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psych Flashcards

1
Q

side effects of mirtazepine

A

increase in appetite
sedation

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2
Q

Where does mirtazepine act?

A

Alpha2 receptor antagonist

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3
Q

what causes the tyramine cheese reaction?

A

Monoamine Oxidise Inhibitor (phenelzine)
>HTN crisis

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4
Q

what is akathisia?

A

inner restlessness, inability to keep still

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5
Q

what causes akathisia?

A

long term AP use
EPSE

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6
Q

threatening behaviour in a public space - appropriate course action?

A

call police 136

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7
Q

best psychotherapy for schizophrenia?

A

CBT

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8
Q

what type of side effects with imipramine AD?

A

anti-muscarinic
blurred vision, dried mouth

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9
Q

common tricyclic AD side effects?

A

drowsiness
dry mouth
blurred vision
constipation
urinary retention
long QT
weight gain

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10
Q

When is ECT mainly indicated

A

in life threatening depression, where catatonia is present

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11
Q

patients with poor oral compliance to APs - what is best option for these patients?

A

Switch to once monthly IM injection depot

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12
Q

adverse effects atypical APs

A

weight gain
hyperprolactinaemia
stroke/VTE

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13
Q

adverse effects clozapine?

A

agranulocytosis
neutropaenia
seizures
constipation
myocarditis
hypersalivation

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14
Q

first line tx mild depression

A

psychological therapy - IAPT

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15
Q

what can cause an increase in clozapine blood levels?

A

smoking cessation

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16
Q

what causes a decrease in clozapine levels?

A

starting smoking/increasing smoking
stopping drinking alcohol
omitting doses

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17
Q

strongest risk factor for psychotic disorders?

A

positive family history

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18
Q

other risk factors associated with psych disorders?

A

black carribean
migration
urban environment
cannabis use

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19
Q

are SSRI’s addictive?

A

No

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20
Q

how long should someone who has been started on SSRI continue taking them before stopping, even if feeling better after a few weeks?

A

6/12

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21
Q

what type of PD can be rigid with morals/ethics/values and cannot delegate work?

A

Anankastic/obsessive-compulsive

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22
Q

hypomania vs mania: time course?

A

mania>7days
hypomania <7days (3-4)

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23
Q

mania vs hypomania key symptoms difference?

A

Mania - psychotic sx

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24
Q

what can Lithium cause?

A

benign leucocytosis

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25
Q

Lithium therapeutic range?

A

0.4-1.0

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26
Q

increased high suicide risk features?

A

left a note
planning
avoid discovery
final acts - sorting out finances
violent means

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27
Q

protective factors vs suicide?

A

family support
children at home
religious belief

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28
Q

speech presentation in mania?

A

pressured
flight of ideas
poor attention

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29
Q

duloxetine MOA?

A

SNRI -
duo - 2!

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30
Q

what type of drug is venlafaxine?

A

SNRI
check BP

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31
Q

mirtazepine MOA:

A

Noradrenergic and specific serotonergic AD

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32
Q

change in Lithium dose - when do you recheck levels?

A

1 week later and 12 hours after the last dose was taken

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33
Q

Over how long should an SSRI be withdrawn?

A

over 4 weeks, gradually
(Not needed with fluoxetine - longer half life)

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34
Q

suicide risk factors:

A

male
previous self-harm
substance misuse
psych disorder
chronic disease
age
social isolation

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35
Q

differentiate OCD from psychosis?

A

True need and belief in obsession/compulsion - poor insight

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36
Q

what does lanugo hair indicate and what causes it?

A

Anorexia nervosa
loss of body fat

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37
Q

physical symptoms of AN?

A

lanugo hair
failure secondary sex characteristics
bradycardia
cold intolerance
yellow tinge skin (hypercarotenaemia)

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38
Q

post-concussion syndrome:

A

headache
fatigue
anxiety/depression
dizziness

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39
Q

how will affects of clozapine affect FBC?

A

decreased leukocytes

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40
Q

How long missed clozapine doses can wait before having to retitrate up slowly?

A

2 days

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41
Q

alcohol withdrawal: seizures - how long will this sx take to manifest?

