABA which incrreases the flow of chloride ions and hence hyperpolarisation of post synaptic membrane –> reduced excitibility

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26
Q

Withdrawal features of benzos

A

anxiety, irritibility, restlessness, tremor, sweating, insomnia

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27
Q

toxicity features of benzos

A

drowsiness, ataxia, slurred speech, reduced conciousness
severe: hypotension, brady cardia
OD: respiratory depression

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28
Q

Antidote for benzo OD

A

Flumazenil

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29
Q

What drugs can be identified on the urinary drug screen

A

alcohol
amphetamines
barbiturates
benzodiazepines
cocaine
cannabis
methamphetamine
opioids
phencyclidine (PCP)

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30
Q

how long can cannabis be detected for on UDS after use?

A

casual use: 2-14 days
heavy use: 30 days

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31
Q

Criteria for dependence in ICD-10 (6 points)

A

meeting 3 or more = diagnosis
1. a strong desireor sence of compulsion to take
2. difficulties in controlling
3. physiological withdrawal Sx when stop taking
4. evidence of tolerance leading to increased doses to feel the same affect
5.
6.

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32
Q

what are the stages of change in the prohchaska and DiClemente’s model

A

pre-contemplation
contemplation
preparation
action
mainatainence
relapse

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33
Q

Screening tools for alcohol misuse

A

CAGE
FAST
AUDIT

34
Q

Key questions to ask in alcohol/ substance misuse history

A

Type of drink and how much in units
when did it start
what time of day
alone or with people
social network
how much money are they spending on substances
pattern of drinking eg. binging/ steadily
any withdrawal sx
triggers
aware of the problem?
any period of abstinence and for how long?
Mental health comorbidity
Diet
any mixing of substances
How is it affecting their life
forensic history, getting into trouble on substances or to get substances

35
Q

how to calculate units of alcohol

A

(total vol of drink (mls) x ABV%) /1000

36
Q

features of alcohol dependence syndrome

A
37
Q

Management options for someone with alcohol dependence

A

psycho:
- motovational interview and discuss evidence for concern eg. deranges LFTs
- discussion of a plan and warn not to go cold turkey
- referral to specialist alcohol services

social:
- notify the DVLA
- drink diary

Bio:
- thiamine replacement

38
Q

alcohol effects on the CNS

A

complex interplay between excitatory and inhibitory systems

39
Q

physical and psychological symptoms of alcohol usage

A
40
Q

medication to help with cravings

A

Naltrexone - reduces the pleasure feelings of alcohol

acampostate - reduces hyperglutamatergic state. Anticraving drug

41
Q

symptoms of alcohol withdrawal

A

tremors
sweating
N+V
anxiety
hypertension, tachycardia, dilated pupils

24-48hrs after last drink : seizures (tonic clonic)
24-72hrs after last drink: delerium tremens

42
Q

Management of alcohol withdrawal

A

alcohol detox: clinical institute assessment for alcohol withdrawal

benzos: long acting eg. chlordiazepoxide

pabrinex

dextrose: NEVER GIVE BEFORE PABRINEX as dextrose can potentiate wernikes in thamine depleted pts

43
Q

risk factors for developing delerium tremens

A

previous DT
co-infeciton
pancreatitis, hepatitis
older age
abnormal liver function

44
Q

What is wernickes encephalopathy

A

vitamin B1 (thiamine) deficiency

confusion
opthalmoplesia (eg. nystagus or CN6 palsy)
ataxia

45
Q

mechanism for thiamine deficiency in AD

A
  1. poor diet due to alcohol
  2. damage to gut from alcohol so poor absorption
46
Q

what is korsakoffs psychosis

A

irreversible complication of wernickes

antegrade and retrograde amnesia
change in personality (frontal lobe dysfunction) eg. childlike behaviour confabulation

psychotic symptoms

47
Q

clinical features of opiate OD

A

reduced GCS
pinpoint pupils
hypotension
respiratory depression
hypotonia
hyporeflexia

