Psych Flashcards
(88 cards)
1
Q
name SSRIs
A
sertraline
fluoxetine
citalopram
2
Q
name SNRIs
A
venlafaxine
duloxetine
3
Q
name NASSAs
A
noradrenergic and specific serotenergic antidepressants
mirtazepine (old + frail)
4
Q
name NARI
A
ruboxetine
5
Q
list TCAs
A
amitriptyline
clomipramine
nortryptiline
6
Q
list MAOi
A
phenelzine
selegiline
7
Q
name a RIMA
A
reversible inhibitors of monoamine oxidase
moclobemide
8
Q
list typical antipsychotics
A
chlorpromazine
haloperidol
flupentixol decanoate
9
Q
list atypical antipsychotics
A
olanzapine respiridone quetiapine aripiprazole clozapine amisulpride
10
Q
mild/moderate/severe depression
A
mild - 2/3 core + at least 2 others - normal life
moderate - 2/3 core + at least 3/4 others - difficulty with normal life
severe - 3 core + at least 4 others - marked functional impairment
11
Q
PHQ9 scale
A
GP rate 0-3 0 = none 5 = mild 10 = mod >15 = severe
12
Q
HADS scale
A
rate 0-3
0-7 = normal
8-10 = borderline
11-21 = abnormal
13
Q
CDI
A
childrens depression index
14
Q
medication steps in depression
A
SSRI trial another SSRI SNRI augment with antipsychotic (quetiapine)/ lithium ECT
15
Q
symptoms of serotonin syndrome
A
ABRUPT
mental status change: agitation, confusion, coma
NM change: jerking, twitching, hyperreflexia
autonomic instability: hyperthermia, labile BP, tachycardia, sweating, dilated pupils, diarrhoea
16
Q
treatment for SS
A
stop drug
bentos eg clonazepam
17
Q
MOA of NASSA
A
presynaptic alpha 2 blockade - high noradrenaline and serotonin
18
Q
recurrent depressive disorder
A
at least 1 previous episode lasting minimum 2 w
separated from current episode by at least 2 months
19
Q
psychotic symptoms in BPAD
A
grandiose delusions
persecutory
auditory hallucinations
20
Q
cyclothymia
A
persistent mood instability
does not meet criteria for depression/ BPAD
21
Q
lithium side effects
A
fine tremor n+v nephrogenic DI arrhythmia hypothyroidism weight gain eyebrow hair loss
22
Q
lithium toxicity symptoms
A
coarse tremor
hyperreflexia
nystagmus
seizures
23
Q
side effects of sodium valproate
A
n+v diarrhoea liver failure thrombocytopenia hair loss weight gain
24
Q
side effects of carbamazepine
A
(enzyme inducer) rash leukopenia dizziiness drowsiness n+v oedema weight gain hyponatraemia
25
bipolar depression
fluoxetine + atypical antipsychotic eg olanzapine
26
schizophrenia theories
+ve symptoms - excess dopamine in mesolimbic
| -ve symptoms - dopamine under activity in mesocortiyal
27
stages of schizophrenia
1 - at risk mental state
2 - acute phase (+ve symptoms) - auditory hallucinations and persecutory delusions, loosening of associations, FTD
3 - chronic phase (-ve symptoms)
28
types of schizophrenia
paranoid - most common, d+h
catatonic - psychomotor disturbance, stupor, posturing, waxy flexibility, perseveration
hebephrenic - 15-25 yrs - disorganised chaotic mood
simple - negative only
(residual - mainly +ve symptoms)
29
schneiders 1st rank symptoms
passivity
auditory hallucinations - echo, 3rd person, running comm.
delusional perception
delusions of though interference
PADD
30
diagnostic criteria for schizophrenia
1st rank symptoms + >/=2 of...
