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psych Flashcards

1
Q

What is a mental disorder as classified by the MHA? + what is the difference between a section 12 approved doctor vs AMHP?

A

Mental disorder = any disorder/ disability of the mind (excluding alcohol and drugs)
Section 12 approved doctors vs. AMHP
Section 12 approved doctors = doctors that have completed a certain years in training, e.g. psychiatrists, certain GPs
AMHP = approved mental health professional, usually a GP, but can also be some social workers, nurses, psychologists or OTs

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2
Q

MHA section 2 - purpose, duration, professionals and evidence?

A

Assessment - 28 days - 2 doctors (1 S12 approved), evidence is for patients own safety or mental disorder present - cannot be renewed!

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3
Q

MHA section 3 - purpose, duration, professionals and evidence?

A

Treatment - 6 months and can be renewed unlike section 2 - 2 doctors (1 s12) - mental disorder present, Rx is available and tx is in patients best interests

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4
Q

MHA section 4 - purpose, duration, professionals and evidence?

A

emergency - 72 hours - 1 doctor/amhp - mental disorder present, patients own safety, not enough time to section properly i.e. lack of other doctor

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5
Q

Section 5(2)?

A

Doctors holding power - 72 hours long - Fy2 or above needs to authorise usually to get a senior to review

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6
Q

Section 5 (4)

A

Nurses holding power - 6 hours - to await medical assessment

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7
Q

Section 135

A

Police section - 36 hours- requires a court order to access ptx home and remove them to a place of safety

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8
Q

Section 136

A

Police section - 24 hours - person sus to have a mental disorder in a public space

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9
Q

What is depression?

A

Depression is a mood disorder causing persistent sadness and loss of interest
If at least one of the two ‘core’ symptoms have been present most days, most of the time, for at least 2 weeks and not secondary to alcohol/drugs/bereavement,

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10
Q

What are the core sx of depression?

A

Core symptoms:
Low mood
Little interest/ pleasure in
doing things (anhedonia)
lasting at least 2w + not due to drugs

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11
Q

What are the 2* sx of depression (assocated sx)?

A

Disturbed sleep (decreased or increased compared to usual).
Decreased or increased appetite and/or weight.
Fatigue/loss of energy.
Agitation or slowing of movements.
Poor concentration or indecisiveness.
Feelings of worthlessness or excessive or inappropriate guilt.
Suicidal thoughts or acts.

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12
Q

How do you determine severity of depression?

A

NICE / DSM5 - basically how many sx they have
Mild: < 5 symptoms resulting
in minor functional impairment

Moderate: > 5 symptoms
with varying functional impairment

Severe: > 5 symptoms markedly interfering with functioning +- psychotic symptoms

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13
Q

What Ix would you do for depression?

A

Hx + MSE
Questionnaire - PHQ-9 i.e.
Bloods to rule out DDx: DDx: hypothyroidism, neurological disorders (Parkinson’s, MS, dementia), substances and adverse drug effects…
Blood glucose, U&E, creatinine, LFT, TFT, calcium levels; FBC, ESR

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14
Q

What is the mx of depression?

A

Subthreshold - Mild:
low-intensity psychological interventions, group CBT, avoid antidepressants

Moderate - Severe: antidepressant + high intensity psychological interventions

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15
Q

What are some low intensity psych interventions that we can use to treat depression?

A

Low-intensity psychosocial interventions are suitable for people with persistent subthreshold depressive symptoms or mild depression, and include:
Individual guided self-help, based on the principles of cognitive behavioural therapy (CBT) — this includes written material or other media relevant to reading age, and usually consists of 6–8 sessions (face-to-face and via telephone) over 9–12 weeks.

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16
Q

What are some high intensity psych interventions that can be used in depression?

A

Individual CBT — usually given over 16–20 sessions over 3–4 months. For people with severe depression, two sessions per week might be provided for the first 2–3 weeks of treatment.

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17
Q

What is the medication for depression?

A

SSRI - 1st line: citalopram,
fluoxetine, paroxetine, sertraline
FluoxeTEEN in teenagers!

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18
Q

What is the medication for depression?

