Psych Flashcards
(191 cards)
1
Q
Explain the pathophysiology of Wernicke-Korsakoff syndrome:
A
Alcohol can cause thiamine deficiency by:
- Interfering with the conversion of thiamine to its active form
- Preventing absorption of thiamine in the duodenum
- Interfering with storage in the liver due to alcoholic liver cirrhosis or fatty liver
Thiamine is involved in numerous important cellular processes:
- Glucose metabolism
- Lipid and carbohydrate metabolism in the brain
- Maintenance of normal amino acid and neurotransmitter levels in the brain
2
Q
What is the difference between Wernicke’s encephalopathy and Korsakoff’s syndrome?
A
Wernicke’s encephalopathy = acute, reverisble stage
Korsakoff’s syndrome = chronic and irreverisble, develops from untreated wernicke’s
3
Q
3 causes of vitamin B1 (thiamine) deficiency:
A
- Inadequate intake (malnutrition)
- Malabsorption (stomach cancer & IBD)
- Alcohol abuse
4
Q
What is anterograde amnesia?
A
Inability to form new memories after an amnesia inducing event
5
Q
What is retrograde amnesia?
A
Inability to recall memories prior to an amnesia inducing event
6
Q
5 psychological symptoms of Wernicke-Korsakoff’s syndrome:
A
- Anterograde amnesia
- Retrograde amnesia
- Hallucinations
- Confabulation
- Loss of coordination
7
Q
3 key symptoms of wernicke-korsakoff’s:
A
- Nystagmus
- Ataxia
- Confusion
8
Q
4 physical signs/symptoms seen in Wernicke-Korsakoff’s:
A
- Muscle atrophy
- Vision changes (double vision, drooping eyelids)
- Signs of liver disease (jaundice, ascites, spider naevi)
- Decreased reflexes
9
Q
What is the emergency treatment for Wernicke’s?
A
Parenteral thiamine for a minimum of FIVE days
e.g. 500mg IV over 30 minutes, oral thiamine from day 5 onwards
NB: high risk of allergic reaction
10
Q
How do you manage wernicke-korsakoff’s syndrome in the long term? (2)
A
- Prophylactic thiamine offered to harmful/dependent drinkers
- Treat co-morbidities e.g. heart failure
25% require long term institutionalisation
11
Q
Give 5 positive symptoms of schizophrenia:
A
- Hallucinations
- Delusions
- Passivity phenomena
- Thought alienation
- Disturbance of mood
- Lack of insight
12
Q
Give 5 negative symptoms of schizophrenia:
A
- Blunting of affect
- Poverty of speech
- Poverty of thought
- Self-neglect
- Amotivation/Anhedonia
- Poor non-verbal communication
- Lack of insight
13
Q
At what age does schizophrenia typically present?
A
20s or 30s
14
Q
3 risk factors for schizophrenia:
A
- Family hx
- Intrauterine and perinatal complications eg.g. low birth weight
- Intrauterine infection, particularly viral
- Abnormal early cognitive/neuromuscular developement
15
Q
Criteria for diagnosing schizophrenia:
A
At least ONE first rank symptom OR at least TWO second rank symptoms
16
Q
Give 4 first rank schizophrenia symptoms:
A
- Thought alienation (insertion, withdrawal, broadcasting)
- Passivity phenomena
- 3rd person auditory hallucinations
- Delusional perceptions
17
Q
Give 3 second rank schizophrenia symptoms:
A
- Delusions/hallucinations
- Catatonic behaviour (mutusm, posturing, stupour)
- Negative symptoms
- Thought disorder (incoherence, irrelevance, neologisms)
18
Q
First line pharmacological treatment for schizophrenia:
A
Atypical antipsychotic e.g. risperidone, olanzapine
19
Q
What is Belle indifference?
A
A lac of concern and/or feeling of indifference about a symptoms or disability e.g. presents with paralysis in both legs but is indifferent/doesn’t carw
20
Q
What is conversion?
A
Transposition of psychological conflict into somatic symptoms which may be of a motor or sensory nature
21
Q
3 side effects of risperidone:
A
Acute parkinsonism
Elevated prolactin
Weight gain
22
Q
7 organic causes of delirium:
A
P - pain I - infection N - hypoNatraemia C - constipation H - deHydration
M - medication
E - environment
23
Q
When does delirium tremens present?
