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OSCE > Psych > Flashcards

Psych Flashcards

1
Q

What are the different areas of discussion in a mental state exam?

A

Appearance, behaviour, speech, mood/affect, thoughts, perception, cognition, insight

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2
Q

What are some features you should comment on in the ‘appearance’ section of a mental state exam?

A

Age, gender, body habitus, clothing/grooming

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3
Q

What are some features you should comment on in the ‘behaviour’ section of a mental state exam?

A

Eye contact and rapport, open/guarded/suspicious, disinhibited/overfamiliarity

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4
Q

What are some features you should comment on in the ‘speech’ section of a mental state exam?

A

Rate, volume, tone, quantity

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5
Q

What are some features you should comment on in the ‘thoughts’ section of a mental state exam?

A

Speed and flow, content (delusions, suicidal/violent thoughts, preoccupied thoughts), interference

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6
Q

What are some features you should comment on in the ‘perception’ section of a mental state exam?

A

Hallucinations and illusions

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7
Q

What are some features you should comment on in the ‘cognition’ section of a mental state exam?

A

Orientation to time/person/place, memory and concentration

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8
Q

What are some features you should comment on in the ‘insight’ section of a mental state exam?

A

Do they recognise that what they are experiencing is abnormal? Do they recognise it is the result of a mental health problem? Do they recognise the need for treatment?

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9
Q

What is a useful question to ask to screen for preoccupied thoughts?

A

Is there anything you tend to think or worry about a lot?

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10
Q

What are the core features to ask about in a history of presenting complaint for psychiatry, in order to make sure you have the information you require for an MSE?

A

Mood (depression/mania) and self-harm/suicide/violence risk, anxiety, delusions, hallucinations, thought disorders

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11
Q

If you have time to cover an in depth personal history in a psychiatry consultation, what things should you ask about?

A

Childhood (family/school), further education/work, relationships, current living situation

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12
Q

What are some additional things you should always ask in a social history for a psychiatric presentation?

A

Have they ever been abused in the past? Have they ever had any involvement with the police?

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13
Q

What are the three core symptoms of depression you should always ask about?

A

Low mood, lack of energy, anhedonia

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14
Q

What are some additional symptoms of depression that are useful to ask about?

A

Sleep pattern, eating, memory/concentration

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15
Q

What is an important blood test to always check in someone presenting with anxiety?

A

TFTs

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16
Q

What is a good question to ask in order to differentiate anxiety from depression?

A

Do you no longer enjoy things that you previously did, or do you still want to do them but are just too anxious to?

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17
Q

When taking a history about an episode of self-harm, what questions should you ask about before the event?

A

Was there any trigger to the episode of self-harm? Was it planned or impulsive? Did they make efforts to ensure they weren’t found? Did they write a note? Were they under the influence of drugs or alcohol?

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18
Q

When taking a history about an episode of self-harm, what questions should you ask about during the event?

A

What did they actually do? Where were they? What was going through their mind at the time? Was the intent to end their life?

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19
Q

When taking a history about an episode of self-harm, what questions should you ask about after the event?

A

How did they get to hospital? How do they feel about it now? What is their mood like now- are they still feeling suicidal? If they were to go home today, what would they do? What is their support network like- do they have any protective factors? Would they be willing to accept help?

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20
Q

When taking a history about an episode of self-harm, after taking the history of complaint using before/during/after, what other things should you ask about?

A

Previous self-harm, previous psychiatric diagnoses, screen for psychiatric conditions, PMH/DH/FH/SH

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21
Q

To be diagnosed with depression, the current episode must have lasted at least how long?

A

2 weeks

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22
Q

What are some lifestyle interventions that can be useful in the management of depression?

A

Stop any depressing drugs (e.g. alcohol, steroids), regular exercise and financial/housing/childcare support if relevant

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23
Q

How would you explain CBT to a patient?

A

CBT works by identifying the negative thoughts and perceptions that feed depression, and then tests the logic of these thoughts

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24
Q

What should you advise any patient starting an anti-depressant medication?

A

Warn them of any side effects and explain that these will likely be transient; explain that they may not begin to feel any benefit until 4-6 weeks later- arrange follow-up

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25
Q

What are the most commonly prescribed SSRI drugs?

A

Citalopram and fluoxetine

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26
Q

Which SSRI is most appropriate in each of the following situations: 1) Cardiac disease? 2) Young people? 3) Epilepsy?

A

1) Sertraline 2) Fluoxetine 3) Citalopram

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27
Q

When should SSRIs and SNRIs be taken?

A

In the morning

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28
Q

What are the most commonly experienced side effects upon starting SSRIs?

A

GI upset, insomnia, agitation

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29
Q

What drugs should an SSRI not be used in combination with?

