Passmed psych Flashcards
(187 cards)
1
Q
Side effects of TCAs?
A
Dry mouth (anticholinergic) and weight gain (antihistaminic)
Urinary retention
2
Q
Why should SSRIs and MAOIs never be mixed?
A
Risk of serotonin syndrome
3
Q
Difference between depression and dementia presentation?
A
Depression - global memory loss rather than short-term (pseudodementia)
4
Q
What is word salad and what is it associated with?
A
Disorganised speech - mania and psychosis
5
Q
Acute stress disorder vs PTSD?
A
Acute stress <4w but PTSD >4w
6
Q
What common symptom can TCAs cause?
A
Urinary retention
7
Q
Management of PTSD?
A
CBT, EMDR
Drugs - SSRI or venlaxafine
8
Q
Are men or women more likely to be successful in a suicide attempt?
A
Men
9
Q
What suggests depression over dementia?
A
Sleep disturbance, stress triggers and normal MMSE with global memory
10
Q
What is the 666 rule for SSRIs?
A
Wait 6 weeks to take effect
Continue for 6 months to stabilise and avoid relapse
Takes at least 6 weeks for the washout period in order to avoid adverse effects
11
Q
What is somatisation disorder?
A
Multiple physical symptoms that can’t be explained by any medical condition
12
Q
What is the life threatening side effect of clozapine and how is it monitored?
A
Agranulocytosis/neutropenia - FBC
13
Q
What is the cutoff for severe depression in the PHQ-9?
A
16
14
Q
Which SSRI is the most likely to prolong QT and cause torsades de pointes?
A
Citalopram
15
Q
What is borderline personality disorder associated with?
A
History of recurrent self-harm and intense interpersonal relationships that alternate between idealisation and devaluation
16
Q
1st line drug for GAD?
A
Sertraline
17
Q
How does Wernicke’s encephalopathy present?
A
Gait ataxia, ophthalmoplegia and nystagmus
18
Q
How does Korsakoff’s syndrome present?
A
Retrograde/anterograde amnesia and confabulation
19
Q
What is De Clerambault’s syndrome?
A
Ertomania -form of paranoid delusion with an amarous quality. The patient is oftena single woman who believes that a famous person is in love with her
20
Q
What is delusional parasitosis?
A
Fixed, false belief (delusion) that they’re infested by bugs
21
Q
What is Hoover’s sign used for? What is the test?
A
Differentiating organic from non-organic leg paresis.
-Non-organic: pressure is felt under paretic leg when lifting non-paretic leg against pressure due to involuntary contralateral hip extension
22
Q
How is hypomania characterised?
A
Elevated mood, pressured speech and flight of ideas without psychotic symptoms
23
Q
What is the risk of schizophrenia for an affected monozygotic twin?
A
50% - suggests genetics play a vital role in schizophrenia development
24
Q
Most common SE of atypical antipsychotics?
A
Weight gain
25
What is akathisia?
Sense of inner restlessness and inability to keep still
26
Management for more severe depression?
Individual CBT and antidepressant
27
What symptoms are seen in SSRI discontinuation syndrome?
GI - diarrhoea
28
What are the risks of antipsychotics in the elderly?
Increased risk of stroke and VTE
29
Common side effect of electroconvulsive therapy?
Memory impairment - retrograde amnesia
30
What is the difference between retrograde and anterograde amnesia?
Retrograde - can't recall memories from past
Anterograde - can't form new memories but can still remember things from before amnesia development
31
What is the risk of zopiclone in the elderly?
Falls
32
In GAD, what do you use if sertraline is ineffective/not tolerated?
Try another SSRI or SNRI
33
What is cotard syndrome?
Characterised by a person believing they're dead or non-existent
34
Short-term SE of ECT?
Arrhythmia, headache, nausea, memory loss/impairment
35
How does tardive kinesis present?
Chewing, jaw-pouting, excessive blinking
36
Three common features of PTSD?
Re-experiencing, avoidance, hyperarousal
37
What is circumstantiality?
Long-winded answer but comes back around eventually whereas tangentiality is when the answer goes off in one direction forever
38
What is echolalia?
Repetition of someone else's speech including the questions being asked (feature of schizophrenia - typically catatonic)
39
What is a neologism?
A made up word
40
What is palilalia?
Automatic repetition of one's own words, phrases or sentences
41
What is echopraxia?
Meaningless repetition or imitation of the movements of others
42
What is copropraxia?
Involuntary performing of obscene or forbidden gestures or inappropriate touching
43
What is a characteristic physical finding of anorexia nervosa?
