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clinical Flashcards

1
Q

Depression core 3 symptoms

A

anhedonia, low mood, fatigue

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2
Q

Depression symptoms

A

(Core 3: anhedonia, low mood, fatigue), guilty, idea of reference, delusions, hallucinations, Anxiety, decreased concentration, suicidal thoughts, low confidence, difficulty sleeping, loss or increased appetite

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3
Q

investigations for depression and somatic syndrome

A

ICD 10, lasts for at least 2 weeks, no mania, not attributable to psychoactive substances

SCID
SCAN
HDRS
BDI-II
HADS
PHQ-9
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4
Q

treatment for depression and somatic syndrome

A

SSRI’s
tricyclic anti-depressants
monoamine oxidase inhibitors
CBT, IPT, individual dynamic psychotherapy, ECT, psychosurgery, DBS, VNS

duloxetine for physical symptoms

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5
Q

1st line treatment for depression and somatic syndrome

A

1st line: psychoeducation, lifestyle advice

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6
Q

2nd line treatment for depression and somatic syndrome

A

line sleep hygiene, active monitoring psychosocial intervention

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7
Q

somatic syndrome symptoms

A

Anhedonia, lack of emotional reactions to events, waking 2 hours before normal time, depression worse in the morning, psychomotor agitation or retardation, loss of appetite, weight loss or libido

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8
Q

mania symptoms

A

Grandiose ideas, disinhibition, stimulant like effects, inappropriate, alteration of senses, irritable, decreased need of sleep

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9
Q

mania investigations

A

SCID
SCAN

Young Mania Rating Scale

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10
Q

antipsychotics for Tx of mania

A

olanzapine
risperidone
quetiapine

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11
Q

mood stabilisers for Tx mania

A

sodium valproate
lamotrigine
(1st line for prophylaxis and acute mania carbamazepine )

lithium
ECT

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12
Q

differentials for mania

A

Mixed affective state, schizoaffective disorder, schizophrenia, cyclothymia, ADHD, drugs and alcohol, stroke, Ms, tumour, epilepsy

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13
Q

hypomania symptoms

A

Lesser degree of psychosis, mild elevation of mood, increased energy and activity, increased sociability, increased sexual energy, irritable, concentration reduced, new interests

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14
Q

bipolar signs

A

2+ episodes of depression and mania or hypomania

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15
Q

bipolar treatment

A

Antidepressants, mood stabilisers; lithium, valproic acid, anti-psychotics if necessary

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16
Q

chronic alcohol use symptoms

A

Hepatomegaly, jaundice, fever, hepatic decompensation, abdominal pain

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17
Q

chronic alcohol use investigations

A 
Elevated GGT
macrocytosis
low platelets
elevated ferritin
enlarged smooth edged liver
Glasgow alcoholic hepatitis score
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18
Q

chronic alcohol use treatment

A

Abstain from alcohol
steroids
management of infection
nutrition

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19
Q

schizophrenia positive symptoms

A

Positive symptoms
Hallucinations
delusional beliefs (grandiose, paranoid, hypochondriacal, self-referential)

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20
Q

schizophrenia negative symptoms

A

negative symptoms
apathy
lack of interest
lack of emotions

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21
Q

schizophrenia primary diagnostic symptoms

A 
More than a month of: 
alienation of thought
delusions of control
hallucinations
persistent impossible delusions
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22
Q

schizophrenia secondary diagnostic symptoms

A 
two more of the following
persistent hallucinations
neologisms
catatonic behaviour
negative symptoms
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23
Q

treatment for acute exacerbation schizophrenia

A

acute exacerbation consider chlorpromazine

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24
Q

treatment for treatment resistant schizophrenia

A

then clozapine

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25
Q

cognitive dysfunction in schizophrenia tx

A

then acetylcholinesterase

inhibitors

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26
Q

schizophrenia persistent negative symptoms augment treatment with

A

antipsychotic with antidepressants
antipsychotics
CBT, family intervention, social skill training

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27
Q

differentials for schizophrenia

A

Delirium or acute organic brain syndrome
depressive episode with psychosis
manic episodes with psychosis
schizoaffective disorder

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28
Q

delirium symptoms

A

Terror, delusions that are persecutory and evanescent, fluctuating worse at night, hallucinations an illusion, global disturbance of cognition, emotional disturbance, psychomotor disturbance, autonomic , rapid onset, less than 6 months

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29
Q

delirium autonomic activation symptoms

A

tachycardia, hypertension, diaphoresis, dilated pupils, fever, dysgraphia

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30
Q

treatment for delirium

A

Treat underlying cause, education of relatives and staff, make environment safe, optimise stimulation, orientation, avoid sedation, use of antipsychotics

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31
Q

paranoid personality disorder symptoms

A

Pervasive distrust and suspiciousness of others that their motives are interpreted as malevolent beginning early childhood and present in a variety of contexts

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32
Q

paranoid personality disorder diagnostic symptoms

A

Suspicious with basis,
preoccupied with loyalty of associates, reluctant to confide for fear of blackmail, reads threats into benign events, bears grudges, interprets attacks on character not apparent to others and quick to react, recurrent suspicions of infidelity of partners

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33
Q

paranoid personality, schizoid, schizotypal disorder differentials

A

Schizophrenia, bipolar, depressive disorder with psychotic symptoms, medication or organic.

