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Pysch Flashcards

1
Q

what is the diagnostic criteria of GAD?

A

>= 4 of, including at least 1 autonomic arousal symptom

  • Autonomic arousal
  • physical symptoms (SoB, choking, chest pain/discomfort)
  • altered consciousness (dizzy, lightheaded, derealisation/depersonalisation, fear of passing out, dying or going crazy)
  • tension (muscle, unable to relax)
  • Exaggerated response to being startled
  • concentration difficulty
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2
Q

DDx to consider with GAD

A

hyperthyroidism, phaeochromocytoma, hypoglycaemia

cardiac arrhythmia

substance abuse

depression, avoidant PD, psychosis

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3
Q

investigation with GAD

A

24 hour urine metanephrines and VMA

TFTs

ECG

blood glucose

UDS and blood EtOH, LFTs & GGT

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4
Q

‘initial help’ to offer in GAD

A
  1. advice and reassurance (with psychoeducation)
  2. Basic councilling (addressing ICE)
  3. problem-solving
  4. self-help (CBT books, computer programs, friends family and faith)
  5. Relaxation techniques and breathing exercises
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5
Q

psychological intervention with GAD

A
  1. CBT
  2. exposure therapy (best with phobias/triggers)
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6
Q

biological management of GAD

A
  1. SSRI - fluoxetine, paroxetine
  2. TCA - clomipramine, imipramine
  3. Busprione (s/e of dysphoria)
  4. BZDs for no more than 2-4 weeks while anticipating SSRI effect
  5. Beta-blocker - good if physical symptoms are central in the worry pattern
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7
Q

GAD prognosis

A

1/3 recover completely

1/3 improve partially

1/3 suffer considerable disability and poor QoL

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8
Q

OCD differentials to consider

A
  1. other anxiety disorder
  2. depression
  3. anakastic personality disorder (OCPD)
  4. Schizophrenia
  5. Organic causes (chorea)
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9
Q

management of OCD

A

Initial - psychoeducation

psychological - CBT and exposure therapy

Biological - SSRI or 2nd line clomipramine

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10
Q

PTSD management

A

psychological - CBT and eye movement desensitisation and reprocessing

biological - SSRIs

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11
Q

what alcohol dependence drug should not be used in pregnancy?

A

acamprosate - teratogenic

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12
Q

Biological management of alcoholism

detox, maintenance and WE

A

Detox - chlordiazepoxide (reducing regime) and thiamine, hydration and supportive care.

Inpatient (hx DT/seizures, lives alone, comorbid medical/psych illness, previous failed community detox) or outpatient (planned to start after a period of psychological preparation for upcoming change)

Maintenance - acamprosate (anti-craving) or disulfiram (Antabuse)

WE - IM Vitamin B1, slow IV saline 0.9%, oral glucose loading

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13
Q

alcoholic screening questions?

A

CAGE

C - ever felt you should cut down on your drinking?

A - have people annoyed you by criticizing?

G - have you felt guilty about your drinking?

E - have you ever had an eye-opener drink the very first thing in the morning?

>= 2 should prompt evaluation

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14
Q

investigations for alcohol abuse

A

FBC, LFTs, BBV screen, UDS

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15
Q

substance abuse history structure

A
  • Current use (TRAP)
    • Type of drug, route of administration, amount, pattern of use
  • Current use - dependence and impact
  • Past use
  • Future use (do you think your drinking is a problem? What are you worried about if you keep drinking?)

Establish a diagnosis of dependence (tolerance, narrowing of rep, craving, withdrawal, use despite harm)

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16
Q

short term psychological management of self harm

A

Risk assessment & Coping strategies

Prevention

  • Tablets/sharp objects hidden – prevent cues
  • Avoid triggering images/situations
  • Call friend/support line
  • Avoid drugs and alcohol
  • Breathing exercises/mindfulness

Alternatives to painful, damaging self-harm:

  • Squeeze ice cubes
  • Snap a rubber band around wrist
  • Bite into something strongly flavoured e.g. ginger root, lemon

Alternatives to drawing blood:

  • Put red food dye on dull side of knife and draw across skin
  • Use a washable red pen
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17
Q

long term psychological management of self harm

A

CBT

Transference-focused psychotherapy

Family therapy

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18
Q

what scales/questionaires are useful in the assessment of a patient following a suicide attempt?

A

SAD PERSONS scale

Tool for assessment of suicide risk (TASR)

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19
Q
  • multiple physical SYMPTOMS present for at least 2 years
  • patient refuses to accept reassurance or negative test results

diagnosis?

