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Yr 4 - PassMed Corrections > Psychiatry > Flashcards

Psychiatry Flashcards

1
Q

What is the most common inherited cause of learning disability?

A

Fragile X syndrome

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2
Q

What is the most common avoidable cause of learning disability?

A

Foetal alcohol syndrome

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3
Q

What are 4 known, predisposing medical conditions for ASD?

A

1) Fragile X syndrome

2) Infantile spasms

3) Congenital rubella

4) Tuberous sclerosis

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4
Q

What genetic mutation is seen in Fragile X syndrome?

A

An expansion of the CGG trinucleotide repeat in the FMR1 gene on the X chromosome.

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5
Q

What gene is implicated in Fragile X syndrome?

A

FMR1 gene on X chromosome

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6
Q

What trinucleotide is implicated in Fragile X?

A

CGG

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7
Q

Classic features in Fragile X syndrome?

A

1) Learning disabily

2) Delayed speech & motor development

3) Large testes

4) Long, narrow face

5) Prominent jaw & forehead

6) Large, protruding ears

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8
Q

What 3 conditions may be associated with Fragile X?

A

1) Autism

2) ADHD

3) Epilepsy

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9
Q

How is Fragile X diagnosed?

A

DNA test that counts number of CGG repeats (FMR1 testing)

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10
Q

What condition is ASD most commonly associated with?

A

ADHD (50%)

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11
Q

What is trisomy 18?

A

Edward’s syndrome

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12
Q

What is trisomy 13?

A

Patau syndrome

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13
Q

People with learning disabilities may present differently with depression.

What type of symptoms are often more prominent?

A

Biological e.g. agitation, appetite, sleep

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14
Q

What valve defect can be seen in Fragile X?

A

Mitral valve prolapse

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15
Q

What CNS abnormalities can be seen in foetal alcohol syndrome?

A

1) Decreased cranial size

2) Structural brain abnormalities

3) Problems with attention

4) Cognitive difficulties

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16
Q

Prevalence of ASD in UK?

A

1 in 100

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17
Q

What may depressive features in people with learning disability also indicate the onset of?

A

Dementia

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18
Q

What IQ score defines a learning disability?

A

<70

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19
Q

Stepwise management of PTSD?

A

1st –> trauma-focused CBT or eye movement desensitisation and reprocessing (EMDR) therapy

2nd –> venlafaxine or SSRI

3rd –> risperidone (severe cases)

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20
Q

What SNRI is indicated in PTSD?

A

Venlafaxine

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21
Q

What antipsychotic is indicated in severe cases of PTSD?

A

Risperidone

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22
Q

What is de Fregoli syndrome?

A

The delusion of identifying a familiar person in various people they encounter.

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23
Q

What is Capgras syndrome?

A

The delusion that a person closely related to the patient has been replaced by an impostor.

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24
Q

When lithium levels are stable, how often are levels checked?

A

Every 6 months, 12 hours after last dose

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25
Q

If a first line SSRI such as sertraline is ineffective or not tolerated in GAD, what is next step?

A

Try another SSRI or SNRI

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26
Q

Diagnostic criteria for mild depression

A

2 core + 2 other

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27
Q

Diagnostic criteria for major depression

A

3 core + 4 other

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28
Q

What is the mechanism of action of memantine?

A

Glutamate antagonist (NMDA receptor antagonist)

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29
Q

When is memantine indicated 1st line over cholinesterase inhibitors (e.g. donepezil)?

A

1) Bradycardia (<60bpm)

2) Heart block

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30
Q

Which lobes are affected in Alzheimer’s?

A

Atrophy of medio-temporal lobes

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31
Q

What 2 medications are indicated in OCD?

A

1) SSRIs
2) Clomipramine

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32
Q

Which Alzheimer’s medication is contraindicated in bradycardia?

A

Donepezil

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33
Q

Disruption to which pathway produces the positive symptoms of schizophrenia?

A

Increased dopamine activity in the MESOLIMBIC pathway.

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34
Q

Disruption to which pathway produces the negative symptoms of schizophrenia?