- paranoid, hebephrenic, catatonic, simple
+ present most of the time >/= 1 month
+ not caused by substance use/ organic cause
(<1 mo = brief psychotic disorder)
impact on social/occupational functioning >6 mo
31
treatment for EPSE
Dystonia - procyclidine
Akathisia - lower dose, propranolol
Parkinsonism* - lower dose procyclidine
Tardive dyskinesia - reduce dose, avoid anticholinergics
* resting tremor, rigidity, bradykinesia
32
antipsychotics side effects
```
hyperprolactinaemia - respiridone
weight gain (o+c)
diabetes
dyslipidaemia
antichoninergic S/E
NMS - haloperidol
arrhythmias - prolonged QT - quetiapine
stroke + VTE in elderly
```
33
symptoms of NMS
gradual
mental state changes: catatonia
muscular rigidity
autonomic instability - hyperthermia, labile BP, tachycardia, sweating
34
blood changes in NMS
```
High CK
high WCC
AKI
high hepatic transaminases
(due to low dopamine)
death due to renal failure secondary to rhabdomylosis
```
35
NMS treatment
stop dose
dantrolene - muscle relaxant
bromocriptine - dopamine agonist
36
normal QT interval
M - <440 m/s
| F - <470 m/s
37
good/ bad prognosis in schizophrenia
good - sudden onset, late, stressful event, no FH, higher IQ
bad - gradual, early, lack of precipitant, FHx, low IQ
38
acute psychosis
sudden onset, no insight, lasts <3 months
| manage with short term benzos/ AD/ mood stabilisers
39
delusional disorder
persistent, life-long delusions with few/ no hallucination
<3 mo = temporary
>3 mo = persistent
no auditory hallucinations, no schizo symptom, cognition intact
40
3 theories of dependence
1 - classical conditioning - craving to cues eg seeing needle
2 - operant conditioning - repetition for known outcome
3 - social learning
41
dependency features
```
compulsion
neglect
tolerance
lack of control
physical withdrawal
persistent abuse despite harm
```
narrowing of repertoire
salience
reinstatement after abstinence
42
units calculation
(volume in ml x % alcohol) / 1000
43
alcohol withdrawal
```
uncomplicated AWS:
4-12 hours
coarse tremor
sweating
insomnia
tachycardia
n+v
psychomotor agitation
hallucinations
cravings
```
36 hours:
AWS with seizures
tonic clonic
44
delirium tremens
```
48-72 hours
disorientation
anterograde amnesia
psychomotor agitation
hallucinations (Lilliputian)
fluctuations
```
45
wernikes encephalopathy
reversible
ataxia
opthalmoplegia
acute confusion
treat with IV thiamine/ pabrinex
46
korsakoffs syndrome
```
irreversible
anterograde amnesia
confabulation
peripheral neuropathy
cerebellar degeneration
```
47
acamprosate vs naltrexone
acamprosate - reduces urge
| naltrexone - reduces cravings
48
opiate intoxication
pinpoint pupils, low RR, bradycardia, constipation, anorexia, low libido
49
opiate withdrawal
6 hours post injection
peaks 36-48 hours
nausea, craving, flu-like, runs, lacrimation, diarrhoea, piloerection, pupils dilate
50
benzo withdrawal
```
insomnia
tachypneoa
tremor
hyperreflexia
anxiety
sweating
```
51
bento long-term use
cognitive impairment
anxiety
depression
dependence
52
nicotine replacement therapies
varenicline - nicotine RA (champix)
| bupropion - DA/NA reuptake inhibitor
53
REPORT criteria personality disorders
```
Relationships
enduring
pervasive
onset in childhood/ adolescence
results in distress
trouble in occupational/social performance
```
54
cluster A PD
Paranoid - SUSPECT
Schizoid - ALL ALONE
Schizotypal - positive schizophrenia symptoms
55
Cluster B PD
histrionic - ACTORS
emotionally unstable ( borderline - scars, impulsive - lose it)
dissocial/antisocial - FIGHTS
*antipsychotics/ antidepressants
56
Cluster C PD
anankastic - DETAILED
anxious/ avoidant - AFRAID
dependent - SUFFER
* antidepressants
57
PD traits
splitting - EUPD
dissociation - assumed a different ID
sublimation - uses unacceptable trait to drive respectable work
reaction formation - replace emotions with exact opposite
identification - models behaviour on someone else
regression - revert to immature behaviour
displacement - take out emotions on a neutral person
projection - person assumes an innocent/ neutral character is responsible