A

somatisation disorder

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20
Q
  • persistent belief in the presence of an underlying serious DISEASE, e.g. cancer
  • patient again refuses to accept reassurance or negative test results

diagnosis?

A

hypochondrial disorder

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21
Q
  • typically involves loss of motor or sensory function
  • the patient doesn’t consciously feign the symptoms (factitious disorder) or seek material gain (malingering)
  • patients may be indifferent to their apparent disorder - la belle indifference - although this has not been backed up by some studies

diagnosis?

A

conversion disorder

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22
Q
  • a process of ‘separating off’ certain memories from normal consciousness
  • in contrast to conversion disorder involves psychiatric symptoms e.g. Amnesia, fugue, stupor

diagnosis?

A

dissociative disorder

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23
Q

the intentional production of physical or psychological symptoms

diagnosis?

A

Munchausen’s syndrome

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24
Q

fruaudelent simulation or exaggeration of symptoms with the intention of financial or other gain

what is this called?

A

Malingering

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25
Q

a psych patient takes an overdose of her TCAs with a view to ending her own life. In resus, cardiac monitoring reveals a tachyarrhythmia.

which antiarrhythmics are contraindicated?

A

1a (quinidine, procainamide);

1c (flecanide);

III (amiodarone, sotalol, dofletide)

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26
Q

what is the management of beta-blocker toxicity/poisoning?

A

IV atropine to increase HR

if resistant, IV glucagon

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27
Q

treatment of organophosphate poisoning

A

atropine, pralidoxime (?)

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28
Q

treatment for digoxin toxicity

A

digoxin-specific antibody fragments

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29
Q

lead antedote?

A

dimercaprol & calcium edetate

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30
Q

what are the 4 components of Schneider’s first rank symptoms?

A
  1. auditory hallucinations
  2. thought disorder
  3. passivity phenomena
  4. delusional perception
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31
Q

what is the target range for blood lithium levels?

when should a monitoring blood test be taken?

A

0.4-1.0 mmol/L

take levels 12 hours after the dose

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32
Q

what is the preferred SSRI in post-MI patients?

A

sertraline - best safety data

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33
Q

what is the clinical indication for initiating clozapine?

A

no improvement following sequential trails of alternative antipsychotics for at least 6-8 weeks each, with at least 1 being an atypical antipsychotic

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34
Q

what are the main risks of starting antipsychotic therapy in the elderly?

A

stroke and VTE risk increases

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35
Q

what are the common short-term side effects of ECT?

A

headache, nausea, short-term memory loss, retrograde amnesia for events prior to ECT, arrhythmia

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36
Q

what are the score thresholds for MMSE?

A

24-30 = no cognitive impairment

18-23 = mild cognitive impairment

<18 = severe cognitive impairement

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37
Q

what are the four main features of anorexia nervosa?

A
  1. Deliberate weight loss
  2. Distorted body image
  3. BMI <17.5
  4. Endocrine dysfunctions
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38
Q

what are the four features of bulimia nervosa?

A
  1. binge eating
  2. purging
  3. dysmorphic body image
  4. BMI >17..5 kg/m^2
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39
Q

what is the ED history screening tool?

A

SCOFF

  • feeling Sick from too much food
  • lose Control around food
  • lost more than One stone/6.5 kg in 3 months
  • feel Fat when others say you are thin
  • feel that Food dominates your life
40
Q

what are the signs for AN?

  • general
  • GI
  • neuro
  • CVS
  • metabolic
  • MSK
A
  • general - lanugo hair, cold extremities, oedema, anaemia, hypothermia
  • GI - tender abdo
  • neuro - peripheral neuropathy
  • CVS - orthostatic hypotension
  • Metabolic - hypokalaemia, hyponatraemia, high GH < high cortisol, hypercholesteraemia, hypercarotaemia (yellowing of palms and soles)
  • MSK - muscle wasting, fractures
41
Q

what investigations are important in the management of eating disorders?

A
  • BMI
  • Squat test
  • organic causes - ESR, TFTs
  • consequences - FBC, U&E with CK , phosphate, albumin, LFTs, glucose
  • ECG - bradycardia, arrhythmias, prolonged QT
42
Q

which biological management is indicated in eating disorders and what is the purpose?

A

SSRIs in bulimia in order to help with impulse control

43
Q

what is the daily calorie intake maximum that would suggest a possibility of refeeding syndrome?