A

36 hours

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42
Q

alcohol withdrawal: delirium tremens - over what timeframe will this manifest?

A

72 hours

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43
Q

alcohol withdrawal: sx start over what timeframe?

A

6-12 hours

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44
Q

alcohol withdrawal mx:

A

chlordiazepoxide (decreasing doses)
pabrinex for thymine deficiency

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45
Q

which psychotic disorder is insomia a feature of?

A

Schizophrenia
circadian rhythms affected

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46
Q

SSRI discontinuation syndrome features:

A

increased mood change
restlessness
difficulty sleeping
unsteadiness
sweating
Gi sx
paraesthesia

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47
Q

involuntary movements including grimacing and sticking out the tongue, excess blinking - what is this ?

A

tardive dyskinesia

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48
Q

how is tardive diskinesia treated?

A

Tetrabenazine

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49
Q

what would treat the side effect akathisia?

A

Propranolol

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50
Q

how would acute dystonia (sfx) be treated?

A

procyclidine
benztropine

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51
Q

AP EPSE’s?

A

parkinsonism
acute dystonia
akathisia
tardive dyskinesia

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52
Q

what might present to A and E with hypokalaemia causing palpitations and show a metabolic alkylosis on BG with low Cl-?

A

BN - vomiting

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53
Q

which disorder will present with persistent belief in underlying disease with refusal to accept negative test results?

A

Hypocondriacal disorder (illness anxiety disorder)

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54
Q

how will somatisation disorder present?

A

multiple physical SYMPTOMS for 2+years
refusal to accept negative tests

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55
Q

which disorder commonly presents with numbness/loss sensation/motor function

A

conversion disorder

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56
Q

In conversion disorder, is the patient faking for gain?

A

No, not feigning sx, or seeking material gain
may be indifferent - la belle indifference

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57
Q

which disorder presents because of separating of certain memories from consciousness and involves psych sx such as fugue, stupor, amnesia ?

A

Dissociative disorder

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58
Q

What is Munchausens also known as?

A

Factitious disorder

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59
Q

What is Munchausens ?

A

factitious conjuring of physical / psych sx

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60
Q

What is malingering?

A

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

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61
Q

what increased risk do APs have in elderly?

A

VTE-stroke

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62
Q

Schneider’s first rank schizophrenia sx (4)

A

auditory hallucinations (3rd - commentary)
delusional perception
thought disorder
passivity phenomenon

persecutory delusions
incongruent affect

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63
Q

which drugs can cause urinary retention?

A

Tricyclics ADs

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64
Q

what is the AD of choice in children and adolescents?

A

Fluoxetine

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65
Q

differentiating between knight’s move thinking and flight of ideas?

A

knights move illogical leaps from topics,
flight of ideas there are discernible links between topics

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66
Q

what is flight of ideas a feature of (disease)

A

BPAD

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67
Q

why can APs cause breast tenderness/enlargement?

A

hyperprolactinaemia

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68
Q

which AP has best side effect profile?

A

Aripiprazole

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69
Q

what type of drugs are associated with hyponatraemia?

A

SSRIs - check U+Es if confusion

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70
Q

which scale can used to assess alcohol withdrawal severity?

A

Clinical Institute Withdrawal Assessment for Alcohol (CIWA) scale

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71
Q

which personality disorder would favour male gender over female gender?

A

Anti-social

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72
Q

what is first line treatment in Anorexia Nervosa?

A

family therapy

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73
Q

what type of memory loss in ECT is sfx?

A

retrograde

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74
Q

poor prognosis factors for schizophrenia?

A

strong family history
gradual onset
low IQ
premorbid history of social withdrawal
lack of obvious precipitant

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75
Q

what type of incontinence is associated with amitryptaline?

A

overflow incontinence

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76
Q

how may tardive dyskinesia present?

A

chewing, jaw pouting or excessive blinking due to late onset abnormal involuntary choreoathetoid movements

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77
Q

she was lying beside an insulin syringe when they found her, despite her not having diabetes

A

Munchausens

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78
Q

charles-bonnet syndrome?