A
Begins 24 to 72 hours after alcohol consumption has been stopped/reduced
24
Q
4 psychiatric and 4 physical symptoms of delirium tremens:
A
Psych:
- Hallucinations
- Confusion
- Severe agitation
- Delusions
Physical symptoms:
- Seizures
- Tachycardia
- Tremor
- Excessive sweating and other signs of chronic alcohol abuse/liver disease
25
How do you manage delirium tremens?
1. ABCDE
2. Check blood sugar
3. Alert ITU
4. Long acting benzo e.g. chlordiazepoxide or diazepam
5. Prophylactic treatment for wernicke's (thiamine IV)
5. Supportive tx (fluids, nutrition)
26
How does alcohol cause feelings of euphoria and reward?
Ethanol is a GABA agonist, increasing the inhibitory actions of GABA on the CNS
Ethanol activates opioid receptors and induces the release of endorphins
Ethanol triggers the release of dopamine in the nucleus accumbens
27
What are the two theories of the pathophysiology of alcohol dependence?
1. GABA, glutamate, dopamine & serotnin receptors become less sensitive to alcohol
2. Neurons have fewer receptors to alcohol through down-regulation
Desensitization leads to increased drinking to reach previous effect
28
When do signs of withdrawal typically begin to present? When do they begin to improve?
~8 hours after a significant fall in blood alcohol levels
Symptoms peak on day 2 and improve by day 4 or 5
29
How do you decide who should be offered community assisted alcohol withdrawal?
Patients who drink 15 units a day and/or score more than 20 on AUDIT
30
3 tools for assessing alcohol dependence:
1. CAGE (cut down, annoyed, guilty, eye-opener)
2. Alcohol use disorder identification test (AUDIT) - 8 or more = harmful drinking
3. Severity of alcohol dependence questionaire (SADQ)
31
Criteria for inpatient alcohol withdrawal: (4)
Risk of suicide
Lack of social support
Hx of severe withdrawal reactions
Significant co-morbidities
32
3 contraindications to benzodiazepines:
1. acute pulmonary insufficiency
2. marked neuromuscular resp weakness
3. unstable myasthenia gravis
4. do not use as sole treatment for depression, psychosis, anxiety etc.
33
2 pharmacological treatments used to help maintain alcohol abstinence:
1. Antabuse/Disulfram: causes a severe and unpleasant reaction to alcohol (risk of death)
2. Naltrexone: used to reduce cravings (risk of overdose)
34
How do you calculate number of units?
Strength (ABC) x volume /1000
35
How many units is a pint of beer?
2
36
What effect would a blood alcohol level of 0.16-0.30% cause?
Alcohol poisoning, blackouts, vomiting, LOC
37
What effect would a blood alcohol of about 0.00-0.05% have?
Relaxed, happy, slurred speech, unbalance
38
How might a patient with an acute opioid overdose present? (5)
1. Pinpoint pupils
2. Respiratory depression
3. Confusion/decreased consciousness
4. N&V
5. Track marks (arms/legs/elsewhere)
39
Pharmacological management of an acute opioid overdose:
400 micrograms naloxone IV or IM
THEN
800 micrograms for up to 2 doses at 1 minute intervals if no response to initial dose
40
Assessment/management of an acute opioid overdose:
```
ABCDE
Get an ABG
Get a CXR
Give naloxone
Maintain airway, ventilate if needed
Give IV fluids
```
41
5 physical symptoms of acute opioid withdrawal:
1. Runny nose/eyes
2. Sneezing
3. N, D&V
4. Dilated pupils
5. Tachycardia
6. HTN
7. Yawning
8. Anorexia
9. Abdominal cramps
42
5 psychological symptoms of acute opioid withdrawal:
```
Craving
Guilt
Anxiety
Loss of cognitive skills
Poor memory function
```
43
Physical complications/risks of long term opioid use:
1. Abscess and cutaneous infections
2. Infective endocarditis
3. Overdose
4. Infection (HIV, TB, sepsis)
5. Chronic venous ulcer leading to amputation
6. Venous and arterial thrombosis
7. Poor nutrition
44
How long is methadone detectable in your system for?
7 to 9 days
45
How long is codeine/morphine/heroin dectable for?
48 hours
46
How long is cocaine detecable for?