A

HYPOactivity of dopamine in the MESOCORTICAL pathway causes negative, cognitive & affective symptoms.

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35
Q

What investigations are needed prior to starting lithium?

A

1) Weight

2) U&Es

3) ECG

4) Pregnancy test

5) TFTs

6) Ca2+

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36
Q

What is the link between sodium and lithium?

A

The kidneys treat lithium and sodium similarly.

This is the reason why sodium DEPLETION can significantly ELEVATE lithium reabsorption.

Causes of sodium depletion (that can predispose to lithium toxicity):
1) diuretics
2) dehydration
3) febrile illness
4) GI loss

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37
Q

Use of which diuretic is most likely to cause lithium toxicity?

A

Thiazide diuretics

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38
Q

How does lithium use affect sodium levels?

A

Lithium can cause sodium depletion.

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39
Q

How can a low sodium diet affect lithium levels?

A

A low-sodium (salt-restricted) diet can decrease lithium elimination, leading to increased risk of toxicity in lithium users who reduce their salt intake.

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40
Q

What are 3 possible renal effects of lithium use?

A

1) Decrease in eGFR

2) Nephrogenic diabetes insipidus

3) Increased risk of CKD

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41
Q

Why is lithium contraindicated in Cardiac disease or Addison’s disease?

A

As it causes salt depletion.

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42
Q

What does a prolonged QT interval represent?

A

Delayed ventricular depolarisation

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43
Q

How can lithium affect the thyroid?

A

Can cause hypothyroidism

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44
Q

What is typically the most prevalent adverse effect experienced by patients treated with clozapine?

A

Clozapine-induced hypersalivation

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45
Q

What cardiac adverse effect can clozapine cause?

A

Myocarditis

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46
Q

Clozapine and epilepsy?

A

Clozapine LOWERS the seizure threshold.

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47
Q

Which SSRI is licensed for treatment in bulimia?

A

Fluoxetine

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48
Q

How can TCAs affect the BP?

A

Can cause hypotension due to inhibition of a1 receptors (causing smooth muscle relaxation).

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49
Q

Cardiac effect of SSRIs?

A

Can prolong QT interval

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50
Q

What are 2 major contraindications of clozapine?

A

1) history of neutropenia

2) severe heart disease

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51
Q

Impact of TCAs on dopamine?

A

TCAs block D2 receptors –> raised prolactin (e.g. menstrual disturbance, galactorrhoea, sexual dysfunction)

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52
Q

What class of drug is mirtazapine?

A

NaSSA - noradrenergic and specific serotonergic antidepressants

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53
Q

What is the mechanism of sodium valproate?

A

Increases activity of GABA (relaxing effect on brain)

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54
Q

What is the effect of a prolonged QT interval?

A

Long QT syndrome can cause sudden fainting and seizures.

Young people with LQTS syndrome have an increased risk of sudden death.

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55
Q

What are some side effects of sodium valproate?

A
  • enzyme inhibitor
  • hair loss
  • hepatitis
  • weight gain
  • GI upset
  • ataxia
  • tremor
  • teratogenic
  • thrombocytopenia
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56
Q

Which medication can exacerbate absence seizures?

A

Carbamazepine

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57
Q

1st line antiepileptic for tonic clonic seizure?

A

Males: sodium valproate

Females: levetiracetam or lamotrigine

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58
Q

1st line antiepileptic for absence seizures?

A

Ethosuximide

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59
Q

2nd line antiepileptic for absence seizures?

A

Male: sodium valproate

Female: lamotrigine or levetiracetam

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60
Q

1st line management of myoclonic seizures?

A

Male: sodium valproate

Female: levetiracetam

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61
Q

1st line management of tonic or atonic seizures?

A

Males: sodium valproate

Females: lamotrigine

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62
Q

1st line antiepileptic for focal seizures?

A

Lamotrigine or levetiracetam

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63
Q

2nd line antiepileptic for focal seizures?

A

carbamazepine

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64
Q

What is the 1st line management of trigeminal neuralgia?

