Deck 8 Flashcards
(107 cards)
1
Q
What does FRAMES stand for?
A
- structured Feed back on risks and harms
- emphasis on the patient’s Responsibility for change
- clear Advice to make a change in drinking
- discuss a menu of options for making change
- express Empathy and be non-judgemental
- Reinforce the patient’s Self-efficacy
2
Q
What type of disorder is hypochondriasis?
A
Anxiety disorder
3
Q
What’s another term for psychopathic disorder?
A
Dissocial PD
4
Q
What is Hurtler’s syndrome and how is it inherited?
A
a defect in metabolism arising from congenital absence of an enzyme, causing accumulation of lipids and mucopolysaccharides, and resulting in mental retardation, a protruding abdomen, and bone deformities including an abnormally large head.
AR
5
Q
What is Lesch-Neylan syndrome and how is it inherited?
A
- also known as juvenile gout, is a rare inherited disorder caused by a deficiency of the enzyme hypoxanthine-guanine phosphoribosyltransferase (HGPRT), produced by mutations in the HPRT gene located on the X chromosome
- build up of uric acid
- a rare hereditary disease which affects young boys, usually causing early death. It is marked by compulsive self-mutilation of the head and hands, together with learning difficulties and involuntary muscular movements.
X linked recessive
6
Q
What are the features of fragile X?
A
- more frequent in boys but can affect girls
- long faces, large ears
- mitral valve prolapse
- performance IQ more affected than verbal IQ
- lax joints
7
Q
What’s the heritability of ADHD?
A
80%
8
Q
Which of the following drugs are recognized to cause delirium?
Diazepam Digoxin Steroids Thiazide diuretics TCAs
A
All of them
9
Q
Which of these are variants of persistent delusional disorder?
de Clerambaut's syndrome Cotard's syndrome Capgras' delusion Morbid jealousy Briquet's syndrome
A
de Clerambaut’s syndrome
Capgras’ delusion
Morbid jealousy
Cotard’s syndrome occurs in psycotic depression
Briquet’s syndrome is a somatoform disorder
10
Q
Which of the following are more common with SSRIs than with TCAs?
Lack of libido Dry mouth Urinary retention Nausea Arrhythmias
A
Lack of libido
Nausea
11
Q
What is hashish?
A
The dried resin of marijuana
12
Q
Which is the most appropriate first-line treatment for opiate withdrawal?
Lofexidine Naloxone Naltrexone Methadone Buprenorphine
A
Lofexidine is licensed for the management of symptoms of opioid withdrawal.
Methadone is used in detox and maintenance of dependence.
Naltrexone is used in the maintenance of abstinence in formerly dependent opiate addicts who have been drug free for over 7 days.
13
Q
When do heroin, methadone and buprenorphine withdrawal symptoms reach their peak? How long might symptoms last?
A
Heroin withdrawal symptoms reach their peak 36–72 hours after the last dose of heroin. Symptoms will have subsided substantially after 5 days.
Methadone withdrawal symptoms typically reach their peak 2–4 days after the last dose of methadone (4–6 days after stopping high doses). Symptoms do not substantially subside for 10–12 days.
Buprenorphine withdrawal symptoms emerge within 3–5 days after the last dose of buprenorphine, and mild withdrawal features continue for up to several weeks.
14
Q
A 25 year old female is brought to A&E with hyperthermia and tachyarrhythmia after a party. She is excited, restless and fidgety, constantly picking at the skin of her arms. Which of the following diagnoses is the best explanation for her presentation?
Heroin intoxication Cannabis intoxication Ketamine intoxication Cocaine intoxication Cocaine withdrawal
A
Cocaine intoxication
Tachyarrhythmia and tachycardia are common toxic effects of cocaine.
Picking at the skin may present a typical hallucinatory disorder of formication (bugs under skin) in a long term cocaine user.
15
Q
What type of drug is memantine?
A
NMDA glutamine receptor antagonist
16
Q
Are obsessional thoughts required to make a diagnosis of OCD?