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34
Q

schizoid personality symptoms

A

Pervasive pattern of detachment from social relationships and restricted expression of emotions in interpersonal setting

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35
Q

schizoid personality diagnostic symptoms

A

Doesn’t enjoy relationships, solitary, little sexual interest, few interests, lacks friends, indifferent, cold and detached

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36
Q

schizotypal symptoms

A

Pervasive pattern of social and interpersonal deficits marked by acute discomfort and reduced capacity for close relationships. Presence of cognitive distortions and eccentricities

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37
Q

schizotypal diagnostic symptoms

A

Ideas of reference, odd beliefs, unusual perceptual experiences, odd thinking, suspicious, inappropriate, eccentric, lack of close friends, excessive social anxiety

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38
Q

antisocial personality disorder symptoms

A

Pervasive pattern of disregard for and violation of the rights of others for 15 years, conduct disorders before15

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39
Q

anti-social personality disorder diagnostic symptoms

A

Failure to conform, deceitfulness, impulsive, irritable, aggressive, irresponsible, lack of remorse

40
Q

borderline personality disorder symptoms

A

Pervasive pattern of instability of interpersonal relationships, self-image, affects and impulsivity

41
Q

borderline personality disorder diagnostic symptoms

A

Frantic efforts to avoid abandonment real or fake, unstable intense relationships, identity disturbance, impulsive, recurrent suicidal behaviour, effective instability, chronic feelings of emptiness, intense anger, transient stress

42
Q

borderline personality disorder treatment

A

dialectic behavioural therapy
mentalisation based treatment
symptomatic prescribing
co-occurring mental illness

43
Q

histrionic personality disorder symptoms

A

excessive emotionality and attention seeking

44
Q

histrionic personality disorder diagnostic symptoms

A

Uncomfortable unless in centre of attention, inappropriate behaviour, shallow emotions, uses physical appearance to draw attention, excessively impressionistic, self-dramatization, considers relationships more intimate than they are

45
Q

dependent personality disorder symptoms

A

Need to be taken care of that leads to submissive and clinging behaviour, fears of separation

46
Q

dependent personality disorder diagnostic symptoms

A

Needs excessive amounts of advice and reassurance, needs others to assume responsibility, difficulty expressing disagreement, difficulty initiating projects, goes to lengths for nurturance, urgently seeks relationships, preoccupied fears of being left alone

47
Q

obsessive compulsive personality disorder symptoms

A

Orderliness, perfectionism, mental and interpersonal control, expense of flexibility, openness, efficiency

48
Q

obsessive compulsive personality disorder diagnostic symptoms

A

Preoccupied with details, perfectionism, devoted to work, over conscientious, unable to discard objects, reluctant to delegate, adopts miserly spending style, rigid.

49
Q

avoidant personality disorder symptoms

A

Pervasive pattern of social inhibition, inadequacy, hypersensitivity to negative evaluation

50
Q

avoidant personality disorder diagnostic symptoms

A

Avoids occupational activities, unwilling to get involved with people, restrained, preoccupied with criticism, inhibited, self-perception of socially inept, reluctant to take personal risk.

51
Q

anorexia nervosa symptoms

A

fear of fatness
avoidance of calories
anxiety

52
Q

signs of anorexia nervosa

A

Onset mid-teens to mid-twenties
17.5BMI, amenorrhoea
cold intolerance, blue hands and feet, constipation, bloating, delayed puberty, dry skin, fainting, hypotension, lanugo hair, scalp hair loss, early satiety, weakness, fatigue, short stature, osteopenia, osteoporosis

53
Q

investigation for anorexia nervosa

A

SCOFF

54
Q

treatment for anorexia nervosa

A

Re-feeding

CBT, SSCM, IPT, fluoxetine, high dose anti-depressants, first line olanzapine, family therapy.

55
Q

bulimia symptoms

A

Bing eating with sense of loss of control, purging or non-purging type. Minimum of 2 times per week for 3 months.