48
Q

opioid substitution therapy

A

methadone:
- reduces euphoria
- more SEs: resp distress, long QTc, constipation, dry mouth

buprenorphine
- less sedation, less euphoria, less SEs but more unpleasant feelings

49
Q

differentials for depression

A

organic- anaemia, low vitamin D, thyroid, cushings
cognitive- dementia
adjustment disorder
insomnia

50
Q

differentials for mania

A

organic- thyrotoxicosis, steroids, antimalarials
acute psychosis
delusional disorder, grandiosity

51
Q

differentials for psychosis

A

organic- porphyrias, pellegra, brain tumour, autoimmune encephalitis, thyrotoxicosis, steroids, antimalarials
delirium
mania
drug induced psychosis/ currently high
depression with psychosis

52
Q

differentials for confusion

A

organic- delerium/ infection, low glucose
dementia

53
Q

What questionnaire is used in the investigations for OCD and what are the questions

A

Yale-Brown obsessive compulsicve scale

5qus for each obsession and compulsion and each qu scored out of 5 (5most severe)

Time, interference, distress, resistance, control

  1. how much time is spent on the obsessions or compulsions
  2. how much do these thoughts/ actions interfere with life
  3. how much distress is it causing you
  4. how much do you try to resist the obsessions/ compulsions
  5. how much control do youe obsessions/ compulsions have over you
54
Q

what are some example themes of typical obsessions

A

agressive obsessions
sexual obsessions
contamination obsessions
hoarding obsessions
religious obsessions
obsession for symmetry
somatic obsessions

55
Q

what are some example themes of typical compulsions

A

checking compulsions
cleaning/ washing compulsions
repeating rituals
counting
ordering/ arranging
sorting compulsions

56
Q

what effects do smoking and alcohol have on clozapine levels

A

smoking cessation - levels will rise
starting smoking/ smoking more will reduce levels

alcohol binging - increase levels
stopping drinking- reduces levels

57
Q

features of PTSD

A

re-experiencing: flashbacks, nightmares, repetitive and distressing intrusive images

avoidance: avoiding people, situations or circumstances resembling or associated with the event

hyperarousal: hypervigilance for threat, exaggerated startle response, sleep problems, irritability and difficulty concentrating

emotional numbing - lack of ability to experience feelings, feeling detached

58
Q

factors associated with poor prognosis of schizophrenia

A

strong family history
gradual onset
low IQ
prodromal phase of social withdrawal
lack of obvious precipitant

59
Q

different classess of medically unexplained symptoms

A

somatisation - physical SYMPTOMS being present. Not reassured by negative test results

hypoChondriasis - believing they have a severe medical condition despite reassurance eg. Cancer

conversion disorder - loss of sensory or motor function usually in leg. common for over worked athletes

dissociative disorder - separating off certain memories from reality eg. amnesia

factitious disorder/ muchaussen syndrome - purposefully causing symptoms eg. causing a hypo by taking insulin

malignering - fraudulent exaggeration or making up of symptoms with the intention of gains eg. financial, opioid medication

60
Q

what features support a diagnosis of depression over dementia

A

short history, rapid onset

biological symptoms e.g. weight loss, sleep disturbance

patient worried about poor memory

reluctant to take tests, disappointed with results

mini-mental test score: variable

global memory loss (dementia characteristically causes recent memory loss)

61
Q

quick and useful clinical tool to differentiate organic from non-organic leg paresis

A

Hoovers sign

get pr to raise unaffected leg and put hand under the heel of the affected leg. In a non-organic causes you will feel pressure under the heel due to involuntary contralateral hip extension

62
Q

what is Cotard syndrome

A

Cotard syndrome is a rare mental disorder where the affected patient believes that they (or in some cases just a part of their body) is either dead or non-existent. This delusion is often difficult to treat and can result in significant problems due to patients stopping eating or drinking as they deem it not necessary.