A

NSAIDs (unless with PPI), anticoagulants, triptans

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30
Q

How should patients be advised to stop SSRIs?

A

Slowly- cut down the dose gradually

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31
Q

When should mirtazapine be used first-line as an anti-depressant?

A

If the patient has poor sleep/appetite

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32
Q

What are some side effects of mirtazapine to warn patients of?

A

Increased hunger and weight gain, sedation, constipation, vivid dreams

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33
Q

When should mirtazapine or tricyclic anti-depressants be taken?

A

At night

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34
Q

Who should tricyclic anti-depressants be avoided in?

A

The elderly/frail, those with cardiac disease and those with suicidal intent

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35
Q

What are some side effects of tricyclic antidepressants to warn patients of?

A

Anti-cholinergic (dry mouth, blurred vision, constipation, urinary retention), anti-histaminergic (weight gain, sedation) and cardiac (tachycardia, postural hypotension, arrhythmias)

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36
Q

What medication should you always stop in a patient presenting with an acute manic or hypomanic episode?

A

Antidepressants

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37
Q

What is usually the first line medication for an acute manic or hypomanic episode?

A

Atypical anti-psychotic (e.g. olanzapine, quetiapine or risperidone)

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38
Q

What is the first line medication for depression in an individual with bipolar?

A

Atypical anti-psychotic (usually olanzapine or quetiapine)

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39
Q

What medications can be used for maintenance treatment of bipolar disorder?

A

Lithium (gold standard), atypical anti-psychotics, sodium valproate/lamotrigine

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40
Q

When should lithium be taken?

A

At night

41
Q

What are some potential side effects of lithium to warn patients about?

A

GI upset, fine tremor, weight gain, nephrotoxicity, hypothyroidism

42
Q

What is the therapeutic window for lithium?

A

Ideally 0.6 - 0.75mmol/L

43
Q

Which blood tests and investigations should be taken prior to initiation of lithium?

A

U&Es, TFTs, parathyroid and renal function and an ECG

44
Q

What monitoring is required after starting treatment with lithium until therapeutic range is reached?

A

Lithium levels weekly and U&Es every 5 days

45
Q

When should lithium levels be taken?

A

12 hours after the last dose

46
Q

What monitoring is required after starting lithium once the therapeutic range is reached?

A

Lithium levels and U&Es every 3 months, TFTs, parathyroid and renal function every 6 months

47
Q

What are some signs of lithium toxicity to be aware of?

A

Coarse tremor, hyper-reflexia, confusion, seizures

48
Q

What is the advice with lithium in pregnancy/breastfeeding?

A

Lithium should ideally be stopped in pregnancy due to the risk of foetal abnormality; however, it should be restarted after delivery since there is a high risk of relapse and breastfeeding should be avoided

49
Q

Which blood tests are required before starting a patient on sodium valproate?

A

LFTs and FBC (for platelet count)

50
Q

What is the advice with sodium valproate in pregnancy/breastfeeding?

A

Avoid in pregnancy and breastfeeding- do not give to females of reproductive age unless absolutely necessary and they are on appropriate contraception

51
Q

What electrolyte abnormality can be caused by SSRIs, especially in older people?

A

Hyponatraemia

52
Q

Non-response to an anti-depressant can be defined as no or inadequate response after what period of time?

A

6 weeks (at the maximum or highest tolerated dose)

53
Q

How long should anti-depressants be continued for after a first episode of depression?

A

6-12 months after full resolution of symptoms

54
Q

How long should anti-depressants be continued for after a second episode of depression?

A

12-24 months after full resolution of symptoms

55
Q

How long should anti-depressants be continued for after a third episode of depression?

A

Indefinitely

56
Q

Lithium should not be prescribed alongside which other drugs?

A

NSAIDs, diuretics, ACE inhibitors/ARBs

57
Q

What are some potential side effects of atypical antipsychotics?

A

Weight gain, sedation, metabolic syndrome, constipation

58
Q

What investigations should be performed before starting atypical antipsychotics and at one month?

A

Blood pressure, weight, ECG and bloods for glucose/lipid profile/FBC/U&Es/LFTs

59
Q

What is the treatment plan for generalised anxiety disorder and panic disorder?

A
  1. Education and self-help 2. CBT or SSRI 3. CBT and SSRI
60
Q

How long should treatment for generalised anxiety disorder be continued for?

A

18 months

61
Q

What are the 4 main symptoms of PTSD, that you may want to explore in a history?

A

Re-experiencing, hyper-arousal, avoidance, emotional numbing

62
Q

How long can benzodiazepines be used for in the treatment of anxiety?

A

Short-term only, < 2 weeks

63
Q

What medication can be used to treat the somatic symptoms of anxiety (e.g. tremors, palpitations)?