A
No, you only need evidence of either obsessions or compulsions.
17
Q
What is a severe side effect of lamotrigine?
A
Steven johnson syndrome. Stop immediately if it does
18
Q
What do the early intervention team do?
A
Manage first episodes of psychosis.
19
Q
Which symptoms of depression have the strongest risk of suicide?
A
- insomnia
- psychomotor agitation
- feelings of worthlessness
- psychotic symptoms
20
Q
What is the commonest mood state in mania?
A
Irritability
21
Q
What type of disorder is IBS?
A
Somatoform autonomic dysfunction
22
Q
What is a haptic hallucination?
A
the sensation of touch in the absence of stimuli; may be seen in alcoholic delirium tremens
23
Q
What’s the term for ‘visual hallucinations of small figures’?
A
Lilliputian hallucinations
24
Q
What’s the difference between OCD and obsessive-compulsive PD?
A
In OCD the obsessions are ego-dystonic
25
What investigations are done for neuroleptic malignant syndrome?
CK, FBC (leucocytosis), LFTs deranged
26
What's the treatment for neuroleptic malignant syndrome?
Dantrolene (muscle relaxant)
| Bromocriptine
27
How do you treat a depressive episode with psychosis?
SSRI + antipsychotic
28
How should you treat a bipolar manic episode?
An antipsychotic e.g olanzapine, risperidone, quetiapine
29
Following a first episode of psychosis how long should you stay on an antipsychotic?
1-2 years
30
If one parent has schizophrenia what's the chance that their child will?
13%
31
If both parent's have schizophrenia what is the chance that their child will?
50%
32
Following the rapid tranquilization of a manic episode what observations should you do?
Temperature, pulse, BP and resp rate every 5-10 minutes
33
Which anxiety disorders are equally common in men and women?
Social phobia and OCD
34
What's the first line treatment with PTSD?
Mirtazapine
35
A charming and pleasant 41-year old man has an established diagnosis of antisocial PD. Which one of the following factors would predict a negative response to therapy?
- recent self harm
- quasi-psychotic symptoms
- diagnosis of depression
- history of violence to others
- presence of anxiety
History of violence
Other features include:
- history of arrest and conviction of a crime
- history of repeated lying
- confidence tricks
- use of aliases
- unresolved legal situations on admission
- hospitalization as an alternative to imprisonment
- organic brain disorder
36
What age criterion is used to define enuresis in children?
5 years
37
What is the only charge diminished responsibility applies to?
- arson
- rape
- theft
- GBH
- murder
Murder
38
What do the crisis resolution team do?
- deal with psychiatric emergencies
- 24/7 service
- short-term interventions (not more than 6 weeks)
with people at home to prevent admission to hospital
39
What do the early intervention service do?
- Work with young people under the age of 35 in their first episode of psychosis
- They attempt to reduce the duration of untreated psychosis as this is a prognostic indicator
40
What should you use to make sure a patient's psychiatric and social needs are met once back in the community after significant contact with psychiatric services?
Use a care programme approach
41
When would you use the outreach team?
- to provide intensive support and treatment in the community for chronically unwell psych patients who have a history of disengagement from mainstream services
- high risk of harm to themselves or others
- community nurses visit several times a week
42
What's the diagnosis?
A 25 year old factory worker, with sudden onset of blindness, for which no neurological explanation can be found, following the discovery of her husband in bed with their neighbour
Dissociative disorder
43
What's the ICD-10 criteria for hypochondriasis?
A. Either one of the following:
A persistent belief, of at least six months' duration, of the presence of a minimum of two serious physical diseases (of which at least one must be specifically named by the patient).
A persistent preoccupation with a presumed deformity or disfigurement (body dysmorphic disorder).
B. Preoccupation with the belief and the symptoms causes persistent distress or interference with personal functioning in daily living, and leads the patient to seek medical treatment or investigations (or equivalent help from local healers).
C. Persistent refusal to accept medical advice that there is no adequate physical cause for the symptoms or physical abnormality, except for short periods of up to a few weeks at a time immediately after or during medical investigations.
