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Psychiatry > Week 2 > Flashcards

Week 2 Flashcards

1
Q

Name 4 psychotic experiances

A

Hallucinations

Passivity Phenomena

Delusions

Formal thought disorders

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2
Q

What is a hallucination?

A

A perception which occurs in the absence of external stimulus

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3
Q

What part of the brain is activated when a pateint is experiancing auditory hallucinations?

A

Same part that is used to produce normal speech except the supplementary motor area doesnt work properly you you miss recognise the inner speech as being external in origin

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4
Q

What is “thought echo”

A

Patient experiances his own thoughts spoken or repeated out load

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5
Q

What is passivity phenomena?

A

Beaviour is experianced as being controlled by an external agency rather than by the individual

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6
Q

what is thought insertion?

A

Someone else is putting thoughts into the patients mind.

The patient is having the thoughts but they arent his

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7
Q

What is thought withdrawal?

A

patients thoughts are disappearing prematurley

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8
Q

What is thought broadcasting?

A

Other people can hear my thoughts

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9
Q

What is “theme” when talking about delusions and what is” content”?

A

Theme is - Nihilism, grandiosity, religious etc

Content is - IRA, Mafia, Plague , evil spirits etc

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10
Q

What are the differential diagnosis for psychotic symptoms?

A

Schizophrenia

Psychoactive substance use

Mania

Depression

Delirium

Dementia

Other organic causes

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11
Q

What are the core psychotic symptoms of schizophrenia?

A

Auditory hallucinations - usually 3rd person

Passivity phenomena

Delusional Perceptions

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12
Q

What are the negative symptoms in schizophrenia?

A

Reduced SMIBS

Speech

Motivation

Intrest

Blunted affect

Social interaction

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13
Q

When is the peak incidence for schizophrenia ( men and woman)?

A

Men 15-25

Woman 25-35

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14
Q

What are schizophrenic people like as kids?

A

Subtle motor, congnitive and social deficits in childhood

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15
Q

What are the schizophrenia outcomes and the percentages of each?

A

20%- one episode, minimal impairment

40%- multiple epsiodes, minimal impairment

40%- multiple episodes, significant chronic progressive impairment

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16
Q

What is the suicide rates amongst schizophrenic patients?

A

10-15%

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17
Q

What is schizophrenia?

A

A genetically determined neurodevelopmental vulnerability later triggered by enviromental stressors

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18
Q

If both my parents are schizophrenic what is my lifetime risk of schizophrenia?

A

45%

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19
Q

What do schizophrenic brains look like?

A

They have enlarged ventricles

The have reduced fronto-temporal volume

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20
Q

What test are schizophrenic patients not very good at?

A

Stroop test

Colours and words

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21
Q

What is the dopmaine hypothesis with regards to schizophrenia?

A

Drugs that release dopamine or are dopamine receptor agonists can produce a psychotic state

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22
Q

What is depressive psychosis?

A

Mood congruent content of psychotic symptoms

Delusions of guilt or worthlessness etc

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23
Q

What is the dopamine cause of psychosis?

A

Subcortical Dopmaine hyperactivity

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24
Q

What is the dopamine cause of the negative symptoms in schizophrenia?

A

Mesocortical daopamine hypoactivity

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25
Q

What three indentified gene alterations cause the brain pathology in schizophrenia?

A

Neuregulin

Dysbindin

DISC-1

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26
Q

What does Neuregulin do?

A

Signaling protetin which mediates cell-cell interactions and plays critical roles in the growth and development of muliple organ systems

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27
Q

What does Dysbindin do?

A

Essential for adaptive neural plasticity

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28
Q

What does DISC-1 do?

A

Involved in neurite outgrowth and cortical development throught its interaction with other proteins

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29
Q

What is Chlorpromazine?

A

Typical antipsychotic

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30
Q

What is haloperidol?

A

Typical antipsychotic

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31
Q

What does haloperidol do?

A

D2 blockade

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32
Q

What does chloropromazine do?

A

D2 blockade

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33
Q

What are the 4 characteristic of Atypical (2nd generation) antipsychotic drugs?

A
  1. less likely t induce extrapyramidal side effects
  2. High 5-HT21 to D2 ratio
  3. Better efficacy against negative symptoms
    1. Effective in patients unresponsive to typical drugs
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34
Q

What is clozapine?

A

Atyoical antipsychotic

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35
Q

What is olanzapine?

A

Atypical antipsychotic

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36
Q

what is risperidone?

A

Atypical antipsychotic

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37
Q

What are the common side effects of D2 blockade?

A

Acute dystonic reaction

Parkinsonism

Akathisia

Tardive dyskinesia

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38
Q

What is akathisia?

A

Restlessness

39
Q

What side effect can 5HT-2 blockade cause?

A

Metabolic syndrome

40
Q

What is important to remember about clozapine?

A

You must have FBC weekly for 6 months then every 2 weeks for 6 monts and then every month thereafter

41
Q

For what illnesses can the meental disorder act be used for?

A
  • Any mental illness
  • Personality disorder
  • Learning disability
  • “however caused or manifested”

Being alcohol dependent or suicidal does not count

42
Q

Who can apply a short term detention order?

A

Only approved medical practitionairs

43
Q

Who can apply an emergency detention under the mental health act

A

Any registered medical practitioner

44
Q

What act can the police use to detain patients with mental inllnesses ?

A

Place a saftey order if the person is in a public space to take them to a place of saftey (hospital) to be assessed?

45
Q

How long does a emergancy detention last for?

A

maximum of 72 hrs

46
Q

Can patients appeal emergancy detentions?