58
investigation results in AN + BN
increase:
cortisol, cholesterol, carotenaemia, GH, salivary glands, LFTs
ECG - bradycardia, arrhythmia, long QT in BN
DEXA - osteoporosis
59
criteria for AN
BMI <17.5 or 15% less than expected
deliberate weight loss
fear of fat
(amenorrhoea, impotence, loss of libido, delayed puberty)
60
AN psychotherapies
CBT-ED
SSCM - specialist supportive clinical management - explore problems causing anorexia
MANTRA - causes of their anorexia
61
inpatient for AN/BN
BMI<13/ very rapid weight loss
serious physical complications
high suicide risk
62
SCOFF questionnaire
```
sick
control
one stone/3 months
fat
food
```
63
criteria for BN
bingeing
purging - laxatives, exercise, diuretics, insulin, vomiting
psychopathy
64
acute stress reaction
daze, narrowing of attention, can't comprehend stimuli, disorientated
at least 3 days
> 1 month - consider ptsd
can use benzos for short-term distress
65
adjustment disorder
onset within weeks
| lasts <6 months
66
PTSD criteria
re-experiencing - flashbacks, nightmares, intrusive thoughts
avoidance
hyper-arousal
67
GAD
free floating anxiety
> 6 months
GAD7, BDI, HADS
68
GAD treatment
education and active monitoring
low intensity psych interventions
high intensity + applied relaxation
drugs - sertraline, SNRI, pregabalin
*never give benzos
69
OCD criteria
recurrent obsessional thoughts and/or compulsive acts
present most days >/2 consecutive weeks
Yale-brown OCD score
70
somatisation
multiple, recurrent, frequently changing physical symptoms >/2 years
- hyperchondriachal
- somatoform autonomic dysfunction
- persistent somatoform pain
71
dementia definition
acquired, chronic, progressive cognitive impairment sufficient to impair ADLs
<65 = early onset
at least 6 months
AD>VD>DLB
72
development of dementia
1 - mood changes
2 - abnormal behaviour
3 - hallucinations/delusions
73
dementia tests
AD --> FDG-PET, CSF, MRI
vascular --> AF + emboli
LBD --> DAT scan
FTD --> shrinking of frontal lobe
74
alzheimers theories
amyloid - B amyloid - Ab - toxic aggregates
tau - neurofibrillary tangles of hyperphosphorylated tau
inflammation - microglial cells - CNS macrophages
75
alzheimers genes
presenilin 1, 2
| beta amyloid precursor protein
76
huntingtons features
HTT
50% change children
chorea, speech, swallow, clumsiness, problems organising, impulse control, depression, chorea, lack of insight
77
ADHD criteria
impaired attention and overactivity
present <6 years lasting >6 months
in 2 or more settings
conners comprehensive behavioural rating scale
78
side effects of ADHD meds
cardiac arrhythmia - ECG
HTN - BP
anorexia and growth suppression - monitor weight and height
other - mood changes, palpitations, tics
monitor weight, height, BMI every 3 months
79
ASD diagnosis
abnormal/impaired development evident =3yo
>/= 6 of:
- impairment in social interactions
- abnormalities in communication
- restricted/repetative and stereotyped patterns of behaviour, interests and activities
80
ASD scales
ADI - autism diagnostic inventory
| CARS - childhood autism rating scale
81
types of CD
<10 - ODD
| >10 - unsocialised CD, socialised CD, CD confined to family context
82
learning disability scale
IQ <70 = LD
mild = 50-70
moderate = 35-50
severe = 20-35
profound = <20
* DS>fragile X
83
tic disorder medications
reassure, educate, stress manage
clonidine (alpha agonist)
atypical antipsychotics
84
causes of delirium
PINCH ME
```
pain
infection
constipation
hydration
medications
electrolyte imbalance
```
85
delirium treatment
treat cause
behavioural management - reorientation, good lighting etc
meds - benzos at night
86
mmse interpretation
```
24-30 = no cognitive impairment
18-23 = mold
0-17 = severe
```
87
clozapine side effects
blocks d1+d4 receptors
sedation, weight gain, lowers seizure threshold, myocarditis, metabolic syndrome, hyper salivation, GI (swallowing problems, constipation)
smoking cessation - lower dose
agranulocytosis, neutropenia
88
discontinuation syndrome symptoms
flu, insomnia, restlessness, mood swings, sweating, tummy problems, off balance, paraesthesia