2 to 3 days
47
Prescibing methadone for opioid addiction:
1mg in 1ml oral solution
Initial dose 10-30mg
Increase incrementally up to 60-120mg /day
NB: it may take several weeks to reach the desired dose so that the patient feels comfortable no longer using heroin
48
What is buprenorphine?
A potent opioid agonist used to assist opiate withdrawal
Has a lower risk of overdose in the induction phase than methadone
May interact with HIV medication
49
A pregnant women is keen to stop using heroin before her baby is born, what can be done to help?
You MUST prevent withdrawal during pregnancy, withdrawal can cause foetal demise and preterm labour
You can give methadone or buprenorphine to substitute heroin but it must be at the exact right level to avoid withdrawal
50
Give two examples of typical antipsychotics:
Haloperidol
| Chlopromazine
51
Give three adverse effects of antipsychotics:
1. Extrapyramidal side effects
2. Hyperprolactinaemia
3. Increased risk of stroke/thromboemobolism in elderly patients
52
Give 4 extra-pyramidal side effects:
1. Parkinsonism
2. Acute dystonia
3. Akathisia (severe restlessness(
4. Tardive dyskinesia
53
Extrapyramidal effects and hyperprolactinaemia are side effects of both typical and atypical antipsychotics - are these side effects more common in typical or atypical antipsychotics?
Typical antipsychotics are more frequently associated with these side effects
54
Give 3 examples of atypical antipsychotics:
Clozapine
Risperidone
Olanzapine
55
What is an oculogyric crisis
Spasmodic movements of the eyeballs into a fixed position (usually upwards)
Occurs in acute dystonia
56
Criteria for mania: (6)
At least 3 of the following, lasting for more than one week:
1. Grandiosity
2. Decreased need for sleep
3. Flight of ideas
4. Distractability
5. Psychomotor agitation
6. Excessive involvement in pleasurable activities without thought for consequences
Psychotic symptoms are also common (believes they have superpowers)
57
DSM-V criteria for bipolar disorder:
One episode of mania without depression
OR
One episode of hypomania with a single episode of major depression
58
What is the difference between bipolar I and II?
I: mania and depression (or sometimes only mainia)
II: more episodes of depression, mild hypomania, rapid cycling
59
What is hypomania?
```
A less intense version of mania, lasts <4 days:
- Elevated mood
- Increased energy
- Poor concentration
- Increased talkativeness
- Mild reckless behaviour
- Decreased need for sleep
- NO psychotic symptoms
etc.
```
60
Alternative causes of mania other than bipolar disorder:
```
Infection
Hyperthyroidism
Stroke
Drugs
etc.
```
61
Treatment of acute moderate-severe mania:
Olanzapine 10mg PO
| Then adjust to 5-20mg/day
62
Long term pharmacological management of bipolar disorder:
First line mood stabiliser = lithium
If lithium not tolerated give sodium valproate (but never to a woman of child bearing potential)
63
6 signs of lithium toxicity:
```
T - tremor
O - oliguric renal failure
X - ataxia
I - increased reflexes
C - convulsions
C - coma/reduced consciousness
```
64
How often should you monitor someone taking lithium?
1. Check Li+ levels weekly, 12 hours post-dose, until the dose has been consistent for 4 weeks
2. Then check monthly for 6 months
3. Then check 3 monthly
65
What are the therapeutic ranges and toxicity level for lithium?
Therapeutic range: 0.4 to 1
Toxticity = >1
66
Other than Li+ levels, what else should you monitor in someone onlithium?
Plasma creatinine, U&Es and TFTs (every 6 months)
67
What complications can arise from taking lithium?
Affects thyroid and kidney function, can lead to hypothyroidism and nephrogenic diabetes insipidus
68
Is there a gender difference in the rates of bipolar I and II?
Yes, lifetime rates of bipolar I are higher in males
Lifetime rates of bipolar II are higher in females
69
Diagnostic criteria for depression:
At lesat 2 of the 3 core symptoms for at least two weeks, persistently and pervastively:
1. Low mood
2. Loss of energy (anergia)
3. Loss of pleasure (anhedonia)
70
What are the three core symptoms of depression?