A

Carbamazepine

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65
Q

1st line management of neuropathic pain?

A

Amitriptyline, duloxetine, gabapentin or pregabalin

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66
Q

Impact of antipsychotics & epilepsy?

A

Antipsychotics lower the seizure threshold

67
Q

2nd line management of bipolar (i.e. that is resistant to lithium)?

A

Carbamazepine

68
Q

What are some side effects of carbamazepine?

A

1) Aplastic anaemia

2) Agranulocytosis

3) Hyponatraemia

69
Q

Why should benzos be avoided in liver failure?

A

Can precipitate hepatic encephalopathy

70
Q

Benzos & neuromuscular disorders (e.g. mysthenia gravis)?

A

Benzos are contraindicated in NMD

71
Q

Interaction between carbamazepine and antipsychotics?

A

Carbamazepine lowers the efficacy of antipsychotics

72
Q

If the use of benzos in liver failure (e.g. alcohol withdrawal) is essential, which should be given?

Why?

A

Lorazepam - depends less on liver for elimination

73
Q

Impact of AChEIs on Schlemm’s canal?

A

Opens it

74
Q

IOP with anticholinergics vs acetylcholinesterase inhibitors (e.g. donepezil)?

A

Anticholinergics –> closes Schlemm’s canal and increases IOP

Acetylcholinesterase inhibitors –> opens Schlemm’s canal and decreases IOP

75
Q

Cautions & contraindications of AChEIs?

A

Caution:
1) Asthma and COPD (due to increased secretions)

2) Those at risk of developing peptic ulcers

Contraindications:

1) Heart block or sick sinus syndrome

2) Bradycardia

76
Q

What MMSE score indicates severe dementia?

A

<10

77
Q

Contraindications of carbamazepine?

A

1) pregnancy

2) hepatic, renal or cardiac disease – increased risk of toxicity

78
Q

Contraindictions of z drugs?

A

1) Obstructive sleep apnoea

2) Respiratory muscle weakness

3) Respiratory depression

79
Q

How long should z drugs be prescribed for?

A

Max 4 weeks

80
Q

Mechanism of naloxone?

A

Opioid antagonist

81
Q

Which dopamine agonist is used in the management of NMS?

A

Bromocriptine

82
Q

MOA of cocaine?

A

Monoamine reuptake inhibitor

83
Q

Why are SSRIs contraindicated in epilepsy?

A

SSRIs can cause hyponatraemia –> can cause seizures when severe

84
Q

Symptoms of SSRI discontinuation syndrome?

A
  • increased mood change
  • restlessness
  • difficulty sleeping
  • unsteadiness
  • sweating
  • GI symptoms: pain, cramping, diarrhoea, vomiting
  • paraesthesia (electric shock sensations)
85
Q

Mx of hypomania in a patient with a known diagnosis of bipolar?

A

Routine referral to community mental health team

86
Q

3 key features of PTSD?

A

1) hyperarousal e.g. hypervigilance

2) avoidance

3) re-experiencing e.g. flashbacks, nightmares

87
Q

How can lithium affect WBCs?

A

Lithium can precipitate a BENIGN leucocytosis

88
Q

ECG features of hypokalaemia?

A

1) Flattened T waves

2) Tall P waves

3) Can cause heart block

89
Q

Peak incidence of delirium tremens after stopping alcohol?

A

48-72 hours

90
Q

Advance decision/directive vs advance statement?

A

Advance decision/directive:
- documents REFUSAL of certain treatments in the future
- legally binding

Advance statement:
- documents general preference about care e.g. wishes, values, beliefs
- not legally binding

91
Q

How are advance decisions and the MHA interlinked?

A

If person is being detained/treated under the MHA, their advance decisions/directives do NOT apply.

Except ECT (you can make an advance decision to refuse ECT).

92
Q

Give the top 4 ‘nearest relatives’ in MHA

A

1) Husband, wife or civil partner

2) Son or daughter

3) Mother or father

4) Brother or sister

93
Q

How long does a standard DoLS last?

A

1 year

94
Q

How long does an emergency DoLS last?