Lanugo hair
44
What should patients with OCD and severe functional impairment?
Referred to the secondary care mental health team - treatment can be started while waiting assessment
45
What is Münchausen's syndrome?
Purposefully causing symptoms for personal gain
46
What is functional neurological disorder?
Conversion disorder - involves loss of motor or sensory function
47
What happens when there is poor oral compliance with antipsychotics?
Switch to IM antipsychotics (depot) - usually once monthly
48
What is Othello syndrome?
Delusional jealousy
49
What is the SSRI of choice for children and adolescents?
Fluoxetine
50
What is the first line treatment for young people with anorexia?
Anorexia focused family therapy
51
How is acute dystonia managed when secondary to antipsychotics?
Procyclidine
52
What are the symptoms of SSRI discontinuation syndrome?
Dizziness, electronic shock sensations, anxiety
53
What is the acute management of mania/hypomania in patients taking antidepressants?
Consider stopping antidepressant and starting antipsychotics
54
When starting ECT treatment on antidepressants, what should be done?
Antidepressants reduced not stopped
55
Which drug can you give to reverse benzodiazepines?
Flumenazil
56
When taking SSRI and NSAID what else should be prescribed and why?
A PPI
57
What's a good type of therapy for patients with OCD and why?
Exposure and response prevention - exposing them to an anxiety-provoking situation
58
What are the useful side effects on mirtazapine?
SNRI - sedation and increased appetite (better eating and sleeping)
59
What are the metabolic side effects of antipsychotics?
Dysglycaemia, dyslipidaemia and diabetes mellitus
60
What are the first rank symptoms of schizophrenia?
Thought broadcasting, thought withdrawal, delusional perceptions and auditory hallucinations
61
What is the strongest risk factor for psychotic disorders?
Family history
62
Before diagnosing GAD, what is important to rule out?
Hyperthyroidism
63
What is a GI side effect of clozapine?
Constipation, intestinal obstruction
64
Which type of antidepressants give the most antimuscarinic SEs?
TCAs - dry mouth and blurred vision
65
Are pseudohallucinations common after grief?
Yes - doesn't imply psychosis
66
What is an important investigation in elderly patients with sudden-onset psychosis?
CT head - rule out organic cause
67
What is the difference between Knight's move thinking and flight of ideas?
Knight's move - illogical leaps from one idea to another
Flight of ideas - links from one idea to another
68
What is the link between clozapine and seizures?
Clozapine reduces the seizure threshold making seizures more likely
69
What is illness anxiety disorder?
Persistent belief in the presence of an underlying disease
70
What is Charles-Bonnet syndrome associated with?
Age related macular degeneration
71
What is Charles-Bonnet syndrome?
Persistent or recurrent complex hallucinations (visual or auditory) occurring in clear consciousness. Generally against a background of visual impairment. Insight usually preserved. Occurs in absence of other psychiatric disorders
72
Circadian rhythm in schizophrenia?
Disturbed
73
Which antidepressant increases the risk of suicide the most at the start of treatment?
Venlaxafine (but all of them do)
74
Feature of avoidant personality disorder?
Fearful of criticism, being unliked, rejected and ridiculed
75
Features of anorexia?
Most things are low except G's and C's:
-Growth hormone, glucose, glands (salivary)
-Cortisol, cholesterol, carotinaemia
76
What is the typical patient at high risk of suicide?
Male with history of drug and alcohol abuse with deliberate self-harm
77
Key feature of bulimia?
Erosion of teeth
78
What happens if a patient misses their clozapine dose for 48h?
Has to be restarted again slowly
79
Which atypical antipsychotic has the best side effect profile?
Aripiprazole (particularly for prolactin elevation)
80
SSRI use in pregnancy?
Weight up benefits and risk:
1st trimester use - small congenital heart defect risk
3rd trimester use - can result in persistent pulmonary hypertension of newborn
81
Paroxetine use in pregnancy?
Increased risk of congenital malformations, particularly in first trimester
(serotonin is required for establishing left-right asymmetry of heart in embryogenesis)
82
What is cotard syndrome associated with?
Severe depression
83
What is an obsession?
Intrusive, unpleasant and unwanted thought
84
What is a compulsion?
Senseless action taken to reduce the anxiety caused by obsession
85
Does smoking affect clozapine levels?
Smoking cessation can cause a rise in clozapine blood levels
86
What is the prognosis of a prodromal phase of social withdrawal in schizophrenia?
Poor prognosis
87
What is the effect of long-term antipsychotic use?
Development of glucose dysregulation and diabetes
88
Features of schizotypal personality disorder?