A

No

47
Q

How long does a short term detention last?

A

28 days maximum

48
Q

How do you make a compulsory treatment order for patient?

A

Made by a mental health officer

Supported by a report from an Approved Medical Practitioner and the patients GP

Goes to a tribunal hearing

49
Q

How long can a compulsory treatment order last?

A

can be renewed every 6 months

50
Q

What is first line in the Tayside rapid tranquilisation policy?

A

Use of distraction

Seclusion

Talking to patient

51
Q

What is second line in the Tayside rapid tranquilisation policy fpr someone with (a) no history of typical antipsyhotics and (b) significant antipsychotic exposure?

A

(a) Oral Lorazepam 1-2mg
(b) Oral Lorazepam 1-2mg plus Haloperidol 5mg

52
Q

What is third line in the Tayside rapid tranquilisation policy for someone with no history of typical antipsychotics?

A

Lorazepam 1-2mg intrasmuscular

53
Q

How do you make up a syringe of Lorazepam ? ( whats in it ?)

A

Lorazepam 1-2mg mixed 1:1 with water or sodium chloride 0.9%

54
Q

What is third line in the Tayside rapid tranquilisation policy for someone with a strong history of typical antipsychotics?

A

Lorazepam 1-2mg IM

in extreme cases add

Haloperidol IM 5mg

55
Q

What type of antipsychotic is usually first line?

A

Antypical antipsychotics

risperidone

56
Q

What is the definition of a learning disability?

A

Learning disability is a condition of arrested or incomplete development of the mind.

57
Q

What is the IQ cut off for learning disability?

A

<70

58
Q

What is the IQ range for mild LD?

A

50-69

59
Q

What is the IQ range for moderate LD?

A

35-49

60
Q

What is the IQ range for sevre LD?

A

20-34

61
Q

What is used to measure IQ ?

A

WAIS

62
Q

What is the normal IQ range for someone with Down’s Syndrome?

A

IQ 30-55

63
Q

What is the autisitc triad?

A

Abnormal social interaction

communication impairment

Reigid/repretitve behaviour

64
Q

What does the mesolimbic pathway do?

A

Motivating signal that incentivises behaviour resulting in addiction

65
Q

What is the Ventral tegmental area?

A

Origin of dopaminergic cell bodies

66
Q

What happens to the D2 receptors in addicted brains?

A

Dopamine D2 receptors are decreased by addiction and never come back

67
Q

What does the pre-frontal cortex do?

A

Helps intention guide behaviour

important in impulse control

sets goals

makes sensible decisions

higher function

68
Q

What happens to the pre-frontal cortext in addicted brains?

A

It doesnt work as well

69
Q

What does the Orbito-frontal cortex do?

A

Decides how important things are to you

70
Q

Why can stress motivate drug seeking in dependent individuals?

A

Stress triggers the release of dopamine in the neural reward pathway so stressed people have down regulated D2 receptors so have to seek out highly rewarding behaviours like cocaine binges

71
Q

What is High risk drinking ?

A

Over 35 untis per week

72
Q

What is increased risk drinking ?

A

Between 15 and 35 units per week

73
Q

What is Low risk drinking ?

A

14 units of alcohol weekly spread over 3 days or more

74
Q

What is “harmful use of alcohol”?

A

Use of alcohol which is cause physical or mental damage

75
Q

What is “alcohol dependence syndrome”?

A
  • Strong desire/compulsion to drink
  • Difficult to control onset and termination
  • Withdrawl symptoms
  • Tolerance
    • neglect of other pleasures
76
Q

What are the two questionaires usually used to identify problem drinking?

A

MAST

and

AUDIT

77
Q

What affect does alcohol withrawal have on the grain?

A

Results in excess glutamate activity and reduced GABA activity

78
Q

What are the common symtpoms of alcohol withdrawl syndrome?

A

Restlessness

Tremor

Sweating

Anxiety

Loss of appetite

Insomnia

79
Q

In alcohol withdrawal syndrome when do symptoms peak and for how long do they usually last?

A

Peak after 1-2 days and last 5-7 days

80
Q

What is Delirium Tremens?

A

Confusion, disorientation, agitation and hallucinatations during alcohol withdrawl

81
Q

How common is delirium tremens in alcohol withdrawl?

A

5% of cases

82
Q

When is the peak onset of Delirium Tremens?

A

2 days of abstinence

83
Q

How do you manage alcohol withdrawl pharmacologically ?

A

Diazepam titred reduction over 7 days

Thiamine supplements

84
Q

Why give Thiamine supplements to people with alcohol withdrawl symptoms?

A

to prevent Wernicke’s encephalopathy because their thiamine levels are likely to be super low

85
Q

What does Disulfiram / anatabuse do?

A

Used to prevent relapse in alcoholics

If you drink while taking these you feel real shitty

86
Q

What does Acamprosate do?

A

Used in alcohol cesastion it acts centrally on glutamate and GABA systems to reduce cravings

87
Q

What is the frist line phamracological treatment to prevent relapse of alcohol addiction?

A

Naltrexone

88
Q

What does Naltrexone do?

A

Reduces reward from alochol

89
Q

How does Naltrexone work?

A

Opioid antagonist so reduces reward from alocohol

90
Q

What is Buprenorphine?

A

Its like methadone but takes longer to be absorbed

91
Q

What are functional disorders?

A

Symptoms unexplained by conventional physical disease processes

92
Q

At what level does Lithium become toxic in the blood?

A

1.5 mmol/L

93
Q
A

Psychiatry (4 decks)

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