1. Low mood
2. Loss of energy
3. Loss of pleasure
71
Give 3 biological symptoms of depression:
1. Change in sleep (early morning waking - ~2hrs before normal time)
2. Change in appetite
3. Change in libido
72
Give 5 cognitive symptoms of depression:
1. Agitation
2. Loss of confidence
3. Guilt
4. Loss of concentration
5. Hopelessness
6. Suicidal ideation
7. Diurnal mood variation
73
How do you classify depression as mild/moderate/severe?
Mild: core symptoms & 2-3 others
Moderate: core symptoms, 4 others, functioning affected
Severe: as above but with suicidal ideation and marked loss of functioning
OR
Severe: with psychotic symptoms
74
4 psychotic symptoms seen in depression:
Psychotic symptoms in depression are mood congruent:
1. guilty delusions
2. derogatory voices
3. nihilistic delusions e.g. believe they are dead or rotting away from the inside
75
NICE guidelines for mild/moderate depression (first, second, third line);
First line: low intensity psychological intervention e.g. group activity program
Second line: high intensity psychological intervention e.g. individual CBT
Third line: antidepressant therapy and/or escalation to psych services
76
Name 3 SSRIs:
Sertraline
Citalopram
Fluoextine
77
What kind of antidepressant is citalopram?
an SSRI
78
5 side effects/complications of SSRIs:
1. Nausea and indigestion
2. Worsening of sexual dysfunction
3. Suicidal thoughts in younger people
4. Serotonin syndrome
5. Hyponatreamia
79
Name two SNRIs:
Venlafaxine
| Duloxetine
80
What kind of antidepressants are venlafaxine and duloxetine?
SNRIs
81
Venlafaxine is contraindicated in which group of patients?
Those with heart disease, it raises their BP
82
Name two tricyclic antidepressants:
Amitriptyline
| Dosulepin
83
What type of antidepressant is dosulepin?
TCA
84
5 side effects of TCAs:
1. dry mouth
2. tachycardia
3. constipation
4. sleepiness
5. weight gain
85
Name 2 monoamine oxidase inhibitors:
Phenelzine
| Moclobemide
86
What type of antidepressant is phenelzine?
MAOI
87
What type of antidepressant is moclobedmide?
MAOI
88
Side effects of MAOIs:
Can cause extremely high BP if taken with tyramine (found in aged cheese, cured meets, broad beans(
89
Name an atypical antidepressant:
Mirtazepine
90
Give 2 side effects of mirtazepine:
drowsy
| weight gain
91
How long might a patient need to stay on antidepressants for? When might they start to feel their effect?
Continue for at least 6 to 9 months following recovery to prevent relapse
Antidepressants can take up to 4 weeks to have an effect and the dose may need titrating
92
3 symptoms of PTSD:
1. Re-experiencing: flashbacks, nightmares, sensory impressions
2. Avoidance or rumination: avoidance of triggers/reminders, suppression of memories, ruminanting excessively ('why me?')
3. Hyperarousal or emotional numbing
93
Management of PTSD:
Pharmacological:
- Do NOT offer benzos
Psychological:
- Trauma focused CBT
- Narrative exposure therapy
- EMDR
94
Which antidepressants are safer to use if a patient drinks alcohol?
citalopram or sertraline
95
Define generalised anxiety disorder:
Excessive anxiety across different situations for >6 months
96
First line management of GAD:
Pyshcological intervention e.g. CBT, mindfullness
| SSRI e.g. escitalopram 10mg OD
97
A to D DSM-V criteria for OCD:
A. Presence of obsessions, compulsions or both
B. Obsessions or compulsions are time-consuming, cause significant distress or impair functioning
C. Symptoms are not attributable to effects of a substance
D. Disturbance is not better explained by another mental disorder
98
OCD management:
Mild functional impairment:
- individual CBT and exposure and response prevention (ERP)
Moderate:
- high intensity psychological intervention AND an SSRI
99
DSM-V definition of a personality disorder (6):
1. An enduring pattern of inner experience and behaviour
2. Deviates from cultural expectations
3. Pervasive and inflexible
3. Onset in adolsences/early adulthood
4. Stable over time
5. Leads to distress
6. Impairments in self and interpersonal functioning
100
Which is the most common type of personality disorder seen in mental health settings?