Lack close friends other than family and have odd/eccentric behaviour, speech and beliefs
89
Prognosis of low IQ in schizophrenia?
Poor prognosis
90
What is tangentiality?
Wandering from a topic without returning to it
91
Does brief psychotic disorder result in long-term consequences?
No - return to baseline functioning
92
Which electrolyte abnormality are SSRIs associated with?
Hyponatraemia
93
Which sex is affected more by antisocial personality disorder?
Men
94
Symptoms of alcohol withdrawal?
6-12h: tremor, sweating, headache, anxiety
36h: seizures
72h: delirium tremens
95
What is a clang association?
Ideas related only by rhyme or being similar sounding
96
What can lithium precipitate on bloods?
Benign leukocytosis
97
What is the difference between type 1 and 2 bipolar disorder?
I - Associated with mania
II - Associated with hypomania
98
How does mirtazapine work?
Noradrenergic and specific seritonergic antidepressant - increases release of neurotransmitters by blocking a2 adrenoreceptors
99
What is malingering?
Lying or exaggerating for financial gain
100
What is used to treat moderate/severe tardive dyskinesia?
Tetrabenazine
101
1st line treatment for acute stress disorders?
Trauma-focused CBT
102
Five negative symptoms of schizophrenia?
Incongruity/bluntness of affect
Anhedonia
Alogia (poverty of speech)
Avolition (poor motivation)
Social withdrawal
103
What is clozapine reserved for?
Cases of treatment resistant schizophrenia
Cases where patients experience negative symptoms
104
What are the negative symptoms of schizophrenia?
Incongruity/blunting of affect
Anhedonia
Alogia
Avolition
Social withdrawal
105
What is seasonal affective disorder?
Recurrent episodes of depression that occur during the same season each year, often in winter
106
What is used to treat moderate/severe tardive dyskinesia?
Tetrabenazine
107
Which antipsychotic makes seizures more likely?
Clozapine - reduces seizure threshold
108
Which medication precipitates a benign leukocytosis?
Lithium
109
Dangerous short-term side effect of ECT?
Cardiac arrhythmia
110
How does tardive kinesia present?
Chewing, jaw pouting or excessive blinking due to late onset abnormal involuntary choreoathetoid movements (conventional antipsychotics - usually long-term)
111
Schizoid vs schizotypal PD?
Both cold and not interested in forming close relationships but schizotypal has odd/eccentric behaviour, speech and beliefs
112
Which type of incontinence do TCAs cause?
Overflow incontinence
113
Malingering vs Munchausen?
Malingering - faking symptoms
Munchausen - self-inflicted symptoms
114
Features of avoidant PD?
Fearful of criticism, being unliked. rejection and ridicule
115
What is acute dystonia?
Sustained muscle contraction such as torticollis or oculoghric crisis
116
Which SSRI has the highest incidence of SSRI discontinuation syndrome?
Paroxetine
117
Treatment of personality disorders?
Dialectical behavioural therapy (DCT)
118
How is acute dystonia secondary to antipsychotics managed?
Procycldine
119
What is Othello syndrome?
Delusional jealousy - usually believing partner is unfaithful
120
Symptoms of SSRIs discontinuation syndrome?
Dizziness, electric shock sensations, anxiety and diarrhoea
121
What is akathisia?
Severe restlessness
122
Symptoms of mania/hypomania in primary care?
Mania - Urgent referral to CMHT
Hypomania - Routine referral to CMHT
123
Most common endocrine disorder developed as a result of chronic lithium toxicity?
Hypothyroidism
124
Most common side effect of clozapine?
Constipation
125
Which electrolyte abnormality occurs to due SSRIs?
Hyponatraemia
126
Pseudohallucinations in grieving?
Normal
127
Factors associated with poor prognosis of schizophrenia?
Family history
Gradual onset
Low IQ
Prodromal phase of social withdrawal
Lack of obvious precipitant
128
What is cotard syndrome?
When patients with severe depression believe they or part of them is dead
129
What is the difference between knight's move thinking and flight of ideas?
Knight's move - illogical leaps from one idea to another
Flight of ideas - discernible links between ideas
130
Patients with obsessive-compulsive PD?
Rigid with respect to morals, ethics and values. Often reluctant to surrender to work
131
Antipsychotic use in the elderly?
Risk of VTE/stroke
132
How to acutely manage mania/hypomania in those taking antipsychotics?
Stop antidepressant and start antipsychotic
133
Main indication for ECT?
Treatment resistant depression and catatonia
134
What is word salad and what is is associated with?