A

SSRI - 1st line either of: citalopram,
fluoxetine, paroxetine, sertraline
FluoxeTEEN in teenagers!

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19
Q

What side effects can you get with SSRI’s and what do you need to know about prescribing them?

A

SSRIs side effects: hyponatraemia (SIADH) in elderly, nausea, headache, GI upset, sexual dysfunction, insomnia, agitation, restlessness, anxiety.
During the first few weeks of treatment, there is a potential increase for agitation, anxiety and suicide risk - especially younger patients.
In general, an antidepressant effect is usually seen within 2-4 weeks of starting treatment.
Treatment should be continued for at least 4 weeks (6 weeks if elderly) before considering switching.
Antidepressants should be taken for at least 6 months after they have recovered, to reduce the risk of relapse. People who are at high risk of relapse may need to take them for longer than this.

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20
Q

What are some other depression medications that are not SSRI’s?

A
  1. SNRI - Mirtazapine,
    Venlafaxine, Duloxetine
  2. Tricyclics - Amitriptyline (sedating), Imipramine (non-sedating). Anticholinergic SE.
  3. Monoamine oxidase inhibitors - Iproniazid, Phenelzine. SE - hypertensive crisis associated with certain ripe cheese
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21
Q

What are some other depressive disorders?

A
  1. Seasonal affective disorder
  2. Dysthymic disorder
  3. Postnatal depression
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22
Q

What is seasonal affective disorder? How do you treat it

A

Seasonal affective disorder is diagnosed if the person has episodes of depression which recur annually at the same time each year with remission in between (usually appearing in winter and remitting in spring). Management is light therapy, then SSRIs.

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23
Q

What is dysthymic disorder?

A

Persistent subthreshold depressive symptoms (sometimes termed dysthymia) is diagnosed if the person has:
Subthreshold symptoms for more days than not for at least 2 years, which is not the consequence of a partially resolved ‘major’ depression.
Mx: SSRI, CBT

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24
Q

Post natal depression? What do you know? how would you manage?

A

Postnatal depression affects about 13% of women after childbirth with suicide being the leading cause of maternal death postpartum. Peak occurrence is 3-4w postpartum - baby blues, on the other hand, commonly occur 2-3 days after birth and resolves within the first 2 weeks.
Paroxetine and sertraline are the drugs of choice for breastfeeding women.

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25
Q

What is bipolar and how would you diagnose it?

A

Bipolar is: Depression + mania/hypomania occurring in episodes usually with months separating them.
Diagnosis requires at least 1 episode of mania or hypomania.

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26
Q

What are the different types of bipolar?

A

Type 1 = Mania + Depression
Type 2 = Hypomania + Depression

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27
Q

What os cyclothymic disorder?

A

Cyclothymic disorder: characterised by recurrent depressive and hypomanic states, lasting for at least 2 years, that do not meet the diagnostic threshold for a major affective episode

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28
Q

What is mania and what does it involve?

A

Mania > 1 week, impaired functioning +- psychosis
(I DIG FAST)
Irritability/elevated mood
Distractibility
Inhibition loss
Grandiosity
Flight of ideas
Activity increased
Sleep not needed
Talkative (pressure of speech)

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29
Q

What is hypomania? What does it involve?

A

Differentiate - never any psychosis , time and affect on functioning
Hypomania 4+ days, doesn’t affect functioning
Elevated mood
Increased energy
Increased talkativeness
Poor concentration
Mild reckless behaviour
Sociability/overfamiliarity
Increased libido
Increased confidence
Decreased sleep

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30
Q

What is the psychosocial mx for bipolar disorder?

A

Psychosocial
Psychotherapy - CBT, interpersonal therapy
Social/ family/ financial support

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31
Q

wHAT MEDICATIONS CAN YOU USE IN BIPOLAR?

A

mood stabilisers: Lithium (narrow therapeutic window 0.4-1.0mmol), Sodium valproate (not for women of childbearing age), Carbamazepine
- Lithium is 1st line

antidepressants - SSRIs - risk of mania !!!!!!!!!!!!
antipsychotics - Olanzapine, Risperidone
emergency - acute mania: Quetiapine + Lithium +- benzodiazepines
ECT if treatment-resistant

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32
Q

What medications can induce bipolar?