A

7 days

95
Q

Can a DoLS be renewed?

A

No must reapply

96
Q

What is a likely side effect of memantine?

A

Constipation

97
Q

What is the definitive diagnostic test for CJD?

A

Tissue biopsy

98
Q

Why are those with Down’s syndrome more likely to get early onset Alzheimer’s?

A

Due to extra copy of APP –> can lead to early onset beta amyloid plaques.

99
Q

What is an alternative to AChEIs in patients with dementia with a contraindication e.g. QT prolongation?

A

Cognitive stimulation therapy

100
Q

What is alogia?

A

Paucity of speech (negative symptom of schizophrenia)

101
Q

What neutrophil count should lead to the discontinuation of clozapine?

A

<0.5

102
Q

What can clozapine toxicity be precipitated by? Why?

A

Acute infection e.g. pneumonia

Clozapine is metabolised by P450 system –> downregulation of these enzymes during infection/inflammation can lead to increased clozapine level

103
Q

What electrolyte abnormality is most likely to be found in blood tests following a panic attack?

Why?

A

Hypocalcaemia

Anxiety –> hyperventilation –> respiratory alkalosis –> causes calcium to bind to albumin –> lowers free calcium –> hypocalcaemia –> paraesthesia.

104
Q

What ECG change may be seen in refeeding syndrome?

Why?

A

Prominent U waves

Due to hypokalaemia

105
Q

What murmur can be heard in AN?

A

Pansystolic murmur (due to mitral valve prolapse)

106
Q

What cardiac abnormalities can AN cause?

A
  • bradycardia
  • mitral valve prolapse
  • hypotension
  • HF
107
Q

What test is used to assess muscle wasting in patients with anorexia nervosa?

What is a red flag?

A

Sit up squat stand (SUSS) test

Red flag = not being able to stand up from chair without using hands

108
Q

What do prominent U waves on an ECG indicate?

A

Hypokalaemia

109
Q

What is semantic dementia a type of ?

A

FTD

110
Q

What is semantic dementia?

A

A loss of memory for words.

The disorder often starts as problems with word-finding and naming difficulties (anomia), but progresses to include impaired word comprehension and ultimately impaired comprehension of objects as well.

111
Q

What receptor does LSD act on?

A

Dopamine

112
Q

Which SSRI has an increased risk of congenital malformations, particularly in the first trimester?

A

Paroxetine

113
Q

What class of drug can induce psychosis?

A

Steroids

114
Q

What class of drug is selegiline?

A

MAOI

115
Q

What class of drug is amitriptyline?

A

TCA

116
Q

In what conditions is ECT indicated?

(4)

A

1) Treatment resistant/life threatening depression

2) Catatonia

3) Severe mania

4) An episode of moderate depression know to respond to ECT in the past

117
Q

When is the peak incidence of seizures following alcohol withdrawal?

A

36 hours

118
Q

Describe the different categories of depression in the PHQ-9

A

0-4 –> No depression identified

5-9 –> Mild depression

10-14 –> Moderate depression

15-19 –> Moderately severe depression

20-27 –> Severe depression

119
Q

Which SSRI is the most likely to lead to QT prolongation and Torsades de pointes?

A

Citalopram

120
Q

Is CBT indicated in schizophrenia?

A

Yes - indicated for all people with schizophrenia

121
Q

What test is used to assess whether there is need for a specialist evaluation concerning alcohol consumption?

A

Alcohol Use Disorders Identification Test (AUDIT)?

122
Q

What scoring system can be used to assess alcohol withdrawal severity?

A

Clinical Institute Withdrawal Assessment (CIWA-Ar)

123
Q

Mx of hypomania in 1ary care?

A

Routine referral to CMHT

124
Q

Mx of mania?

A

consider stopping antidepressant if the patient takes one

consider starting antipsychotic therapy e.g. olanzapine or haloperidol

125
Q

How can lithium cause hypercalcaemia?

A

Due to hyperparathyroidism

126
Q

1st line mx of Wernicke’s?

A

Pabrinex (NOT chlordiazepoxide)

127
Q

Mx of phobias?