Emotionally unstable personality disorder (EUPD)
101
4 common features of EUPD:
1. Attachment issues
2. Trauma
3. Any experience of deprivation/distress as a child/baby
4. Frequent co-mobidities e.g. anxiety, depression, PTSD, substance abuse
102
5 psychological symptoms of EUPD:
1. Impulsivity - capricious mood, acting without thinking of consequences
2. Fear of abandonment
3. Uncertainty regarding self image, aims, preferences
4. Thoughts of self-harm/suicide
5. Intense/unstable relationships
103
What is the gold standard psychological intervention for personality disorders?
Dialectal behaviour therapy (DBT)
104
What is DBT?
A third wave CBT included group and individual sessions over 12 months. Helps patients with 4 areas of skill:
1. emotional regulation
2. distress tolerance
3. interpersonal effectiveness
4. mindfullness
105
What is delirium?
An acute confusional state that fluctuates in severity and is usually reversible
106
What is dementia?
A syndrome of acquired, chronic, global impairment of higher brain function, in an alert patient, which interferes with the ability to cope with daily living
107
Name 8 causes of dementia:
1. Alzheimer's dementia
2. Vascular dementia
3. Pick's disease
4. Creutzfeld-jakob
5. Parkinson's disease
6. Huntington's disease
7. HIV dementia
8. Lewy body dementia
108
What is creutzfeld-jakob disease?
A neurodegenerate illness caused by the accumulation of small infectious pathogens contained protein but lacking nucleic acid
Indentified by a triphasic EEG pattern and extensive motor involvement
109
What is Pick's disease?
A rare front-temporal dementia that causes slow changes to character, intellect, memory and language
Parietal lobes are unaffected so full orientation and good skills are maintained until very late stage
110
At what age does huntington's disease typically onset?
30s to 40s
111
Three features of Huntington's disease:
1. Choriform movements (facial twitching)
2. Slurred speech
3. Distinctive gait: walking on heels, wide base
112
What is lewy body dementia?
Death of dopamine producing neurones and acetylcholine producing cells resulting in movement and cognitive symptoms of dementia
113
How might the progression/presentation of dementia vary by type? (alzheimers, lewy-body, frontotemporal, vascular)
Alzheimers: onset in 70s, gradual deterioration
Lewy-body: initial progress is more rapid than Alzheimers, hallucinations, personality changes
Fronto-temporal: slow progression
Vascular: step-wise deterioration, onset in mid to late 60s
114
What is memantine?
An NMDA antagonist used to help with the psychological symptoms of dementia in those with severe impairment or who cannot tolerate acetylcholinesterase inhibitors
115
Name 3 acetylcholinesterase inhibitors used in the management of dementia:
Donepezil
Galantamine
Rivastigmine
116
3 side effects of AChEis:
Bradycardia
Diarrhoea
Headache
117
5 features of hyperactive delirium:
1. agitation
2. delusions
3. hallucinations
4. wandering
5. aggression
118
5 predisposing factors for hyperactive delirium:
1. Fracture neck of femur
2. past hx of delirium
3. significant comorbidities
4. change in environment
5. dementia
119
What is hypoactive delirium often misdiagnosed as?
depression
120
4 symptoms of hypoactive delirium:
1. lethargy
2. slowness with everyday tasks
3. excessive sleeping
4. inattention
121
What is mixed delirium?
A combination of hyper and hypoactive delirium within 24 hours
122
6 causes of pseudo-dementia/congnitive decline:
D - drugs (inc. benzos)
E - emotional illness (depression, anxiety)
ME - metabolic (hyponatremia)
N - nutrition
T - tumour/trauma/normal pressure hydrocephalus
I - infection
A - alcoholism
123
What is ARBD?
alcohol related brain damage
124
What is included in confusion screen bloods?
```
FBC
LFTs
U&Es
TFTs
Calcium
Glucose
Folate
Cultures
```
125
3 tools used to assess cognitive impairment/dementia:
ACE3: score of ≤83
MSE: score of ≤24
MOCA
126
What is catatonia?
A state of apparent unresponsiveness to external stimuli in a patient who appears to be awake
Occurs in a number of conditions, may be episodic, triggered by medication or other circumstances
127
3 main features of catatonia:
1. Motoric immobility: catalepsy, waxy flexibility, stupor
2. Mutism: verbally minimally responive
3. Negativism: involuntary resistance to passive movement or involuntary oppositional behaviour
128
What is catalepsy?