A

TCA, SNRI, Benzodiazepines, anti-Parkinson’s medications, antipsychotics

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33
Q

What do you know about lithium and lithium monitoring?

A

Needs to be kept in a narrow therapeutic range and can fuck the kidneys if not monitored and controlled.

Prior treatment: measure the person’s weight or BMI and arrange tests for urea and electrolytes including calcium, estimated glomerular filtration rate (eGFR), thyroid function and a full blood count. + ECG if CVS risk

Measure plasma lithium levels 1 week after starting lithium and 1 week after every dose change, and weekly until the levels are stable.

Aim to maintain plasma lithium level between 0.6 and 0.8 mmol per litre in people being prescribed lithium for the first time.
Measure the person’s plasma lithium level every 3 months for the first year.
After the first year, measure plasma lithium levels every 6 months

Measure the person’s weight or BMI and arrange tests for urea and electrolytes including calcium, estimated glomerular filtration rate (eGFR) and thyroid function every 6 months

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34
Q

How do you diagnose GAD?

A

DSM5: sx > 6 mnths

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35
Q

What are the RF’s for GAD?

A

RF: female, Hx of trauma, Hx of anxiety disorders, FHx of anxiety, physical/ emotional stress, chronic conditions, substance abuse

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36
Q

What are some physical and mental sx of GAD?

A

mental SSx: restlessness/ nervousness, easily fatigued, poor concentration, irritability
physical SSx: lightheaded, palpitations, dizziness, GI upset, headaches, muscle tension, trembling, back pain, sleep disturbances, breathing difficulties

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37
Q

What sort of presentation of GAD would you get in lets say primary care?

A

In primary care, people with GAD often present solely with physical symptoms such as headaches, muscle tension, gastrointestinal symptoms, back pain, and insomnia, and may not readily report worry or psychological distress.
Symptoms:
Autonomic arousal- palpitations, tachycardia, sweating, dry mouth
Physical symptoms- breathing difficulties, choking sensation, chest pain, nausea
Mental state - depersonalisation/derealisation, fear of losing control, concentration difficulties
General symptoms- hot flushes/chills, numbness, tingling
Symptoms of tension- muscle aches/pains, restlessness/inability to relax
RF: living alone, divorced/ separated, 35-54 y.o., single parent

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38
Q

What is the NICE guidance on GAD?

A
  1. Education about GAD + active monitoring - everyone
    2.Low intensity CBT: individual self-help or psychoeducational groups- ppl without functional impairment
    3.High intensity CBT or SSRI (sertraline, paroxetine, escitalopram) - marked functional improvement or if step 2 hasnt worked
    4.Refer for specialist Rx
    short-term: Propranolol, benzodiazepines
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39
Q

How would you differentiate between PTSD and acute stress disorder?

A

PTSD>4 weeks sx and ASD<4 weeks

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40
Q

What is the classic quadrad of PTSD sx?

A

Classic Quadrad: HEAR
Hyperarousal
Emotional Numbing
Avoidance
Reliving the Situation

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41
Q

What does DSM say about dx of PTSD?

A

Quadrad +Traumatic event, onset between 1-6 months after event, lasts more than 4 weeks

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42
Q

What is the tx of PTSD?

A

Rx:
EMDR + TF-CBT
Sert + Ven
Zopiclone
EMDR - Eye movement desensitization reprocessing is first line tx, can be with trauma focussed CBT
other symptoms include dissociative amnesia

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43
Q

What is the main differential for PTSD?

A

Acute Stress disorder - presents within 1 month of event, Rx = Trauma focussed CBT + anti-depressents

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44
Q

What is OCD?

A

Chronic anxiety and depression + obsession and/or compulsion

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45
Q

What do you mean by obsession and compulsion in OCD?

A

Obsession - pts own idea/impulse, repetitive + intrusive
Compulsion - pt recognises it as a problem but can’t resist

Differential is OCPD where the ptx does believe and rationalises their actions

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46
Q

How would you dx OCD?