A

Beta blockers

64
Q

Which personality disorder involves a pervasive distrust and suspiciousness of others?

A

Paranoid PD

65
Q

Which personality disorder involves a pervasive pattern of detachment from social relationships and a restricted range of emotions in interpersonal settings?

A

Schizoid PD

66
Q

Which personality disorder involves a disregard for and violation of the rights of others?

A

Antisocial PD

67
Q

Which personality disorder involves a pattern of instability of interpersonal relationships and self-image and marked impulsivity?

A

Borderline (emotionally unstable) PD

68
Q

Which personality disorder involves a pattern of excessive emotionality and attention seeking?

A

Histrionic PD

69
Q

Which personality disorder involves a pattern of social inhibition, feelings of inadequacy and hypersensitivity to negative evaluation?

A

Avoidant PD

70
Q

Which personality disorder involves an excessive need to be taken care of?

A

Dependent PD

71
Q

Which personality disorder involves a pattern of preoccupation with orderliness, perfectionism and mental and interpersonal control?

A

Obsessive-compulsive (anankastic) PD

72
Q

What is the most effective treatment for personality disorders?

A

Treatment of co-existing anxiety and depression

73
Q

What is a specific treatment that is available for borderline (emotionally unstable) PD?

A

Dialectical behavioural therapy

74
Q

What term is used to describe patients making up new words?

A

Neologism

75
Q

What are the four forms of thought interference you should screen for in psychotic patients?

A

Thought insertion, withdrawal, broadcasting and blocking

76
Q

How long must a psychotic illness have lasted before it can be diagnosed as schizophrenia?

A

At least 1 month

77
Q

How do typical anti-psychotic drugs work?

A

Blockage of the D2 dopamine receptor

78
Q

What are some examples of extrapyramidal side effects that may occur with typical antipsychotic drugs?

A

Acute dystonic reactions, drug-induced Parkinsonism, akathisia, tardive dyskinesia

79
Q

How is an acute dystonic reaction treated?

A

Anti-cholinergic medication (e.g. prochlorperazine)

80
Q

If a patient who is taking clozapine complains of any sign of infection, what must you do?

A

Take bloods for FBC (risk of agranulocytosis)

81
Q

How often does routine monitoring take place for patients on clozapine?

A

Every month

82
Q

What diagnosis should you consider if a patient presents with pyrexia, muscle rigidity, tachycardia/tachypnoeoa/hypertension and confusion within hours-days of starting an antipsychotic medication?

A

Neuroleptic malignant syndrome

83
Q

How is neuroleptic malignant syndrome treated?

A

Stop antipsychotic medication and rehydrate

84
Q

What questions should be asked in the CAGE questionnaire to screen for alcohol dependence?

A

Have you ever thought about cutting down your alcohol intake? Have you ever felt annoyed by someone commenting on your alcohol intake? Have you ever felt guilty for drinking too much? Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover?

85
Q

Other than the CAGE questionnaire, what is a good too to use to screen for alcohol dependence?

A

AUDIT

86
Q

A score of what on the CAGE questionnaire is suggestive of problematic drinking?

A

2 or more

87
Q

When taking an alcohol related history, what questions should you ask about their drinking habits?

A

Was there any trigger to the drinking problem? How often do they drink alcohol? How much would they drink in an average day? What are their drinking behaviours? Have they ever tried to cut down before?

88
Q

What are some important symptoms to ask about in an alcohol history?

A

Tremors, sweating, nausea/vomiting, mood… Any other physical changes?

89
Q

When taking an alcohol history, you should ask the patient what effect their drinking has on what aspects of their lives?

A

Relationships, work, driving, crime

90
Q

What are the alcohol rules in Scotland for men and women?

A

They should not drink more than 14 units per week, if they are drinking this amount it should generally be spread over at least 3 days

91
Q

1 unit of alcohol is equivalent to what volume of pure ethanol?

A

10mls

92
Q

How is the number of units of alcohol calculated?

A

% (as a decimal) x volume / 10

93
Q

When do symptoms of alcohol withdrawal tend to peak? When do they usually resolve by?

A

24-48 hours / 5-7 days

94
Q

At what point of alcohol withdrawal may generalised seizures occur?

A

3-5 days

95
Q

When is the peak onset of delirium tremens?

A

2 days post-abstinence

96
Q

What are the three main principles of treatment of alcohol withdrawal?

A

Generalised support, benzodiazepines, thiamine supplemention

97
Q

What are some physical consequences of anorexia?

A

Hypersensitivity to cold, constipation, hypotension/bradycardia, amenorrhoea, osteoporosis

98
Q

In those who binge and purge, what are some metabolic changes that may be visible on blood testing?

A

Hypokalaemia and alkalosis

OSCE (14 decks)

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