56
Q

signs of bulimia

A

mouth sores, pharyngeal trauma, dental caries, heartburn, chest pain, oesophageal rupture, impulsivity, muscle cramps, weakness, diarrhoea, irregular periods, fainting, swollen parotids, hypotension

57
Q

binge eating disorders symptoms

A

Absence of purging behaviours, cycles of fast eating, large amounts of food, uncomfortably full, buzzed after eating, embarrassment, shame and guilt

58
Q

generalised anxiety disorder

A

Persistent Psychological arousal, muscle tension, hyperventilation, sleep disturbance

59
Q

diagnostic symptoms for anxiety

A

Excess anxiety and worry for 6 months, finds if difficult to control, associated with 3+ restless, fatigue, irritable, muscle tension, sleep disturbance, difficulty concentrating

60
Q

treatment for anxiety

A

Counselling, relaxation training, SSRI, TCA, CBT, augment with anti-psychotics in Tx resistant, buspirone

61
Q

1st line for anxiety

A

1st line: self-help, psychoeducational programs

62
Q

differentials for anxiety

A

Depression, schizophrenia, dementia, substance misuse, thyrotoxicosis, pheochromocytoma, hypoglycaemia, asthma, arrhythmias

63
Q

social phobia symptoms

A

Inappropriate anxiety where a person feels observed, blushing, tremor as well as GAD symptoms

64
Q

social phobia treatment

A

CBT, SSRI (6 months) , education, advice

65
Q

OCD symptoms

A

Obsessional thoughts, unpleasant and distressing, recognised as individual thought, anxiety arises from resistance, not helpful, not enjoyable, viewed as preventing harm, compulsions

66
Q

OCD diagnostic

A

> 1hr time consuming, significant distress, functional impairment

67
Q

OCD treatment

A

SSRI fluoxetine, Clomipramine, education CBT, psychosurgery

68
Q

OCD 1st line

A

CBT

69
Q

OCD 2nd line

A

SSRI’s

70
Q

OCD 3rd line

A

clomipramine

71
Q

OCD 4rth line

A

buspirone + SSRI’s

72
Q

PTSD symptoms

A

Hyperarousal, re-experiencing phenomena, avoidance of reminders

73
Q

PTSD diagnostic symptoms

A

Anxiety, insomnia, poor concentration, flashbacks, nightmares, emotional numbness, recall difficulties, diminished interests

74
Q

PTSD treatment

A

CBT, eye movement desensitisation and reprocessing, SSRI or TCA

75
Q

autism symptoms

A

Associated low IQ
repetitive behaviour, obsession, preoccupations, rigid and inflexible behaviour patterns, non-verbal communication, emotional concerns, decreased other perspective

76
Q

autism treatment

A

Establishing needs, appreciated the won’t, decreasing demands and stress, psychopharmacology

77
Q

ADHD symptoms

A

Poor cognitive control, developmental inattention, hyperactive, impulsive

78
Q

ADHD investigations

A

Connor questionnaire

79
Q

ADHD treatment

A

Resistant to pure behavioural, psychoeducation, stimulants atomoxetine, behavioural interventions, parent training, school interventions

80
Q

ADHD 1st line

A

Methylphenidate,

81
Q

ADHD 2nd line

A

bupropion

82
Q

learning disability investigations

A

Wechsler IQ test

Vineland scale

83
Q

dementia symptoms

A

Memory loss, dysphasia, dyspraxia, dysgnosia, dysexecutive, functional decline

consciousness clouded, disturbed sleep wake cycle, progressive decline, normal attention span, psychomotor changes

84
Q

dementia investigations

A

brain scans
neuropsychology
bloods and physicals

MMSE
MOCA
SPECT

85
Q

dementia ABCD

A

Activities of Daily living
Behavioural
Cognitive impairment
Decline

86
Q

dementia treatment

A

Acetylcholinesterase inhibitors, memantine, neuroleptics, communication, distraction, care homes

87
Q

Lewy body dementia symptoms

A

Deficits of attention, frontal executive and visuospatial, fluctuation, visual hallucination, parkinsonism
REM sleep disorder, falls, syncope, loss of consciousness, autonomic dysfunction

88
Q

Lewy body Dementia investigations

A

DAT scan

89
Q

frontotemproral dementia symptoms

A

Behavioural disorder, early onset, emotional blunting, speech disorder, altered output, stereotypy, echolalia, perseveration, mutism, Parkinson’s later, incontinence

90
Q

panic disorder symptoms

A

Palpitations, tachycardia, sweating, muscle trembling, shaking, shortness of breath, sensations of smothering, choking sensation, chest pain, nausea, abdo distress, dizzy, depersonalisation, fear of dying, numbness, chills, fears of losing control

91
Q

panic disorder 1st line

A

self help

92
Q

panic disorder 2nd line

A

CBT

93
Q

panic disorder 3rd line

A

SSRI, not fluoxetine

94
Q

prolonged grief disorder symptoms

A

Marked distress, disability, persistence more than 6 months post

95
Q

prolonged grief disorder treatment

A

Counselling, antidepressants, behavioural, cognitive, exposure therapies

psychiatry (3 decks)

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