A

400-600 kcal/day

44
Q

what is the rate of weight loss that would suggests refeeding syndrome?

A

1 kg/week

45
Q

what must be monitored before feeding in any patient at risk of refeeding syndrome?

A

ECG

46
Q

what areas should you cover in a mania HPC?

(7)

A

mood, energy, sleep, concentration, libido, dangerous behaviour, psychosis

47
Q

what areas should be specifically risk assessed in a mania history? (6)

A

work, gambling, money, sex, drugs, alcohol

48
Q

what is the monitoring schedule for lithium?

A

‘level’ taken at 12 hours post dose (peak)

start medication, take level at 5 days

take level 1 weekly after until stable

take levels 3 monthly

monitor TFTs and U&E every 6 months (risk of renal failure and hypothyroidism)

49
Q

what are the common side effects experienced by 75% of patients on lithium?

A

acne, weight gain, polyuria, polydipsia, fine tremor, GI disturbance, hair loss, oedema

50
Q

what are the signs of lithium toxicity that must be advised to patients starting the medication and repeated at follow up visits?

A

coarse tremor, myoclonic jerks, restlessness, slurred speech, drowsiness, arrhythmia, seizures, visual disturbance

51
Q

what are the definitions of the different types of bipolar affective disorder?

A
  • Type I BPAD:
    • Manic episodes interspersed with depressive episodes
  • Type II BPAD
    • Mainly recurrent depressive episodes, with less prominent hypomanic episodes
  • Rapid cycling BPAD
    • >=4 episodes per year
    • More common in women
    • May respond better to valproate
52
Q

what are the GAD-2 screening questions?

A
  1. Over the last 2 weeks, how often have you been bothered by feeling nervous, anxious or on edge?
  2. Over the last 2 weeks, how often have you been bothered by not being able to stop or control worrying?

‘Not at all’ scores 0;
‘Several days’ scores 1;
‘More than half the days’ scores 2;
‘Nearly every day’ scores 3.

NICE 2014

53
Q

what are the domains of the presentaion of ADHD?

A

attention/concentration

hyperactivity

impulsivity and recklessness

54
Q

what are some primary management options when assessing a child for ADHD?

A

questionnaire - Conner’s Rating scale

classroom observation with teacher feedback

educational psycholgist assessment

55
Q

ADHD stimulant therapy - what are the drug options?

what are the side effects?

do they stop the child from growing properly?

A

methylphenidate (ritalin) or dexamphetamine

improves concentration and allows for better learning and maturation

S/e: appetite suppression, insomnia. NOT ADDICTIVE

with drug holidays (school breaks, not on weekends) this limits growth to 1 cm finally

56
Q

what is the timeframe for alcohol withdrawal symptoms?

A

6-12 hours - any symptoms

36 hours - seizures

72 hours - delerium tremens

57
Q

amitryptyline, clomipramine, dosulepin

are these sedative or non-sedative?

A

sedative

58
Q

nortryptaline, imipramine, lofepramine

are these sedative or non-sedative?

A

non-sedative

59
Q

which are the most dangerous TCAs to use because of toxicity/overdose?

A

amitryptaline and dosulepin

60
Q

while on methylphenidate for ADHD, what should be monitored?

A

growth every 6 months

blood pressure and pulse rate every 6 months

61
Q

which SSRI should be used in adolescents and children if needs be?

A

fluoxetine

62
Q

what is the major side effect of SSRI?

A

GI symptoms of nausea, diarrhoea and GORD

if on NSAID, should be prescribed PPI as well

63
Q

what should be offered instead of SSRI when a patient is on warfarin/heparin?

A

mirtazapine

64
Q

what are the side effects of mirtazapine?

A

apetite stimulant (so put on weight)

drowsiness

65
Q

what are the 4 features of autism?

A
  1. poor social interaction
  2. poor communication skills
  3. poor imaginaiton: restricted play/behaviours
  4. onset before age 3
66
Q

what congenital diseases can present with features of autism?

A

Downs

neurofibromatosis

tuberosclerosis

phenylketonuria

fragile X syndrome

67
Q

what are some symptoms of social impairment in autism?

A
  • Interacting with others; plays alone/prefer own company
  • Eye contact (gaze avoidance)
  • Attachment impoverished, lack mutuality or warmth
  • cannot read emotional states
68
Q

what are some symptoms of communication impairment in autism?