A

visual hallucinations associated with eye disease (ARMD)

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79
Q

risk factors for charles-bonnet syndrome?

A

Advanced age
Peripheral visual impairment (ARMD)
Social isolation
Sensory deprivation
Early cognitive impairment

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80
Q

pattern of global memory loss rather than short-term memory loss

A

psuedo-dementia
(depression)

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81
Q

what is cortad’s syndrome?

A

believes dead

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82
Q

with anxiety, which condition is it important to rule out?

A

hyperthyroid disease

83
Q

can normal grief reaction present with psychological features eg hallucinations?

A

yes

84
Q

flight of ideas is linked only by rhyme or similar sounding words.
What is the medical term for this psychiatric symptom?

A

Clang association

85
Q

what is zopiclone sfx?

A

increased risk of fall in elderly

86
Q

re-experiencing e.g. flashbacks, nightmares
avoidance e.g. avoiding people or situations
hyperarousal e.g.hypervigilance, sleep problems

A

PTSD

87
Q

Indifference to praise and criticism
Preference for solitary activities
Lack of interest in sexual interactions
Lack of desire for companionship
Emotional coldness
Few interests
Few friends or confidants other than family

A

schizoid PD
all negative schizophrenia sx

88
Q

Ideas of reference (differ from delusions in that some insight is retained)
Odd beliefs and magical thinking
Unusual perceptual disturbances
Paranoid ideation and suspiciousness
Odd, eccentric behaviour
Lack of close friends other than family members
Inappropriate affect
Odd speech without being incoherent

A

schizotypal PD

89
Q

is clozapine depot ok to use?

A

not in UK

90
Q

in poor compliance with APs, what should be trialled?

A

Olanzapine depot

91
Q

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

A

catatonia

92
Q

vomiting, can be use of laxatives or diuretics or exercising

A

purging

93
Q

what asthma drug might lead to psychosis?

A

pred
CS

94
Q

lack close friends other than family and can have odd or eccentric behaviour, speech and beliefs??

A

schizotypal

95
Q

Sudden onset psychosis following course of corticosteroids??

A

steroid-induced psychosis

96
Q

which foods when taken alongside monoamine oxidase inhibitors cause a hypertensive crisis to occur?

A

cheese (tyramine)

97
Q

Chronic insomnia may be diagnosed after how long?

A

3 months

98
Q

how many nights a week must one struggle to get to sleep or stay asleep for dx of chronic insomnia?

A

3/7

99
Q

OCD tx:

A

exposure response therapy
if severe + SSRI, CBT

100
Q

how long before OCD dx?

A

2/52

101
Q

how long PTSD sx before dx can be made?

A

1 month

102
Q

clozapine - what needs monitoring??

A

FBC - Agranulocytosis/neutropenia

103
Q

bloods: Anorexia nervosa - ?

A

most things low
Gs and Cs raised:
growth hormone
glucose
salivary Glands
Cortisol
cholesterol
carotinaemia

104
Q

SSRI + NSAID =

A

GI bleed risk - GIVE A PPI

105
Q

when does tardive dyskinesia present?

A

after many years APs

106
Q

agitation, hyperthermia, hyperreflexia, sweating and dilated pupils.

A

serotonin syndrome
(SSRI+MAO-I)

107
Q

ECT sfx:

A

nausea
cardiac arrhythmias
short term memory impairment
headache

108
Q

sertraline in 1st trimester pregnancy:

A

congenital heart defects

109
Q

He says that over the last year he has been experiencing nearly constant nervousness, which gets worse at random points, and is not associated with any particular trigger. During the worst of these he becomes short of breath and feels his heart beating in his chest. There are no other symptoms of note, and nothing found on examination.