Disorganised speech - associated with mania and psychosis
135
Metabolic side effects of antipsychotics?
Dysglycaemia, dyslipidaemia and diabetes mellitus
136
What is hypomania?
Elevated mood, pressured speech and flight of ideas without psychotic symptoms
137
When checking lithium levels, when are the bloods taken?
12h post dose
138
Difference between type I and type II bipolar?
Type I - mania
Type II - hypomania
139
Before diagnosing GAD, what has to be ruled out?
Thyroid disease
140
What are the symptoms of delirium tremens?
Hallucinations, confusion and delusions
141
What is tangentiality?
Wandering from a topic without returning to it
142
Bloods for bulimia?
Hypochloraemic hypokalaemia metabolic alkalosis due to excessive vomiting
143
Most serious side effect of clozapine and how to monitor?
Agranulocytosis/neutropenia - FBC
144
PTSD management?
Trauma focussed CBT or EMDR
Venlaxafine
145
First-line treatment for children and young-people with anorexia?
Family focused CBT
146
First-line treatment for acute stress disorders?
Trauma-focused CBT
147
Most commonly used drug in panic disorder?
SSRI - Sertraline
148
What is echolalia?
Repetition of someone else's speech including the questions being asked
149
Which antipsychotic has the most tolerable side effect?
Aripiprazole
150
How do benzodiazepines work?
GABA agonist
151
Risk of SSRI and NSAIDs?
Bleeding risk - give PPI
152
Common features of PTSD?
Re-experiencing
Avoidance
Hyperarousal
153
What is somatisation disorder?
Multiple physical symptoms not explained by an organic cause
154
Schizoid PD?
Prefer to be alone, don't like relationships, low libido
155
Treatment for OCD?
SSRI requiring a higher dose and a longer duration (12w)
156
Most likely SSRI to cause Torsades to Pointes?
Citalopram - most likely to prolong QT interval
157
How should an SSRI be stopped?
Remain on it for at least 6 months during remission then gradually reduce over 4 weeks
158
Who are more likely to be successful in suicide?
Men
159
Post-MI, which SSRI is preferred?
Sertraline
160
What is catatonia?
Stopping of voluntary movement or staying still in an unusual position
161
What is the difference between an obsession and a compulsion?
Obsession - intrusive, unpleasant and unwanted thought
Compulsion - senseless action taken to reduced the anxiety caused by the obsession
162
When does PHQ9 score indicate severe depression?
15+
163
Management of severe depression?
SSRI and CBT
164
Management of severe OCD?
Add SSRI alongside CBT/ERP
165
What is illness anxiety disorder?
Persistent belief in the presence of an underlying serious disease
166
What is circumstantiality?
Inability to answer a questions without giving excessive, unnecessary detail
167
Brief psychotic disorder?
Return to baseline functioning
168
Mirtazapine mechanism of action?
Noradrenergic and serotongeric antidepressant increasing the release of neurotransmitters by blocking alpha2 adrenoreceptors
169
Which drug may cause psychosis?
Corticosteroids
170
Treatment of delirium tremens/alcohol withdrawal?
Chlordiazepoxide or other benzodiazepines
171
Zopiclone use in the elderly?
Increases the risk of falls
172
Useful side effects of mirtazapine?
Sedation and increased appetite
173
Why are triptans avoided in patients taking SSRIs?
Increased risk of serotonin syndrome
174
Anorexia features?
Most things low but G's and C's raised:
-GH, glucose, salivary glands
cortisol, cholesterol, carotinaemia
175
What is clozapine reserved for?
Cases of treatment resistant schizophrenia
Cases where patients experience negative symptoms
176
What is conversion disorder?
Functional neurological disorder - typically loss of motor or sensory function
177
Protective factors against completed suicide?
Social support, religious belief, having children at home and regretting an attempt
178
When can a PD be diagnosed?
After 18 years of age
179
What is exposure and response prevention?
Used in OCD - exposing patient to an anxiety provoking situation
180
What are clang associations?
Ideas related only by rhyme or being similar sounding
181
Purging behaviours in bulimia?
Vomiting, laxatives, diuretics or exercising
182
Choice of SSRI in children and young people?
Fluoxetine
183
What is Russell's sign?
Calluses on knuckles or back of hand due to repeated self-induced vomiting
184
For moderate/severe OCD what may be used instead of SSRI?
Clomipramine (TCA)
185
What is the strongest risk factor for psychotic disorders?
Family history
186
What can long-term lithium use result in?
Hyperparathyroidism and hypercalcaemia
187
