EXAM QUESTIONS Flashcards

1
Q

What is early morning wakening defined as?

A

waking up 2 hours before normal

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2
Q

What are the core symptoms of depression?

A

low mood
anhedonia
anergia

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3
Q

What are the somatic symptoms of depression?

A
decreased energy
decreased appetite
sleeping problems: disturbance, emw
concentration problems 
loss of libido
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4
Q

How long do anti-depressants need to be given for to assess response?

A

at least 4 weeks (6 weeks if elderly)

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5
Q

When can anti-depressants be used?

A
moderate-severe depression
dysthymia 
GAD
panic disorder
OCD
PTSD
bulimia
PMS
neuropathic pain
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6
Q

What is globus hystericus?

A

the experience of not being able to swallow/eat

associated with anxiety

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7
Q

How long can a panic attack last?

A

45 minutes

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8
Q

criteria for anorexia

A

1 - weight <85% of predicted or BMI < 17.5kg/m2
2 - fear of weight gain, even when underweight, leading to dieting, induced vomiting or excessive exercise
3 - feeling fat when thin
4 - amenorrhoea or decreased libido (due to hypothalamic-pituitary-gonadal dysfunction)

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9
Q

What happens to cortisol levels in unipolar depression?

A

they are chronically high

- not suppressed by dexamethasone

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10
Q

What is a schema?

A

the rules someone has about the world

- content of assumptions and automatic thoughts

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11
Q

Will a patient need further treatment after ECT?

A

yes, only effective short-term

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12
Q

How can you detain a patient who is refusing treatment and is confused?

A

emergency detention certificate (cannot treat)

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13
Q

features of PTSD

A
FAANDER
flashbacks
avoidance
arousal
nightmares
dissociation
emotional numbness
re-enactment
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14
Q

how long does GAD need to be present before diagnosis?

A

6 months

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15
Q

how long must an episode last to be classed as depressive?

A

2 weeks

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16
Q
How many symptoms present in
a) mild
b) moderate
c) severe
depression?
A

a) 4 symptoms
b) 2 core + 4 extra = 6 symptoms
c) 3 core + 5 extra = 8 symptoms

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17
Q

when does bipolar disorder tend to present?

A

20s

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18
Q

what is bipolar I ?

A

at least one manic episode + depressive/hypomanic

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19
Q

what is bipolar II?

A

hypomanic + depressive

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20
Q

what is bipolar III?

A

hypomania after treatment for depression

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21
Q

How long does elevated mood have to be present to classify

a) hypomania?
b) mania?

A

a) 4 consecutive days

b) 7 consecutive days

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22
Q

What distinguishes mania from hypomania?

A

delusions of grandeur
reckless behaviour
flight of ideas
loss of social inhibitions

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23
Q

combining MAOI with another antidepressant can cause which disorder?