A

Dx criteria:
O or C or bof
time consuming
pt knows their sx are unreasonableDx obsession or compulsion or both, time consuming or significant social/occupational impairment, pt knows there is something wrong

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47
Q

How would you differentiate Schizo and OCD?

A

Schizophrenia is a differential - main difference is that OCD is ACTIVE symptoms, pt knows they are doing the action themselves, Shizophrenia is PASSIVE - they think their actions are made against their will

48
Q

What are some examples of compulsions?

A

compulsion examples: checking, overt cleaning, covert mental acts (Trying to suppress unwanted thoughts. Thinking special words, sayings, images, Trying to change a “bad” thought into a “good” thought. Saying prayers over and over or in accordance with specific rules.

49
Q

How would you treat OCD?

A

Rx
ERP + CBT (ERP: exposure and response prevention)
SSRI (1st line pharm)
Clomipramine (2nd line)

50
Q

What are the + sx of schizo?

A

‘Delusions Held Firmly Think Psycho’
Delusions
Hallucinations
Formal Thought disorder
Thought interference
Passivity

51
Q

Negative sx of Schizo?

A

Negative Sx:
A6C
Anhedonia
Affect blunted
Asocial
Alogia
Attention deficit
Avolition
Catatonia

52
Q

What is the onset of Schizo

A

Bimodal either quite young or quite old

53
Q

What would be a MSE presentation of someone with Schizo?

A

MSE EXAMPLE: Appearance + Behaviour: bizarre + catatonic
Mood: Anhedonia, blunted/incongruent affect
Speech: pressured and distracted (verbigeration, word salad)
Thought content: delusional - grandiose, religious
Thought form: tangential, circumstantial
Perception: 3rd person audio hallucination: running commentary
Passivity: present, in feelings and actions
Insight: absent (*can be present)

54
Q

What are some poor prognostic factors for schizo?

A

Fam hx, abuse history, and substance misuse (in that order) are the top 3 worst prognostic factors. the others are there but not as strong as the first 3.
other factors include: premorbid schizoid personality, acute psychosis, prodromal -ve symptoms, male , teenage onset

55
Q

What are some differentials for schizo?

A

Psychotic Depression (sx = nihilistic and derogatory delusions)
Schizoaffective (mood disorder + schizophrenia)
Personality Disorder
Bipolar
Substance abuse

Hypercalcaemia -> psychosis
B12/Folate deficiency -> psychosis

56
Q

What is a delusion? what different types?

A

Delusions - fixed false belief, cant convince them it’s nonsense
types: nihilistic, persecutory, grandiose, religious, ideas of reference (eg radio news is talking about them)

57
Q

2nd person auditory hallucinations?

A

2nd person auditory hallucx - talking TO the pt, command or insults directly to them

58
Q

3rd person auditory hallucinations?§

A

3rd person auditory hallucx - talking ABOUT the pt, running commentary, insults (between the commentators about the pt)

59
Q

What are the first rank sx for Schizo?

A

1st: (ICD10 Group A)
Delusional Perception
3rd person audio hallucx
Thought Interference
Passivity

60
Q

2nd rank sx for Schizo?

A

2nd: (ICD10 Group B)
2nd person audio hallucx
-ve sx
other delusions

61
Q

What investigations would you do in someone with schizo?

A

CT/MRI Head
Bloods (FBC, U+E, LFT)
B12 + Folate
Toxicology
Hx + MSE,

62
Q

What are the different Personality disorders?

A

A:
Paranoid (jealous, suspicious)
Schizoid (reduced emotions, no close friends)
Schizotypal: Above but wants relationships etc
B:
EUPD (unstable relationships, fear of abandonment, suicidal, poor anger control)
Histrionic (vain, attention seeking, sexually inappropiate)
Dissocial (deceitful, callous, violent)

C:
Dependent (low self confidence, needs reassurance and companionship)
Anxious (feels inadequate, social inhibitions, needs to be certain they are liked)
Anankastic (workaholic, perfectionist, stubborn)

63
Q

What are the investogations you can do for personality disorders?