D. Most commonly used exclusion criteria: not occurring only during any of the schizophrenia and related disorders (F20-F29, particularly F22) or any of the mood disorders (F30-F39).
44
If you think someone might have hypochondriasis but they only have a belief of 1 medical condition then what's the diagnosis?
Persistent delusional disorder
Symptoms need to be present for 3 months
45
What is procyclidine?
An anticholinergic/antispasmodic drug used to treat symptoms of Parkinson's disease or involuntary movements due to the SEs of certain antipsychotics.
46
What is the term for the therapy described below?
A type of behavioural therapy that is useful to treat phobias. It involves graded exposure and relaxation techniques
Systematic desensitization
47
What word describes an increased intensity of perception?
Visual hyperaesthesia
48
What is lofexidine?
A centrally acting alpha-adrenoreceptor agonist that reduces sympathetic outflow. Used in opiate withdrawal.
49
What are the clinical signs of neurosyphilis?
- onset several years after initial infection
- personality change
- grandiose behaviour
- dementia
- upper motor neurone abnormalities such as brisk reflexes and extensor plantars
50
What's described?
I hear a man in Newcastle talking to me even though I live in Edinburgh
Extracampine hallucination
51
What does zero order pharmokinetics mean?
a constant amount of drug is eliminated per unit time
52
What are 'trips'?
LSD
53
What is 'charlie'?
Cocaine hydrochloride
54
What are 'pills'?
MDMA, ectasy
55
What's the term for erosion of dental enamel caused by repeated vomiting?
Perimylolysis
56
What's the term for dry nails often associated with anorexia nervosa?
Onychorrhexis
57
What's the best first line antidepressant for a 49 year old stunt man on long term ibuprofen for back pain?
Mirtazapine. SSRIs increase the risk of bleeding when co-prescribed with NSAIDs
58
What's the best first line antidepressant for a 32 year old teacher whose chief complaint is insomnia?
SSRIs. Sleep disturbance often resolves as depression improves.
59
What's the best first line antidepressant for a 45 year old butcher who says he will stop any antidepressant that affects his sexual function?
Mirtazapine
60
What's the best first line antidepressant for a 64 year old librarian with stress incontinence?
Duloxetine is licensed for both stress incontinence and depression
61
Which antipsychotic is least likely to be associated with weight gain and metabolic syndrome?
Aripiprazole
62
Give examples of typical antipsychotics
- haloperidol
- chlorpromazine
- sulpiride
- fluphenazine (available as a depot)
- flupentixol (available as a depot)
- zuclopenthixol (available as a depot)
63
Which antipsychotic medication is the least likely to cause extra-pyramidal side effects?
Quetiapine
64
Which psychological therapies are recommended for moderate to severe GAD?
CBT or applied relaxation
65
Which drug can help take the edge off opiate withdrawal?
Lofexidine
66
What medication would be useful for someone undergoing a detoxification from dihydrocodeine but has profuse diarrhoea?
Loperamide
67
Which benzo out of chlordiazepoxide, lorazepam and diazepam has the shortest half life and is there for good for alcohol withdrawal with liver failure?
Lorazepam
68
What does acamprosate do?
Helps reduce cravings
69
Which drug is associated with neural tube defects?
Sodium valproate
70
Which antipsychotic is associated with gestational diabetes?
Olanzapine
71
Which drug is assoicated with heart defects and pulmonary hypertension in the newborn?
Paroxetine
72
Which antidepressant has been associated with pulmonary hypertension and low birth weight?
Fluoxetine
73
For what conditions are cholinesterase inhibitors contraindicated?
- bradycardia/conduction defects
- COPD/asthma
- peptic ulcers
74
Which cholinesterase inhibitor is indicated in parkinson's disease with dementia recommended?
Rivastigmine
75
What's the treatment for frontotemporal lobe dementia?
Isn't one
76
Which medication is appropriate for a 7 year old girl that suffers from nocturnal enuresis where other strategies have failed?
