SPMM Flashcards
After individuals with bulimia stop purging what may they get?
Parotitis - often painless
When can a child copy a circle, square and triangle?
Circle - aged 3
Square - aged 4
Triangle - aged 5-6
When can a child build blocks of 2, 3, 6-7, 9-10
2 - 15 months
3 - 18 months
6-7 - 2 years
9-10 - 3 years
How should one switch from a TCA to SSRI?
Half dose of TCA start the SSRI and slowly withdraw the TCA
How should you switch from Trazodone to another anti-D (not MAOI)?
Cross-taper cautiously
In CJD what are the initial symptoms?
Often cerebellar or visual:
- Ataxia, clumsiness, dysarthria
- Diplopia, distorted vision, blurred vision, field defects, changes in colour perception, visual agnosia
Name some changes to the cerebellum?
Hypoplasia of the cerebellar vermis
Reduced Purkinje cell count of the cerebellum
Lesion in which artery of the brain is most likely to produce akinetic mutism?
Anterior cerebral artery
Does Lewy Body Dementia showed reduced acetylcholine counts?
Yes - that’s why acetylcholine-esterases are used in these conditions
What is the cerebral torque?
Opposing right-left asymmetry of frontal and parietal-occipital regions - may be disturbed in psychosis
What anti-depressants perinatally have been linked to cleft palate in neonates?
SSRIs
MAOI > other anti-depressants for which condition?
Social phobia
What measures may improve lithium induced tremor?
Taking smaller, more frequent doses
Propanolol
How long does persistent delusional disorder need to last?
1 month
In grief attentional bias to objects belonging to the dead person is known as?
Incentive salience
What is interoception?
Awareness of one’s physiological state
What is the most long lasting cognitive effect after ECT?
Retrograde amnesia for autobiographical memory
Confusion and disorientation usually resolves within 24-48 hrs
Anterograde amnesia resolves in
What is the most long lasting cognitive effect after ECT?
Retrograde amnesia for autobiographical memory
Confusion and disorientation usually resolves within 24-48 hrs
Anterograde amnesia resolves in
What is the most long lasting cognitive effect after ECT?
Retrograde amnesia for autobiographical memory
Confusion and disorientation usually resolves within 24-48 hrs
Anterograde amnesia resolves within the first few weeks
Does high EE affect men or women more with regards to risk of relapse post psychotic episode?
Men
What is the primary ego defence?
Repression
Is the risk of Clozapine induced agranular cytosis dose dependent?
No
Afro-Caribbean, young and low baseline count are risk factors
First 6 months of treatment risk is highest
Name antipsychotics high risk of weight gain?
Clozapine
Olanzapine
Moderate:
- Risperidone
- Quetiapine
- Palliperidone
- Chlorpromazine
Others are generally low risk inc. Zuclopenthixol, Haloperidol. Sulpride, Amilsulpride, Aripiprazole etc
Which anti-dementia drug undergoes minimal hepatic involvement for breakdown and is metabolised by choline-esterase itself?
Rivastigmine
Are there interactions between OCP and Sodium Valproate?
No
Which cells promote clearance from the synapse?
Stellate cells
Which cells link the cortex to the spinal cortd for motor transmission?
Betz cells
Name a common defence mechanism seen in Naricssism?
Projection
How may extraversion, neuroticism and psychoticism change in age?
All decrease in both males and females
How long does puberty tend to last for boys?
2-3 years
What is the most common feature in Parkinson’s?
Unilateral resting tremor
Describe features of late onset Schizophrenia?
Predominantly female
Less negative symptoms
Less thoughts disorder
Prominent hallucinations visual
Social isolation
Sensory impairment
Premorbid paranoid personality traits
In psychopathology the tendency to feel inappropriately euphoric is known as?
Moria
What does the Stanford Binet test assess for?
Intelligence
In extroverts how does the ascending reticular activating system act?
Under-active –> therefore seek out social contact
Introverts –> may be over active and want alone time
Name some mechanisms that account for sexual dysfunction with antipsychotics?
Alpha - 1 - antagonism - erectile dysfunction (also known to attribute to priapism for chlorpromazine, thioridazine and trazadone)
D2 blockade - hyperprolactinaemia or reduced drive
H1 blockade - sedation
Anticholinergic blockade - Reduced peripheral vasodilation
Which anti-depressants are most/least associated with sexual dysfunction?
Mirtazapine
Moclobemide
Vortioxetine
Reboxetine
Buproprion
Agomelatine
Those with a lot:
- SSRI
- SNRI (Venlafaxine > Duloxetine)
- Tricyclics
What is the inheritance pattern of Fragile X
X-linked dominant
How does Flumazenil work?
Competitive inhibition at GABA-A receptor
Which TCA is the
a) Most serotenergic
b) Most noradrenergic
c) Most histaminergic
c) Least anticholinergic
a) Clomipramine - best for OCD
b) Desipramine - most noradrenergic (secondary amine)
c) Doxepin
d) Secondary amines - Nortriptyline, Desipramine, Amozapine
What are the ECG in myocarditis?
Saddle shaped ST elevation - if pericardial involvement
Tachycardia
Prolongation of PR interval
Diffuse TWI
What can acetylcholine-esterase inhibitors do to ECG?
Bradycardia and PR prolongation
Lhermitte’s sign is seen in which condition?