A

GAD

110
Q

GAD characterised by:

A

free floating, persistent anxiety

111
Q

Panic disorder: description

A

random panic attacks on the back of no usual anxiety

112
Q

SSRI use during third trimester -

A

risk of persistent pulmonary hypertension of the newborn

113
Q

most common endocrine disorder developing as a result of chronic lithium toxicity

A

hypothyroidism (6-18/12)

114
Q

adverse Li effects

A

nausea/vomiting, diarrhoea
fine tremor
nephrotoxicity: polyuria, secondary to nephrogenic diabetes insipidus
thyroid enlargement, may lead to hypothyroidism
ECG: T wave flattening/inversion
weight gain
idiopathic intracranial hypertension
leucocytosis
hyperparathyroidism and resultant hypercalcaemia

115
Q

once established, how often do you check Li dose?

A

3 months and 12 hours after last dose

116
Q

what should be checked every 6/12 in Li use:

A

thyroid and renal function

117
Q

Othello syndrome - define>

A

delusional jealously, usually believing their partner is unfaithful

118
Q

which endocrine condition can anorexia nervosa cause in some individuals?

A

hypothyroidism

119
Q

panic disorder, what is the most appropriate first-line drug treatment?

A

SSRI

120
Q

if no response by 12 weeks on SSRI, 2nd line for panic disorder?

A

imipramine, clomipramine

121
Q

Erotomania - define

A

presence of delusion (of a famous person being in love with them) with absence of other psychotic symptoms
De Clerambault’s

122
Q

what type of AP sfx is oculogyric crisis?

A

acute dystonia
another eg is torticollis

123
Q

The risk of developing schizophrenia if one monozygotic twin is affected is approximately:

A

50%

124
Q

Symptoms of mania in primary care: Mx->

A

urgent referral to CMHT

125
Q

PTSD features:

A

hyperarousal
nightmares
avoidance
emotional numbing

126
Q

Metabolic side effects of antipsychotics include: (olanzapine)

A

dysglycaemia, dyslipidaemia, and diabetes mellitus

127
Q

Benzos: MOA:

A

enhance the effect of GABA, the main inhibitory neurotransmitter

128
Q

how do benzos affect Chloride channels?

A

Frequently bend
increase the frequency of Cl channels

129
Q

how do barbituates affect GABA?

A

during BarbBQ
enhance effect of GABA by increasing duration of Cl channel opening

130
Q

in trauma leading to worsening headaches, more forgetful, more irritable -> think:

A

post-concussion syndrome

131
Q

how long do post-concussion syndrome symptoms last after trauma?

A

3/12

132
Q

benzos (lorazopam) sfx:

A

anterograde amnesia

133
Q

23-yom finds when he wakes up and less often when he is falling asleep he is ‘paralysed’ and unable to move. This sometimes associated with what the patient describes as ‘hallucinations’ such as seeing another person in the room. He is becoming increasingly anxious about these recent episodes. Dx?

A

sleep paralysis

134
Q

Mx: sleep paralysis-

A

if troublesome clonazepam may be used

135
Q

Borderline personality disorder?

A

history of recurrent self-harm and intense interpersonal relationships

136
Q

SSRI of choice in post-MI?

A

sertraline

137
Q

The patient’s reply to most of the questions consisted of sentences which did not make any sense such as - ‘painting pizza prince bus brush’. This is a good example of which of the following thought disorder?

A

word salad
(psychosis and mania)

138
Q

Echolalia:

A

repeating what someone else said exactly

139
Q

perseveration:

A

repeating the same word/sentence

140
Q

short history and rapid onset memory loss:

A

depression

141
Q

PHQ9 for?

A

depression

142
Q

SADPERSONs score?

A

suicide risk

143
Q

re-experiencing e.g. flashbacks, nightmares
avoidance e.g. avoiding people or situations
hyperarousal e.g.hypervigilance, sleep problems

A

PTSD

144
Q

prefer to be alone, don’t like relationships, low libido

A

schizoid

145
Q

pseudohallucinations?