A

Investigations:
Hx, MSE
PDQ-IV
MRI/CT Head
>18 yo for diagnosis

64
Q

Mx of personality disorders?

A

Mx
DBT (1st line for eupd)
MBT (mentalization based therapy)
CBT all basically CBT
PDT
Risk Assessment

65
Q

Medical management of personality disorders?

A

Rx (symptom control) off license:
low dose antipsychotic (anger, impulse, paranoid PD)
antidepressant (EUPD)
mood stabilizers (EUPD)

66
Q

What is the ICD-10 criteria for addiction and substance misuse?

A

ICD10 criteria - 3 or more of the following for more than 1 month
Acute intoxication
Harmful use
Dependence
Withdrawal sx
Psychotic disorder lasting 2 days within 2 weeks of misuse
Amnesia
Residual disorder (flashbacks, dementia, cog impairment)

67
Q

How would you facilitate smoking cessation?

A

Smoking:
To stop smoking cigs - NRT
To reduce craving - Varenicline (Champix)
To reduce pleasure - Bupropion (Zyban)

68
Q

How would you treat someone with opioid dependence ? As in wean them off?

A

Detox - Buprenorphine (Lofexidine if young or low level of addiction)
Maintenence - Methadone (full agonist), Buprenorphine (partial agonist + antagonist)
Relieve withdrawals - Lofexidine
Prevent relapse - Naltrexone
Overdose Rx - Naloxone

69
Q

What are the sx of alcohol intoxication?

A

intoxication sx:
slurred speech, ataxia, impaired judgement
severe sx - coma, stupor, hypoglycaemia

70
Q

What are the withdrawal sx for alcohol ? Timesclae

A

6 hrs - malaise, tremor, nausea
36 hrs - seizures
72 hrs - delirium tremens

Delly Treemies (Tree = 3 days or 72 hours)

71
Q

What is the pathophysiology of alcohol abuse?

A

up-regulation of NMDA receptors + down-regulation of GABA receptors -> cessation causes CNS-hyperexcitability

72
Q

What is the aclohol dependence Mnemonic for sx?

A

SAW DRINk
Subjective awareness
Avoids sx
Withdrawals
Drink-seeking
Reinstating drink after quitting
Increased tolerance
Narrow repertoire

73
Q

How would you medically treat alcohol withdrawal in the short and long term?

A

to treat withdrawal - PO Chlordiazepoxide + IV thiamine (Pabrinex)
long term tx:
Disulifram: induces bad sx when drinking alcohol
Acamprosate - reduce cravings
Naltrexone - reduce pleasure

74
Q

NON-PHARM TX OF ALCOHOL WITHDRAWAL?

A

non - pharmacological rx:
CBT + motivational interview
AA meetings
Family support

75
Q

What is neuroleptic malignant syndrome?

A

The pathophysiology is unknown but one theory is that the dopamine blockade induced by antipsychotics triggers massive glutamate release and subsequent neurotoxicity and muscle damage.

76
Q

How does neuroleptic malignant syndrome present?

A

It occurs within hours to days of starting an antipsychotic (antipsychotics are also known as neuroleptics, hence the name) and the typical features are:
pyrexia
muscle rigidity
autonomic lability: typical features include hypertension, tachycardia and tachypnoea
agitated delirium with confusion

77
Q

How would you treat neuroleptic malignant syndrome?

A

stop antipsychotic
IV fluids to prevent renal failure
dantrolene may be useful in selected cases
thought to work by decreasing excitation-contraction coupling in skeletal muscle by binding to the ryanodine receptor, and decreasing the release of calcium from the sarcoplasmic reticulum
bromocriptine, dopamine agonist, may also be used

78
Q

What causes serotonin syndrome?

A

Causes
monoamine oxidase inhibitors
SSRIs
St John’s Wort, often taken over the counter for depression, can interact with SSRIs to cause serotonin syndrome
ecstasy
amphetamines
TCA’s and lithium as well?

79
Q

What is serotonin syndrome?

A

high synaptic conc of serotonin caused by meds and results in nasty sx such as:
neuromuscular excitation:
hyperreflexia
myoclonus
rigidity

autonomic nervous system excitation:
hyperthermia
sweating

altered mental state:
confusion

80
Q

How would you manage serotonin syndrome?

