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D TO REVISE - PHASE 3A > TO REVISE PSYCH > Flashcards

TO REVISE PSYCH Flashcards

1
Q

MANIA
what are the cardinal symptoms of mania?

A

DIG FAST

Distractibility
Indiscretion
Grandiosity

Flight of ideas
Activity increased
Sleep deficit
Talkative (pressure of speech)

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2
Q

GAD
What are some organic differentials for GAD?

A
  • Endo = hyperthyroidism, pheochromocytoma, hypoglycaemia
  • CVS = arrhythmias, cardiac failure, anti-hypertensives, MI
  • Resp = asthma (excessive salbutamol), COPD, PE
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3
Q

ANOREXIA NERVOSA
What screening tool can be used in anorexia?

A

SCOFF –
- Do you ever make yourself SICK as too full?
- Do you ever feel you’ve lost CONTROL over eating?
- Have you recently lost more than ONE stone in 3m?
- Do you believe you’re FAT when others say you’re thin?
- Does FOOD dominate your life?

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4
Q

ANOREXIA NERVOSA
What is the pathophysiology of refeeding syndrome?

A
  • Reduced carb consumption leads to reduced insulin secretion so the body switches from carb > fat + protein metabolism
  • Electrolyte stores depleted as needed to convert glucose>energy
  • Reintroducing food causes abrupt shift from fat>carb metabolism + insulin secretion surges, driving electrolytes from serum>cells to help convert glucose>energy causing further serum concentration decrease
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5
Q

ANOREXIA NERVOSA
What is the clinical presentation of refeeding syndrome?

A
  • Fatigue, weakness, confusion, dyspnoea (risk of fluid overload)
  • Abdo pain, vomiting, constipation, infections
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6
Q

BULIMIA NERVOSA
What is the diagnostic criteria for bulimia?

A

BPFO ≥2 a week for ≥3m –
- Behaviours to prevent weight gain
- Preoccupation with eating (compulsion to eat but regret after)
- Fear of fatness
- Overeating ≥2/week

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7
Q

PERSONALITY DISORDERS
What are some investigations for personality disorders?

A
  • Assessed (Hx + MSE) more than once
  • Minnesota Multiphasic Personality Inventory (MMPI)
  • Eysenck Personality Inventory + Personality Diagnostic Questionnaire
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8
Q

LITHIUM TOXICITY
What is the clinical presentation of lithium toxicity?

A
  • Ataxia, dysarthria, confusion (drunk)
  • COARSE tremor, blurred vision, hyperreflexia
  • N+V, diarrhoea
  • Myoclonus, seizures + coma if severe
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9
Q

NMS
What is the clinical presentation?

A

Bodybuilder–
- Pyrexia >38 + diaphoresis
- Muscle rigidity (diffuse “lead-pipe” rigidity)
- Confusion, agitation, altered consciousness
- Tachycardia, high/low BP
- Hyporeflexia

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10
Q

NMS
What is the management of NMS?

A
  • ABCDE approach
  • Stop antipsychotic (wait >2w before restarting, consider atypical)
  • Give L-dopa if dopamine withdrawal in Parkinson’s
  • IV dantrolene or lorazepam to reduce rigidity 1st line (amantadine second)
  • Bromocriptine prophylaxis
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11
Q

SEROTONIN SYNDROME
What is the clinical presentation of serotonin syndrome?

A

Sx onset + recovery fast–
- Neuro = confusion, agitation
- Neuromuscular = myoclonus, tremors (incl. shivering), hyperreflexia, ataxia
- Autonomic = hyperthermia, diarrhoea, tachycardia, mydriasis

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12
Q

SEROTONIN SYNDROME
What is the management of serotonin syndrome?

A
  • ABCDE
  • Stop offending agent
  • IV access to correct volume + reduce risk of rhabdomyolysis as in NMS
  • BDZs like slow IV lorazepam for agitation, seizures + myoclonus
  • Serotonin receptor antagonists like PO cyproheptadine or chlorpromazine if severe
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13
Q

AUTISM SPECTRUM
What are some risk factors for autism?

A
  • M>F
  • Obstetric complications
  • Perinatal infection (rubella)
  • Genetic disorders (Fragile X, Down’s)
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14
Q

ADHD
What are some risk factors for ADHD?

A
  • Epilepsy, low socioeconomic status, learning difficulties
  • Premature or LBW
  • Brain damage (in vitro or after severe head injury later)
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15
Q

GENDER DYSPHORIA
What are some risks of the hormone therapy?

A
  • Oestrogen = clots, gallstones, high triglycerides
  • Testosterone = polycythaemia, acne, dyslipidaemia
  • Both = elevated LFTs, infertility, weight gain
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16
Q

ANTI-PSYCHOTICS
What regular investigations are done for people on anti-psychotics?