A

serotonin syndrome

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24
Q

how does serotonin syndrome present

A
neuromuscular excitation (e.g. hyperreflexia, myoclonus, rigidity)
autonomic nervous system excitation (e.g. hyperthermia)
altered mental state
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25
criteria for bulimia
1 - recurrent episodes of binge eating characterised by uncontrolled overeating 2 - preoccupation with control of body weight 3 - regular use of mechanism to overcome the fattening effects of binges e.g. starvation, vomit-induction, laxatives, over-exercise 4 - BMI > 17.5
26
How long until you can diagnose PTSD?
3 months
27
Treatment of PTSD
EMDR | trauma-focused CBT
28
Parts of the brain implicated in OCD
orbitofrontal cortex | caudate nucleus
29
Psychological treatment of OCD
ERP | CBT
30
Who is likely to complete suicide after DSH?
Older. Male. Unemployed. Single/Separated/Divorced. Isolated. Poor Health. Violent DSH. Suicide note. Hx of DSH.
31
Who is likely to repeatedly DSH?
previous DSH. Personality disorder. Unemployed. Low socio-economic group. Criminal record. 25-54 years of age. Single/Separated/Divorced
32
Can an adult develop learning disability?
no, onset must be before age 18
33
``` How do we classify a) mild b) moderate c) severe d) profound learning disability? ```
``` Mild = IQ 50-69 Moderate = IQ 35-49 Severe = IQ 20-34 Profound = IQ < 20 ```
34
What is affected in ADHD?
executive functioning and self-regulation
35
Triad of symptoms in ADHD
inattention, hyperactivity and impulsivity
36
What is delirium tremens?
a complication of alcohol withdrawal (2 days after) - often presents insidiously with night time confusion - coarse tremor, confusion, delusions, auditory and visual hallucinations, fever, tachycardia
37
alcohol relapse prevention
- 1st line = Naltrexone (Decreases desire) - Disulfiram [Antabuse] = S.E = flushed skin, tachycardia, N+V, arrhythmia, hypotension Acamprosate = started as soon as detox complete and continue through relapse. Helps with alcohol cravings. S.E. = headache, diarrhoea, nausea
38
What does increased arousal in PTSD mean?
``` disturbed sleep irritable decreased concentration hyper-vigilance exaggerated startle response ```
39
Which 3 areas of symptoms are needed to diagnose PTSD?
``` intrusive symptoms (1+) avoidance symptoms (3+) increased arousal (2+) ```
40
name some avoidance symptoms in PTSD
``` avoid thoughts/conversations/reminders amnesia loss of interest detachment emotional numbness ```
41
name some intrusive symptoms of PTSD
recurrent recollections, nightmares or flashbacks | physiological reaction eg. being sick
42
What is an idea of reference?
false beliefs that random or irrelevant occurrences in the world directly relates to a person
43
"Everywhere I go there is this terrible smell, I keep washing but I can't get rid of it, other people say they can't smell it but I think they're just being polite"
olfactory hallucination
44
Who can use a short-term detention certificate? and what does it do?
A psychiatrist | Detention + treatment
45
A 24 year old man with schizophrenia is brought to hospital by the police. He is very agitated and attempts to punch one of the nurses. He is restrained and given 5mg haloperidol intramuscularly. He initially becomes calmer but an hour later begins screaming. On review he complains of an extremely sore back and neck, saying he cannot move his neck.
An acute dystonic reaction is an extrapyramidal side effect which tends to occur within hours of administration of an antipsychotic.
46
A 55 year old man takes olanzapine for schizoaffective disorder. He presents to the emergency department with chest pain and is found to be having a myocardial infarction.
metabolic syndrome due to atypical antipsychotic
47
Which neurotransmitter would be involved in "A 21 year old man with known illicit drug use who attends the Emergency Department following a suspected epileptic fit."
In withdrawal from sedative-hypnotic drugs there is a reduced GABA.
48
Which drug can be used to sedate someone with delirium?
haloperidol lorazepam if hx of parkinsons
49
What investigation needs to be done prior to starting someone on lithium?
Us+Es
50
Which certificate allows detention of a patient in hospital for 6 months in the first instance?
a compulsory treatment order
51
treat mania in pregnancy
olanzapine
52
treatment resistant schizophrenia
clozapine
53
What does alcohol do to neurotransmitters?
alcohol is a depressant so it will decrease glutamate activity and increase GABA activity
54
What does alcohol withdrawal do to neurotransmitters?
since you no longer have the inhibitory effect it will increase glutamate and decrease GABA
55
How do you manage alcohol withdrawal?
a benzodiazepine like chlordiazepoxide | thiamine (vitamin B1)
56
A 45 yr old woman comes to you with fatigue, weight gain and constipation. Examination reveals cool and dry hands, bradycardia and slow-relaxing reflexes. She has been taking a psychiatric medication for a long-time what is it likely to be?
signs of hypothyroidism --> lithium
57
How long can a patient be held with a a) emergency detention certificate b) short term detention certificate c) compulsory treatment order
a) 72 hours b) 28 days c) 6 months then 6 months then 1 year
58
What is the difference between PoA and welfare guardianship?
PoA is granted when patient has capacity | Welfare guardian is appointed by a court to someone without capacity
59
What do you do if you think someone cannot consent?
fill out a section 47 certificate
60
Treating a patient in an emergency is covered by which law?
common law
61
What is an intervention order of the adults with incapacity act?
This is a court appointment which authorises a person to act and take a one-off action or make decisions on behalf of an adult with incapacity.
62
What is the difference between dystonia and dyskinesia?
dystonia = abnormal tone eg neck position, eye position dyskinesia = abnormal movements eg. pouting/chewing
63
management of mania
consider stopping antidepressant if the patient takes one; antipsychotic therapy e.g. olanzapine or haloperidol
64
What is pica?
an eating disorder that involves eating items that are not typically thought of as food and that do not contain significant nutritional value, such as hair, dirt, and paint chips
65
Which neurotransmitter helps with sleep?
serotonin
66
What drug reduces alcohol cravings?
acamprosate
67
What drug causes severe reaction to alcohol? why?
disulfram: alcohol intake causes severe reaction due to inhibition of acetaldehyde dehydrogenase
68
Are pupils small in opiod use or withdrawal?
use
69
Reverse paracetamol overdose
n-acetylcysteine
70
reverse benzodiazepine overdose
flumazenil
71
reverse TCA overdose
Iv bicarbonate
72
can bipolar be diagnosed after one manic episode
no need 2
73
autistic triad
social communication + social interaction + repetitive behaviour
74
What is the hereditability of schizophrenia?
monozygotic twins: 50% 80% hereditability
75
How should painful neck muscle spasms following haloperidol be managed?
acute dystonia --> procylidine
76
How is neuroleptic malignant syndrome diagnosed?
raised creatinine kinase