A

supportive including IV fluids
benzodiazepines
more severe cases are managed using serotonin antagonists such as cyproheptadine and chlorpromazine

81
Q

What is an acute dystonic reaction?

A

An acute dystonic reaction is an acute medication-induced dystonia. Dystonic reactions, in general, are movement disorders characterized by involuntary contractions of muscles, and typically develop within minutes or hours following a trigger, such as a medication

82
Q

What can an acute dystonic reaction be caused by?

A

caused by typical antipsychotics - EPSEs (PADT)

83
Q

What is the presentation of an acute dystonic reaction?

A

Sx - painful contraction in the:
eyes - oculogyric crisis
neck - antero/latero/retro/torticollis
jaw

84
Q

How would you treat and manage and acute dystonic reaction?

A

Procyclidine

85
Q

What are some complications of alcohol withdrawal?

A
  1. Wenickes encephalopathy
  2. Korsakoffs psychosis
86
Q

What do you know about Wernickes encephalopathy ? What would you expect how would you treat it?

A

Wernicke’s Encephalopathy - due to acute thiamine deficiency
Sx = delirium, nystagmus, hypothermia, ataxia
Rx = Pabrinex (IV thiamine)

87
Q

What do you know about korsakoffs? Presentation and tx?

A

Korsakoff’s Psychosis - due to untreated WE
Sx = irreversible short term memory loss, confabulation, disorientation to time
Rx = Pabrinex

88
Q

What are the delly trellies (delerium tremens)?

A

72 hrs after alcohol cessation
Sx = cog impairment, Lilliputian hallucination, paranoid delusion, tremor, fever, tachycardia, sweating, dehydration

89
Q

How would you manage the delly trellies?

A

Rx = Pabrinex, Lorazepam (both 1st line)
If psychotic features, give IM haloperidol (CI if LBD or PD)

90
Q

What are the sx of lithium toxicity?

A

due to Lithium in blood > 1.5mmol/L
Sx = TOXICCC
Tremor (coarse)
Oliguric renal failure
ataXia ;)
Increased reflexes
Convulsions, Coma, Consciousness reduced

91
Q

What is the tx for lithium toxicity?

A

Rx
Stop Lithium immediately
high fluid + IV NaCl
if severe - renal dialysis
(renal damage due to lithium action on parathyroid -> increase PTH -> increase Ca2+ -> kidney damage)

92
Q

Difference between hallucination and pseudohallucination?

A

Pseudohallucination is like in a grief reaction when the person knows that the hallucination is not real.
In normal hallucinations the ptx has no idea that they are hallucinating - think it is real

93
Q

What are the adverse affects of atypical antipsychotics?

A

weight gain
clozapine is associated with agranulocytosis
hyperprolactinaemia

94
Q

What is the risk of using atypical antipsychotics in elderly patients?

A

increased risk of stroke
increased risk of venous thromboembolism

95
Q

Why is clozapine a big no no drug till everything else fails?

A

Clozapine, one of the first atypical agents to be developed, carries a significant risk of agranulocytosis and full blood count monitoring is therefore essential during treatment. For this reason, clozapine should only be used in patients resistant to other antipsychotic medication.

96
Q

What is the guidance along the use of clozapine?

A

Clozapine should be introduced if schizophrenia is not controlled despite the sequential use of two or more antipsychotic drugs (one of which should be a second-generation antipsychotic drug), each for at least 6–8 weeks.

97
Q

What are the horrible side effects of clozapine?

A

agranulocytosis (1%), neutropaenia (3%)
reduced seizure threshold - can induce seizures in up to 3% of patients
constipation
myocarditis: a baseline ECG should be taken before starting treatment
hypersalivation

Also with clozapine - it is affected by smoking so a dose adjustment needs to be done if ptx has started or stopped smoking

98
Q

What scoring system would you use for alchol withdrawal and why cant you use AUDIT or CAGE instead?

