Pastest - PSYCHIATRY Flashcards
(170 cards)
What are the objective signs of opioid withdrawal?
dilated pupils, yawning, rhinorrhoea (nose running), eiphoria (eyes watering)
Which med is used to treat hypersalivation in clozapine-treated patients?
hyoscine
A 60-year-old male is admitted to the in-patient psychiatric unit last night. On reviewing him this morning, he is a poor historian, answering most questions minimally and stating he does not need to be here as he is deceased, and hospitals should be for living patients.
What is the name of this delusional disorder and which condition is it most commonly associated with?
Cotard syndrome and major depressive disorder
You have been asked to review a patient with chest pain awaiting assessment by the psychiatry team.
Examination and investigations are normal, however, you note that he is acting strangely. He is reluctant to answer questions and does not maintain eye contact. After developing trust with him, he discloses he has never been in a relationship and that he prefers to be on his own as he won’t embarrass himself. He has no friends and doesn’t speak to his family because they criticise everything he does.
Which form of personality disorder is he likely suffering from?
Avoidant
A 29-year-old man is on the psychiatric ward under section 2 of the mental health act for suspected schizophrenia. He has a 3-month history of increasing suspicion of his family and had recently begun to collect weapons to defend himself. He started olanzapine 2 weeks ago. He has no other medical conditions and takes no other medications.
Today staff on the ward raised concerns due to his abnormal behaviour. He was found in his room sat on the floor with his back arched and legs hunched upwards. It is reported that he has been like this for the last 2 hours. His observations are normal. He has not spoken or made any movements during this time.
Which of the following best describes his current presentation?
Catatonia = stopping of voluntary movement or staying still in an unusual position
A 64-year-old male who has been on long term chlorpromazine presents with repetitive eye blinking. He reports he is unable to control this and is worried about what might be causing it. He is otherwise well in himself and has no visual disturbance. He has a normal facial and ocular examination with the exception of excessive rapid blinking.
What is the most likely cause of his symptoms?
tardive dyskinesia: can present as chewing, jaw pouting or excessive blinking due to late onset abnormal involuntary choreoathetoid movements in patients on conventional antipsychotics
A 23-year-old man presents to the emergency department following a recent diagnosis of migraine by his GP. He describes the headaches as right-sided, lasting around 6 hours, and brought on by work stress. He often feels nauseated with the headaches which resolve when he lies in a quiet room. He has a past history of depression and takes sertraline. He has no allergies. Neurological examination is unremarkable. The doctor reviewing him is concerned about a medication he has started for his symptoms.
What is the medication that the doctor is most likely to be concerned about in this patient?
Options:
1. ibuprofen and omeprazole
2. metoclopramide
3. paracetamol
4. prochlorperazine
5. sumatriptan
sumatriptan - triptans should be avoided in patients taking a SSRI
when does delirium tremens tend to occur?
48-72 hours after acute alcohol withdrawal
what is the most appropriate next step in management of more severe OCD which is unresponsive to CBT/exposure and response prevention?
Add an SSRI eg sertraline or fluoxetine
What is dialectical behaviour therapy (DBT) and when is it indicated?
focuses primarily on emotional regulation and is predominantly used in patients with emotionally unstable personality disorder (EUPD)
What is EMDR and when is it indicated?
eye movement desensitisation and reprocessing
predominantly used in PTSD
What type of urinary incontinence is the most associated with amitriptyline?
overflow incontinence - associated with tricyclic antidepressants
What are confabulations?
fabrications of imaginary experiences due to loss of memory - common phenomenon in patients with significant cognitive impairment eg dementia
A patient presents with complaints of involuntary muscle movements of her tongue, fingers and trunk for the past 2 months. She was diagnosed with schizophrenia 5 years ago and has been on flupenthixol and the haloperidol with good compliance. There is pronounced choreoathetoid movement. What is the next line of management of this patient?
stop the haloperidol and start olanzapine
which axis is involved in the pathophysiology of anxiety disorders, panic disorder and PTSD…?
hypothalamic pituitary adrenal axis (HPA)
Which Questionnaire is used to monitor response to treatment in patients with depression?
patient health questionnaire (PHQ-9)
What is schizoid personality disorder?>
disorder where patient has a long history of loneliness, odd behaviours and flat affects
they do not have any weird/magical thinking (schizotypal) or psychotic symptoms (schizophrenia, schizoaffective disorder)
which blood investigations can be used for assessing alcohol intake?
mean corpuscular volume
LFTs
gamma glutamyl transferase
what is the level for lithium toxicity?
levels above 1.5 mmol/l
what is the mechanism of action of duloxetine?
serotonin and noradrenaline reuptake inhibitor
what is used to treat delirium tremens/alcohol withdrawal?
chlordiazepoxide or diazepam
what are the criteria in ICD-10 for mania?
elated mood/occasional irritability
increased energy
psychotic symptoms (?)
to diagnose need at least 3 of DIGFAST:
D – distractibility/inability to sustain attention
I – indiscretions/impulsivity/loss of social inhibitions/aggression (excessive pleasurable activities, risky sexual behaviour, drug taking, fast driving)
G – grandiosity (mood congruent – as elated)/extravagance
F – flight of ideas– difficult to interpret
A – activity increase/excessive optimism
S – sleep deficits/decreased need for sleep
T – talkativeness/pressure of speech
what is hypomania according to ICD-10?
lesser degree of mania but too persistent and marked to be cyclothymia
features:
elated mood, increased energy and activity
Feeling of mental and physical wellbeing and efficiency
Increased sociability, overfamiliarity, sexual drive
Decreased need for sleep
Irritability
NO PSYCHOTIC SYMPTOMS, OR DISRUPT TO WORK/SOCIAL ACTIVITIES
What is the difference between hypomania and mania?
hypomania has no psychotic symptoms and it does not disrupt work/social activities