Imipramine (TCA, anticholinergic effects)
77
Which treatment is indicated?
A 13 year old boy has Tourette's syndrome. There is no suggestion of ADHD or OCD. His symptoms are troublesome and he has not responded to psychosocial interventions
Haloperidol
78
What's the difference between oppositional defiance disorder and conduct disorder?
Both are:
- negativistic
- rebellious
- defiant
- disruptive
Difference:
- behaviour associated with oppositional defiance disorder does not violate the rights of others
- troubles with the law are less common in oppositional defiance disorder
79
What's the diagnosis? How does it differ to a potential differential diagnosis?
An 11 year old girl has stereotyped hand-flapping and appears obsessed with trains. She does not appear interested in playing or interacting with others. Her parents report that her development was entirely normal until just after she was 2 years old, after which she seemed to deteriorate.
Heller's syndrome.
Rett's syndrome is just in girls.
In Heller's syndrome development tends to be more advanced before decline.
80
Which condition has stereotyped tortuous wringing of the hands?
Retts
81
A 72 yr old woman is asked to immediately repeat back 3 words that are said to her in the MMSE. What component of memory does this test?
Registration
82
If you ask a patient to point to objects and name them what type of memory are you testing?
Semantic
83
If you ask a patient to start at 100 and subtract 7 each time what are you testing?
Working memory and attention
84
How could you test recall?
Ask the patient to recall objects named or the word spelt backwards a few minutes later
85
What type of memory is affected?
A 54 year old man who has been involved in a RTA has a memory deficit for what happened for 24 hours after the event
Anterograde memory loss
86
What type of memory is affected?
An 85 year old woman with advanced Alzheimer's disease cannot recall many details from the last few years of her life or the name of the current prime minister
Semantic memory
| Autobiographical memory
87
How long do symptoms need to be present for a persistent delusional disorder?
3 months
88
Which of the following medications is the least effective protection against relapse of mania?
```
Lithium carbonate
Sodium valproate
Carbamazepine
Lamotrigine
Olanzapine
```
Lamotrigine
89
Schneider's first rank symptoms are reported to occur at what frequency in manic psychosis?
10-20%
90
What is the incidence of schizophrenia?
15/100 000
91
What's the peak age of onset of schizophrenia and does it affect males or females more?
15-35 1:1 ratio
92
What's the treatment for first episode of psychosis?
Low dose antipsychotic
93
If someone on an antipsychotic develops depression what do you do?
Give antidepressant
94
If someone on clozapine complains of drooling what do you do?
Start hyoscine hydrobromide
95
What's the life time risk of depression?
15%
96
What's the average age of onset of depression?
25-35
97
What proportion of panic disorder is associated with agoraphobia?
20%
98
If one child has autism what is the chance that the sibling will?
10%
99
What is the term for the following condition?
Interest in rubbing usually one's pelvic area or erect penis against a non-consenting person for sexual pleasure
Frotteurism
100
Which medical condition is not as common in schizophrenic patients as it is in the general population?
Rheumatoid arthritis
101
When would you consider a medical admission for AN?
- BMI 14 or less
- syncope
- postural myopathy (stand-up-squat test)
- electrolyte imbalance K < 2.5 mmol/L, Na <125 mmol/L, hypophosphatemia <0.5 mmol/L
- hypoglycaemia <2.5 mmol/L
- petechial rash and platelet supression <110 x 10^9/L
102
High levels of clozapine can cause what?
seizures
103
What should you not prescribe if someone is on lithium?
NSAIDS
ACE inhibitors
Diruetics
104
GI side effects of SSRIs come about due to interaction of which receptor?
5HT3
105
What type of drug is bupropion?
Noradrenaline-dopamine reuptake inhibitor
106
What therapeutic strategies can be used for personality disorders?
Dialectial behavioural therapy
| Cognitive analytical therapy
107
What is voyerism?
Voyeurism is the sexual interest in or practice of spying on people engaged in intimate behaviours, such as undressing, sexual activity, or other actions usually considered to be of a private nature.