A

CBT

128
Q

What is an alternative to lithium in mx of bipolar disorder?

A

Sodium valproate

129
Q

Mx of LBD?

A

Can use acetylcholinesterase inhibitors (e.g. donepezil, rivastigmine) and memantine.

130
Q

Mx of hypomania?

A

Same as mania (i.e. antipsychotics)

If on an antidepressant, stop it and start antipsychotic.

131
Q

What is malingering?

A

Manufactering or exaggerating symptoms for a purpose OTHER than the sick role:

  • financial gain (e.g. compensation)
  • evading police
  • obtaining shelter
  • obtaining drugs e.g. morphine
132
Q

Define perinatal period

A

From getting pregnant up to 12m after giving birth.

133
Q

When do the baby blues peak?

A

3-5th day postnatal

134
Q

Which diagnosis makes a woman most likely to experience postpartum psychosis?

A

Bipolar type 1

135
Q

What condition can antipsychotics increase the risk of in the mother?

A

Gestational diabetes

136
Q

What is the most common medical complication of pregnancy?

A

Depression

137
Q

Mx of more severe OCD?

A

SSRI + CBT (including ERP)

138
Q

What receptors do opioids bind to?

A

Mu-opioid receptors

139
Q

What receptor does LSD mainly bind to?

A

Serotonin (5-HT3)

140
Q

1) Is there a possibility of illicit use on top of methadone use?

2) Is there a possibility of illicit use on top of buprenorphine use?

A

1) Yes

2) No - due to partial antagonist effect

141
Q

What does disulfiram inhibit?

A

Aldehyde dehydrogenase

Results in increased serum aldehyde

142
Q

MOA of MDMA?

A

Blocks serotonin reuptake

143
Q

MOA of cocaine?

A

Blocks monoamine reuptake (increased dopamine, serotonin & noradrenaline)

144
Q

1st line mx of delirium tremens?

A

Oral lorazepam

145
Q

What drug is an opiate blocker that is used in alcohol detox?

A

Naltrexone

146
Q

Key side effect of methadone?

A

QTc prolongation

147
Q

What are 3 contraindications for disulfiram?

A

1) heart disease
2) psychosis
3) those at high risk of suicide

148
Q

What is the role of naltrexone in alcohol detox?

A

Opiate blocker, makes alcohol less enjoyable and less rewarding.

149
Q

Initial dose of naloxone given IV in opioid overdose?

A

400 micrograms

150
Q

Role of acamprosate in alcohol detox?

A

Increases GABA and decreases glutamate –> anti-craving

151
Q

Who is naltrexone contraindicated in? (2)

A

1) opioid use
2) liver failure

152
Q

How long should patients avoid alcohol before and after taking disulfiram?

A

24h before

1 week after

153
Q

How can you calculate how many units there are in an alcoholic drink?

A

Units = % (ABV) x volume (ml) / 1000

154
Q

What receptor does THC bind to?

A

CB1 receptors

155
Q

Once detox is complete, what drug can be used to prevent opiate relapse?

A

Naltrexone

156
Q

Side effects of zopiclone?

A
  • agitation
  • bitter taste in mouth
  • constipation
  • decreased muscle tone
  • dizziness
  • dry mouth
  • increased risk of falls (especially in the elderly)
157
Q

Zopiclone withdrawal symptoms?

A
  • convulsions
  • tremor
  • hyperventilation
158
Q

1st line for acute stress disorder?

A

Trauma-focused CBT

159
Q

How can OCD be differentiated from psychosis?

A

By the level of insight into their actions

160
Q

What is the most common endocrine disorder developing as a result of chronic lithium toxicity?

A

Hypothyroidism

161
Q

What should you do if you clozapine doses are missed for >48h?

A

Dose will need to be restarted again slowly (i.e. re-titrated)

162
Q

Who should all patients with OCD with severe functional impairment be referred to?

A

2ary care mental health team - treatment (SSRI) can be started whilst waiting for assessment.

163
Q
A

Yr 4 - PassMed Corrections (36 decks)

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