Multiple sclerosis
- it is the presence of brief shock like sensations starting in the neck and radiating down the body towards the limbs
How is subclinical hypothyroidism managed in a patient taking Lithium?
Initially monitored
Are perceptual abnormalities seen in parkinson’s?
Yes - 40%
Commonly perception of a person next to them - 25%
Sometimes formed visual hallucinations - 22%
Can be auditory hallucinations - 9.7%
Shenjing Shuairuo is a culture bound illness from which country?
China - it means weak nerves
Symptoms similar to chronic fatigue/fibromyalgia
- Multiple somatic complaints
- Dizziness, headaches, chronic pain, fatigue
The social acceptance of individuals with learning disabilities without devaluation is known as?
Social role valorisation
Name a new mental disorder in ICD-11
Prolonged grief disorder
In ICD-11 can all disorders be diagnosed at any age?
Yes
What anti-D is associated with a lower risk of manic switch?
SSRI
Clonidine is a….
Alpha-2-adrenergic agonist
- it’s effects are typically act on presynaptic alpha 2 adrenergic receptors this reduces the release of noradrenaline
- on cessation there may be rebound hypertension
- Clonidine is used for tics and tourettes and also ADHD
Side effects;
- dizziness
- sedation
- orthostatic hypotension
- dry mouth
- depression
Which oral benzodiazepine has the shortest onset of action?
Diazepam
How does reserpine work?
It prevents the storage and synthesis of NA from axon terminals
What is a haptic hallucination?
Other name for tactile hallucination
What is the most common obsession in OCD?
Fear of contamination
In Minuchin’s study of families of patients with anorexia nervosa what behaviours did he find?
Overprotectiveness
Rigidity
Poor resolution conflict resolution skills
Emneshment
How does vision develop in the neonate?
Birth - track objects, bright light perception, can fixate on objects at 20cm, figure-ground perception
1 month - discriminate faces
2 months - prefers 3D > 2D and depth perception
4 months - colour vision and accommodation
6 months - adult acuity
Name a neurochemical theory for tardive dyskinesia?
High D-2 sensitivity (supersensitivty)
What muscarinic receptor blockade is most likely to lead to anti-cholinergic effects in TCAs?
M3
Name some neurological conditions associated with autism?
Tuberous sclerosis
Neurofibromatosis
What are the hold tests in the WAIS?
Information
Object assembly
Picture completion
Vocabulary
- these are meant to be resistant to brain damage
Non-hold tests are block design, digit span, digit symbol, similarities
What is the risk of alcoholism in close relatives?
3-4 x more likely
What is the increased risk of inheriting panic disorder in close relatives compared to the general population?
6 - 17%
4 - 8 x more likely
The isoforms of MAO A/B are encoded on which chromosome?
X chromosome
What scan would differentiate Parkinson’s from drug induced Parkinson’s
Beta-CIT-SPECT or FP-CIT (DATscan)
Techtineum-HMPAO-SPECT (99mTc) assess for?
Indirectly assess blood flow
What stage of sleep are saw tooth waves seen?
REM sleep
Also low voltage mixed frequency alpha and theta waves seen
Are dystonias dose dependent?
Yes
How does Mianserin work?
Alpha-2 antagonism and weak alpha-1 antagonism - prevents the uptake of Na mainly, some Serotonin
Can be delivered OD due to half life 10-29 hours
Sedative and weak antimuscarinic effects
What are phase 1 and phase 2 reactions?
Phase 1 - oxidation, reduction, hydrolysis
Phase 2 - conjugation, methylation, n-acetylation, glucuronidation
What can SSRI’s cause?
Nocturnal myoclonus
The MOHOST is a scale that assesses?
ADL functioning
Capgras syndrome is what type of delusion?
Reduplicative paramnesia - the sense that a place, person has been duplicated and the person is simultaneously experiencing it
What personality traits was Jung associated with?
Introversion/Extroversion
Restless leg syndrome may be treated with what type of drug?
Dopamine agonist
carbi/levo-dopa
Prameprixole
Restless leg syndrome may be treated with what type of drug?
Dopamine agonist:
- carbi/levo-dopa
- pramiprexole
- rapinirole
Clonazepam 2nd line
Fronto-striatal executive dysfunction is a neuropsychological theory for which condition?
ADHD
What type of chromosome is formed by Robertsonian translocation?
Metacentric - p arms get discarded
The health of nations outcomes scale assess for?
Assess recovery and clinical outcomes
Name a non-clinical administered scale fully structured interview used in epidemiological studies to identify a lifetime diagnosis?
Diagnostic interview schedule
Pimozide and Carbamezepine are broken down by BLANK enzymes
CYP3A4 - grapefruit juice, paroxetine, fluvoxamine and fluoxetine are inhibitors
Name some antipsychotics with prominent orthostatic hypotension?
Clozapine & Risperidone - due to alpha-1-adrenergic blockade
Which anti-epileptic is associated with motor disturbances?
Vigabatrin
Name some indications for Tetrabenazine?
- Huntington’s
- Tardive Dyskinesia
- Tourette’s
What is a hygric hallucination?
A feeling of fluid
Name some defence mechanisms used in OCD?
Undoing, reaction formation and isolation
When is the steady state of clozapine/sodium valproate reached?
2-3 days
What has been previously referred to as bodily distress disorder?
Neurasthenia