63
Q

what is Charles Bonnet syndrome

A

is a psychophysical visual disorder where patients with significant vision loss have vivid, often recurrent visual hallucinations. These hallucinations can be simple (i.e. shapes, patterns) or complex (i.e. detailed objects, people) but patients almost always have insight into the fact that they are not real and do not suffer from any other forms of hallucinations (e.g. auditory) or delusions.

64
Q

what is the mechanism of hypocalcaemia in someone who is hyperventilating

A

hyperventilation leads to low CO2 ad respiratory alkalosis

alkalosis promotes albumin binding to calcium in the blood and therefore causes reduces free Ca

Sx: tingling or numbness in hands and feet and around the mouth, funny turns

65
Q

particular autoantibody associations with autoimmune encephalitis and paraneoplastic conditions

A

Anti-Hu: Small cell lung cancer
NMDA receptor antibodies: Ovarian teratoma
Anti-Yo: breast and ovarian tumours

66
Q

management of paracetamol overdose

A

if injested <1hr ago - activated charcoal

if injested <4hrs ago- wait til 4hrs to take blood sample

if dose >150mg/kg- start N-acetylcysteine

if staggered dose takene- start N- acetylecystein immediately

if injested >24hrs ago - start NAC immediately

calculation of paracetamol treatment level done using the NOMOGRAM
- blood paracetamol level vs time after injestion. If above line then commence Rx

67
Q

pathophysiology of paracetamol OD and antidote

A

Paracetamol is metabolised by CyP450 into NAPQI which is toxic

glutothione binds to NAPQI into a non toxic conjugate

in paracetamol OD the gutathione stores become depleated so you get toxic build up of NAPQI which is hepato and nephrotoxic

NAC provides cystine for glutathione synthesis to help remove toxic build up

68
Q

which is the preferred SSRI in breastfeeding women

A

paroxetine

69
Q

contraindications oto Ach inhibitors in dementia

A

pre-existing QT prolongation

70
Q

schneiders first rank symptoms

A

auditory hallucinations:
hearing thoughts spoken aloud
hearing voices referring to himself / herself, made in the third person
auditory hallucinations in the form of a commentary

thought withdrawal, insertion and interruption

thought broadcasting

somatic hallucinations

delusional perception
feelings or actions experienced as made or influenced by external agents

71
Q

definition of learning disability

A

significant or resuced ability to understand new or complex information or skills

reduce ability to cope independently

present from before adulthood with persistent effect

72
Q

tools used to help diagnose LD

A

weshcler adult intellegence scale to determine IQ

Adaptive/Social functioning established via clinical interview
and ABAS II (Adaptive Behaviour Assessment System)

• Presence in childhood established using clinical interview and
school reports

73
Q

values for mild moderate and severe LD in terms of IQ

A

mild 50-69
moderate 35-49
severe 20-34
profound <20

74
Q

common causes of LD

A

most common is genetic
hypoxia
infection

75
Q

genetic diseases with LD

A

Downs syndrome
fragile X
prader will/ angelmans
lesch nyan syndrome
congenital hypothyroidism
phenylketouria
diGeorge

76
Q

what physical illnesses are common in people with LD

A

epilepsy
obestiy, DM, HPTN- due to poorer lifestyles
hearing impairment

77
Q

what psychiatric conditions are common in people with LD

A

autism
schizophrenia
mood disorders

78
Q

vulnerability factors in people with LD

A

rejections/ neglect/ abuse
poorer coping stratergies
sexual/ emotional vulnerability
low self esteem
bereavement/ adjustment issues

79
Q

what might challenging behaviour be as result of in someone with LD

A

physical problems- eg. pain, discomfort, dererium

psychological- eg. anxiety, depression, psychosis, dementia

social- eg. change in routine, carers, bereavement, ABUSE!!!

80
Q

principles of management of someone with LD

A

BIO- regular physical health checks at GP
treat any co-morbidities
PSYCHO- counseling, support groups, CBT, behavioural therapy, family therapy
SOCIAL- RISK assessment especially abuse, educational support, support with life skills etc..

Psychiatry (4 decks)

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