A

after normal bereavement - do not imply psychosis

146
Q

PTSD management -

A

trauma-focused cognitive behavioural therapy or EMDR
if needs meds - venlafaxine or SSRI

147
Q

suicide risk:

A

Gender - males are three times as likely to take their own life as females
Age - people aged 35-49 years now have the highest suicide rate
Mental illness
The treatment and care they receive after making a suicide attempt
Physically disabling or painful illnesses including chronic pain
Alcohol and drug misuse
The loss of a job
Debt
Living alone - becoming socially excluded or isolated;
Bereavement
Family breakdown and conflict including divorce and family mental health problems
Imprisonment

148
Q

paroxetine in pregnancy:

A

risk of congenital malformations

149
Q

haloperidol for treatment-resistant schizophrenia. She presents to her general practitioner with a 1-day history of neck pain and difficulty moving the neck. On examination, she has normal observation except a mild tachycardia of 105 and neck stiffness with restricted range of motion. Her neck is involuntarily flexed to the right. She has normal facial movements.

A

acute dystonia - TORTICOLLIS

150
Q

can PDs be dx in children?

A

no hasa to be pervasive >18 only

151
Q

Symptoms of hypomania in primary care

A

routine referral to CMHT

152
Q

how long must sx be present for dx of : depressive episode?

A

2 weeks

153
Q

elderly patients with new sudden onset psychosis: Ix?

A

CT head

154
Q

class of drugs most likely to interfere with SSRI?

A

triptan (causes seratonin syndrome)

155
Q

risk factor for generalised anxiety disorder:

A

Aged 35- 54
Being divorced or separated
Living alone
Being a lone parent

156
Q

Sleep disturbance, stress triggers and normal mini-mental test score with global memory loss suggest

A

depression rather than dementia

157
Q

pyrexia
muscle rigidity
autonomic lability: typical features include hypertension, tachycardia and tachypnoea
agitated delirium with confusion

A

Neuroleptic malignant syndrome

158
Q

Neuroleptic malignant syndrome Tx:

A

stop antipsychotic
patients should be transferred to a medical ward if they are on a psychiatric ward and often they are nursed in intensive care units
IV fluids to prevent renal failure
dantrolene* may be useful in selected cases
bromocriptine, dopamine agonist, may also be used

159
Q

neuromuscular excitation (e.g. hyperreflexia, myoclonus, rigidity)
autonomic nervous system excitation (e.g. hyperthermia)
altered mental state

A

serotonin syndrome

160
Q

mx: serotonin syndrome:

A

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

161
Q

long QT in?

A

tricyclic antidepressants, selective serotonin reuptake inhibitors (especially citalopram)
methadone
chloroquine
terfenadine**
erythromycin
haloperidol
ondanestron

162
Q

mx:long QT:

A

BBs

163
Q

3 risk factors for ADHD:

A
  • Prematurity
  • Maternal smoking/alcohol/drugs during pregnancy
  • FHx
  • Socioeconomic status
  • Epilepsy
  • Looked after
  • Acquired brain injury
164
Q

Inattention sx in ADHD:

A
  • Reluctant to engage in mentally-engaging tasks
  • Easily distracted
  • Loses things
  • Doesn’t like homework
  • Failure to plan/organise tasks
165
Q

hyperactivity sx ADHD:

A
  • Talks excessively
  • Interruptive/ intrusive to others
  • Spontaneously leave the seat when expected to sit
166
Q

questionnaire for Dx of ADHD:

A

SNAP-iv for parents and teachers to complete

167
Q

ASD questionnaire:

A

ADOS

168
Q

MSE signs of depression:

A
  • blunted affect
  • Psychomotor retardation
  • Catatonia
  • Unkempt
  • Poor eye contact
  • Non-spontaneous speech
169
Q

type of delusions in depression:

A

nihilistic
derogatory
persecutory
guilt
hypochondriacal

170
Q

Name three underlying principles of the Mental Health Act (3).

A
  • Respect for patients past and wishes and feelings
  • Respect for diversity
  • Minimise restriction on liberty
  • Involve patients in planning
171
Q

when can a section 3 be renewed?

A

after 6/12

172
Q

a litre of 50% whisky each day - units?

A

50 per day (50x1000/1000)

173
Q

alcohol dependence sx (3):

A
  • Subjective awareness of compulsion
  • Narrowing of repitoir
  • Primacy of alcohol
  • Spends more money and time on drink
  • Reinstatement
  • Avoidance of withdrawals with a drink
  • Drink seeking behaviour
174
Q

questionnaire for dependence to alcohol?