A
  • Lipids + BMI at 3m
  • Fasting glucose + prolactin at 6m
  • Frequent BP during dose titration
  • FBC, U+Es, LFTs, lipids, BMI, fasting glucose, prolactin + CV risk yearly
17
Q

ANTI-DEPRESSANTS
What are the side effects of SSRIs?

A
  • GI Sx most common (N+V, hyponatraemia, abdo pain, bowel issues, increased bleed risk)
  • Sedation + sexual impotence
  • Citalopram + QTc prolongation (dose-dependent)
18
Q

ANTI-DEPRESSANTS
What is the mechanism of action of monoamine oxidase inhibitors (MAOI)?

A
  • Inhibits monoamine oxidase enzyme which reduces breakdown of adrenaline, noradrenaline + serotonin so increases level
19
Q

ANTI-DEPRESSANTS
What are some side effects from MAOIs?

A
  • Sexual dysfunction, weight gain + postural hypotension
20
Q

MOOD STABILISERS
What are the side effects of lithium?

A

LITHIUM –
- Leukocytosis
- Insipidus (diabetes, nephrogenic)
- Tremors (fine if SE, coarse if toxicity)
- Hydration (easily dehydrates, renally cleared)
- Increased GI motility (N+V, diarrhoea)
- Underactive thyroid
- Mums beware (Ebstein’s anomaly)

Can cause weight gain + derm (acne, psoriasis) long-term too

21
Q

HYPNOTICS
What is the mechanism of action of hypnotics?

A
  • GABA agonists on alpha2-subunit of GABA(A)-BDZ receptor/Cl- channel complex
22
Q

ANTI-PSYCHOTICS
How is akathisia managed?

A

Reduce dose, introduce beta-blocker (propranolol)

23
Q

MOOD STABILISERS
What is the mechanism of action of mood stabilisers?

A

Lithium inhibits cAMP production which inhibits monoamines

24
Q

HYPNOTICS
What are the adverse effects?

A

Same as BDZs
- Amnesia, ataxia (esp elderly = falls risk), confusion, drowsiness, dizziness next day (hangover effect), tolerance
- Monitor for resp depression (caution in resp disease)

25
Q

BDZs
What is the mechanism of action of anxiolytics/benzodiazepines (BDZs)?

A
  • Enhance effect of inhibitory GABA by increasing frequency of Cl- channels + flow of Cl- ions causing hyperpolarisation of membrane + so prevention of further excitation
26
Q

BDZs
How would you manage an overdose?
What is the risk of using this?

A

IV flumazenil (danger of inducing status epilepticus or death though)

27
Q

SUBSTANCE ABUSE
List 8 features of dependence

A
  • Withdrawal
  • Cravings
  • Continued use despite harm
  • Tolerance
  • Primacy/salience
  • Loss of control
  • Narrowed repertoire
  • Rapid reinstatement
28
Q

ALCOHOL DEPENDENCE
How does alcohol affect the activity of neurotransmitters in the brain?

A
  • Ethanol > ADH > acetaldehyde > ALDH > acetate > CO2 + H2O
  • Ethanol binds to GABA + makes inhibitor/depressant effect stronger
  • Glutamate antagonism which decreases excitatory neurotransmission
  • Activates opioid receptors to release endorphins
  • Release dopamine + serotonin
29
Q

ALCOHOL DEPENDENCE
What are the CAGE questions?

A
  • Have you ever felt you need to CUT down on your drinking?
  • Have people ANNOYED you by criticising your drink?
  • Have you ever felt GUILTY about your drinking?
  • EYE-opener – ever felt you need drink first thing in morning to steady your nerves?
30
Q

ALCOHOL DEPENDENCE
What are the AUDIT questions?

A
  • How often do you have a drink containing alcohol?
  • How many units of alcohol do you drink on a typical day?
  • How often did you have >6 units on a single occasion in the past year?
31
Q

ALCOHOL DEPENDENCE
What is the mechanism of action of naltrexone?

A
  • Opioid receptor antagonist
  • Blocks euphoric effects of alcohol
  • Helps people stick to detox programme + avoid relapse
32
Q

ALCOHOL DEPENDENCE
What is the mechanism of action of acamprosate?

A
  • NMDA antagonist acts on GABA to reduce cravings + risk of relapse
33
Q

BDZs
What drugs can BDZs interact with?

A
  • Anti-hypertensives as enhanced hypotensive effect
34
Q

SUBSTANCE ABUSE
What is an addiction?

A
  • Compulsive substance taking behaviour with physiological withdrawal state
35
Q

OPIATES/OPIOIDS
With opioids, what are the symptoms of withdrawal

A

“Goose flesh” (piloerection),
raised HR/BP,
fever,
pupil dilatation,
abdo cramps,
insomnia,
agitation
(everything runs > D+V, lacrimation, rhinorrhoea, diaphoresis)

36
Q

PHENOMENOLOGY
what is Fregoli syndrome?

A

Fregoli = idea various people are the same person

D TO REVISE - PHASE 3A (9 decks)

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