A

The revised Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar) scale is a scoring system that determines the severity of withdrawal by collating scores of symptom severity.
The Alcohol Use Disorders Identification Test (AUDIT) and the CAGE questionnaire are both screening tools designed to identify patients who may have problem drinking behaviours or alcohol misuse problems. These are not useful in this patient as he has already been seen by Drug and Alcohol Services.

99
Q

What is the guidance if a first line SSRI is not useful in GAD?

A

If a first line SSRI such as sertraline is ineffective or not tolerated, try another SSRI or an SNRI for GAD

100
Q

What is the most common mimic for dementia in elderly patients?

A

Severe depression can mimic dementia but gives a pattern of global memory loss rather than short-term memory loss - this is called pseudodementia

101
Q

What is the best atypical anti-psychotic to use for least side effects?

A

Aripiprazole has the most tolerable side effect profile of the atypical antispsychotics - just for everything , particularly for prolactin elevation
So good if someone has any breast tenderness etc. Increases prolactin the least of all atypical antipsychotics
Also works for male ED

102
Q

What are clang associations?

A

Clang associations - ideas related only by rhyme or being similar sounding

103
Q

What is Echolalia?

A

Echolalia is the patient repeating words or phrases of the individual they are talking to.

104
Q

What is a neologism?

A

Neologism is when the patient creates new words or uses a recognised word incorrectly.

105
Q

How would you differentiate between schizoid and schizotypical PD?

A

. A person with a schizoid personality disorder may display indifference to praise and criticism, prefer time alone, lack interest in companionship or sexual interactions, and have few interests and few friends other than family.

atients diagnosed with schizotypal personality disorder may lack close friends other than family and can have odd or eccentric behaviour, speech, and beliefs. They may display magical thinking (the false belief that unrelated events are connected despite no evidence of a causal link), ideas of reference (the false belief that innocuous events relate to oneself,) unusual perceptual disturbances, paranoid ideation, inappropriate affect, and odd but coherent speech.`

106
Q

What is the risk of using SSRIs in pregnancy ?

A

BNF says to weigh up benefits and risk when deciding whether to use in pregnancy.
Use during the first trimester gives a small increased risk of congenital heart defects
Use during the third trimester can result in persistent pulmonary hypertension of the newborn
Paroxetine has an increased risk of congenital malformations, particularly in the first trimester

107
Q

What is catatonia?

A

Stopping of voluntary movement or staying still in an unusual position = catatonia

108
Q

What can be a solution for patients with poor compliance of antipsychotics?

A

Patients with poor oral compliance to antipsychotics should be considered for once monthly IM antipsychotic depot injections

109
Q

How does DBT differ from CBT?

A

Cognitive behavioural therapy (CBT) - incorrect as this is not a targeted therapy personality disorder patients and is more beneficial for patients suffering from depression or anxiety related conditions.

Dialectical behaviour therapy (DBT) - correct - this is a targeted therapy that is based CBT, but has been adapted to help people who experience emotions very intensely.

110
Q

When you check lithium levels how long after the dose should levels be xheked?

A

When checking lithium levels, the sample should be taken 12 hours post-dose

111
Q

What is first line for tx resistant schizophrenia?

A

Clozapine

112
Q

What is an oculogyric crisis?

A

An oculogyric crisis is a further example of an acute dystonia. Patients experience sustained upward deviation of the eyes, clenched jaw and hyperextension of the back/neck with torticollis.

113
Q

What is tardive dyskinesia?

A

Tardive dyskinesia occurs in patients on long term typical antipsychotics and is characterised by uncontrolled facial movements such as lip-smacking.

114
Q

What is akathisia?

A

Akathisia is characterised by severe restlessness with patients having difficulty in sitting still. Patients may rock, tap their legs or cross and uncross the legs. It typically occurs with long term use of antipsychotics.

115
Q

What is the difference between Conversion and somatisation disorder?

A

Conversion disorder
- associate with stress, usually have competition or exams
- NOT CHRONIC (no history of going to other GP)

Somatisation
- S for Symptom
- KEY POINT : refuses to accept reassurance (so in question they will state that the patient went ti multiple GPs regarding the SYMPTOM)
- because multiple GP so we can conclude that the symptom is chronic (below say more than 2 years)

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