A

SADQ

175
Q

when can someone not undergo detox in community (2):

A
  • If no social support
  • Previous failed detox
  • Pregnancy
  • Abuse
  • Poor physical health
  • Previous MH hx
  • Homeless
176
Q

3 long term alcohol abstinence medicines to help maintain abstinence:

A

Disulfiram (vom after alc)
Acamprosate (cravings reducer)
Naltrexone (relapse prevention)

177
Q

in learning disability - what could lead to increase in challenging behaviours?

A

physical pain
needs not being met

178
Q

learning disability 3 core criteria:

A

low intelligence - IQ<70
present from birth/early childhood
wide ranging impact on function

179
Q

inverse care law define:

A

availability of good medical or social care tends to vary inversely with the need of the population served.

180
Q

first choice tx: manic episode:

A

AP - olanzapine
lithium/valproate mood stabaliser

181
Q

which antiepileptic drug is not effective as a mood stabaliser?

A

lamotrigine

182
Q

suicide attempt and not previously known to services - mx?

A

once medically stable admit to psych ward

183
Q

what is not part of normal grief reaction?

A

insomnia

184
Q

what is circumstantiality of speech and what does it indicate?

A

round the houses but will eventually answer Q
thought disorder- schizophrenia

185
Q

when to use lorazepam over chlordiazepoxide ?

A

if liver failure

186
Q

Antidepressant medication should be ???????????? when a patient is about to commence ECT treatment?

A

reduced but not stopped (SSRIs)

187
Q

GAD mx:

A
  1. SSRI
  2. different SSRI/SNRI
188
Q

PTSD sx but <4/52?

A

Acute stress disorder

189
Q

neologism?

A

formation of new words

190
Q

A 45-year-old man describes successful abstinence from alcohol for the past six months following inpatient detoxification. During his admission, he was started on a ‘deterrent’ medication. He takes this medication daily and reports that if he consumes alcohol he will ‘violently vomit’. -?

A

disulfiram

191
Q

A 45-year-old man describes successful abstinence from alcohol for the past six months following inpatient detoxification. During his admission, he was prescribed an ‘anti-craving medication’. He takes this medication three times a day and would like you to continue the prescription as he finds it very helpful. It is safe in combination with alcohol and he has experienced no side effects. ???

A

acamprosate

192
Q

A 38-year-old man presents with opioid dependence syndrome presents to clinic. He currently takes 30 mL of methadone daily. He wishes to come off of his methadone as he finds it too sedating and is finding the stigma of being on methadone challenging. He reports friends have successfully come off methadone after stitching to a ‘tablet that goes under your tongue’ and wishes to try this.?

A

buprenorphine

193
Q

patients who are overly sensitive and can be unforgiving if insulted, question loyalty of those around them and are reluctant to confide in others - dx?

A

paranoid personality disorder

194
Q

early morning waking and changes in appetite and weight - what type of symptoms?

A

somatic depression sx

195
Q

An effective treatment for borderline personality disorder is?

A

dialectical behaviour therapy (DBT)

196
Q

highest risk SSRI for stopping suddenly?

A

paroxetine

197
Q

personality disorder is characterised by inappropriate sexual seductiveness, suggestibility and intense relationships?

A

histrionic

198
Q

what is an obsession?

A

intrusive, unpleasant and unwanted thought

199
Q

what is a compulsion?

A

senseless action taken to reduce the anxiety

200
Q

23M wants referral to plastics. Treated for anxiety and depression with fluoxetine, off work with back pain 3/12.C/o ears are too big in proportion to his face. Seldom leaves the house. OE ears normal. What is the most appropriate description of this behaviour?

A

dysmorphophobia

201
Q

Safest TCA in overdose?

A

Lofepramine

(Amitriptyline, dosulepin most dangerous)

202
Q

I’m diabetic neuropathy what is first line treatment?

A

Duloxetine

203
Q

Patient with a fixed, false belief (delusion) that they are infested by ‘bugs’ →

A

delusional parasitosis

204
Q

rx for bulimia once CBT has been tried?

A

high dose fluoxetine

3a (7 decks)

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