A
  • poor use of nonverbal behaviours; gestures/pointing/ facial expression
  • Speech delays?, reduced variation in words or tone
  • Struggles with sarcasm
  • Echoes questions, repeats instructions, refers to self as ‘you’
69
Q

what are some symptoms of imagination impairment in autism?

A
  • routines & rituals
  • violence if these are not adhered to
  • stereotypical movements
    • hand flapping and tip toe walking
  • poverty of imagination in play and with activities
  • peculiar interests/obsessions
70
Q

what comorbidities should you screen for in ASD?

A

special learning difficulties

epilepsy

71
Q

what is the prognosis for children with autism?

what factor affect the prognosis?

A

only 10-15% function independently in adult life

about 15-20% function well with support

IQ >70; supportive family/home environment; good language skills at age 5-7 are positive prognostic factors

72
Q

along with AChE-I, is aspirin indicated in the management for Alzheimer?

what is the medication for moderate-severe Alzheimer?

A

no

memantine (NMDA antagonist)

73
Q

when stopping SSRI, what is the reducing schedule?

A

taper down over 4 weeks

NOT NECESSARY with fluoxetine

74
Q

what is the review after starting SSRI?

A

normally follow up in 2 weeks to check how they’re getting on. reassure that anxiety will imrpove and check compliance

if under 30 with increased risk of suicide, follow up in 1 week

75
Q

is imipramine better or worse than other TCAs for side effects?

A

has the worst profile for anti-muscarinic s/e’s

76
Q

what are the symptoms of BZD withdrawal? How long does this last without management?

A

insomnia, irritability, tinnitus, perceptual disturbance, nausea & anorexia, tremor, anxiety, sweating

seizures

up to 3 weeks

77
Q

which TCA is most dangerous in overdose?

A

dosulepin - so don’t prescribe it

78
Q

what is the monitoring schedule for clozapine?

A

weekly for 18 weeks, 2 weekly thereafter up to a year from starting

then monthly thereafter

79
Q

what medication is useful in the treatment of tardive diskineasia?

A

anticholinergic meds - procyclidine

80
Q

what is the time frame for diagnosing schizophrenia?

A

symptoms >=1 month

81
Q

what is the absolute and relative contraindications for ECT?

A

absolute - raised ICP

relative - high anaesthetic risk, cerebral aneurysm

82
Q

what is the calculation for units of alcohol?

A

[volume (mL) * ABV (%)]/1000

83
Q

what are two positive and 6 negative prognostic factors for depression?

A

positive - young age, acute onset

negative - old age, insidious onset, low self esteem, poor social support, comorbidity, neurotic depression

84
Q

when do you start to give mood stabilisers in the treatment of BPAD?

A

only if they have had an episode of mania before

coming out of manic episode first time managed with antipsychotics (i.e. olanzapine)

85
Q

what drugs are a risk factor for depression? (6)

A

opiates, NSAIDs, steroids, BZDs, beta-blockers, anticonvulsants

86
Q

what are the police sections of the mental health act?

A

135 - go into someone’s home if they are at risk of hurting themselves/neglect

136 - take someone off the street who is acting crazy and bring them to a place of safety (jail, A&E or 136 suite in mental health hospital)

87
Q

can ECT be used for NMS?

A

yes

88
Q

can ECT be used for dementia?

A

no

89
Q

how do you tell the difference betwen dementia and pseudodementia on MMSE?

A

patient with pseudodementia has memory loss/cognitive decline mainly becuase of their loss of motivation

the answer to questions will be “don’t know”

in dementia, the patient will confabulate and give an answer with no meaning

90
Q

hebephrenic schizophrenia

A

disorganized speech and behaviour

&

flat or inapprorptiate affect

91
Q

paranoid schizophrenia

A

most common and best outcome

prominent hallucinations and positive symptoms, increased risk of suicide

92
Q

simple schizophrenia

A

only ever negative symptoms

93
Q

chronic schizophrenia

A

negative symptoms persistent 1 year beyond the resolution of positive symptoms

94
Q

what is the time frame for transient pyschotic episode?

A

cresciendo to maximum in 2 weeks and resolution in 3 months

95
Q

what is the incidence in the population for suicide?

what is the incidence for completed suicide 1 year following a suicide attempt?

A

1 in 10,000 (0.01%)

1 in 100 (1%) - 100 times greater than the general public

96
Q

what are the actelycholinesterase inhibitors?

what is the next step up from this for more severe alzheimer treatment?

A

donepezil, rivastigmine, galantamine

memantine

Specialty PACES (3 decks)

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