An extreme form of posturing. The patient keeps an uncomfortable, rigid and fixed posture despite external stimulus or resistance
129
What is stupor?
Extreme hypoactivity, minimal response to stimuli, including painful ones
130
How do you manage catatonia
the majority of patients will respond to benzos
those who do not respond might be treated with ECT
131
What is acute dystonic reaction?
Sustained muscle contraction caused by starting a new drug or in rare cases increasing the dose
132
How does acute dystonic reaction present? (2)
1. Torticollis (wry neck, twisted, tilted)
| 2. Oculogyric crisis (involuntary upwards deviation of both eyes)
133
What is serotonin syndrome?
A potentially life threatening drug induced condition caused by too much serotonin in the synapses of the brain
134
Name 5 drugs that can cause serotonin syndrome:
Most cases involve two drugs that increase serotonin overlapping or an overdose of one drug.
1. MAOIs
2. SSRIs
3. Ilicit drugs (cocaine, MDMA, amphetamines, LSD)
4. Antiemetics (metoclopramide)
5. Analgesics (tramadol)
6. Herbal remedies
135
Triad of serotonin syndrome:
1. Autonomic hyperactivity: HTN, sweating, hyperthermia, hyperactive bowels
2. Neuromuscular abnormality: tremor, clonus, hyperreflexia, hypertonia
3. Mental status change: confusion, coma
136
How do you treat serotonin syndrome?
1. Stop causative drug(s)
2. Supportive measures - fluids, benzos for agitation
Mild cases usually resolve within 24 hours
137
What is tardive dyskinesia?
Involuntary repetitive movements in response to medication
Tardive = delayed as onset is usually months after commencing the medication
138
Risk factors for tardive dyskinesia:
1. >6 months tx with neuroleptics
2. Prolonged use of antipsychotics
3. Advancing age
139
How does tardive dyskinesia present? (4)
1. Orofacial mouthing with lip smacking, tongue protrusion, grimacing, excessive blinking
2. Body rocking
3. Distal chorea
4. Decrease in voluntary movement
140
How do you manage tardive dyskinesia?
1. Assess using the abnormal involuntary movement scale (AIMS)
2. Stop and switch to a different medication (avoiding withdrawal)
141
What might trigger lithium toxicity in a patient on a stable dose of lithium? (4)
1. Taking a higher dose (e.g. accidently taking it twice(
2. Dehydration
3. Interaction with other medication e.g. NSAIDs, anti-HTN, AEDs
4. Decreased sodium intake in diet
142
What is neuroleptic malignant syndrome?
A rare but potentially life threatnening reaction to neuroleptic drugs
143
What causes neuroleptic malignant syndrome? (5)
1. Withdrawal of parkinson's medication
2. use of neuroleptic drugs and genetic/metabolic susceptibility
3. high doses and depot preparations
4. high ambient temp and dehydration
5. previous episode
144
Diagnostic criteria for neuroleptic malignant syndrome:
```
Neuroleptics commenced within 1 to 4 weeks
Hyperthermia (above 38)
Muscle rigidity
And 5 of the following:
- changed mental status
- tachycardia
- hypo or hypertension
- incontinence
- excessive sweating
- & more....
```
145
How do you manage neuroleptic malignant syndrome?
```
ABCDE
IV benzos
IV fluids
Antipsychotics
Refer to ITU
```
146
What might you include in a physical examination of a patient with a possible eating disorder? (5)
1. Sit and squat test
2. Peripheral circulation exam
3. Lying and standing BP
4. Core temperature
5. Skin & nail changes
147
Diagnostic definition of binge eating disorder:
Recurrent episodes of binge eating with no purging or compensatory behaviour
Rapid eating, uncomfortably full and feeling unable to stop
Feelings of embarrassment, depression, guilt
Occurs at least once a week for 3 months or more
148
5 possible physical symptoms of an eating disorder:
1. Amenhorroea >3 months
2. GI disturbance
3. Delay in secondary sexual development
4. Fatigue
5. Abdo pain
& many more
149
Severe signs in an eating disorder requiring urgent intervention and referal: (5)
```
BMI <13
Rate of weight loss more than 0.5kg/week
Pulse <40 bpm
Postural drop >10mmHg
Failed squat and/or sit test
```
150
5 complications/risks of an eating disorder:
1. refeeding syndrome
2. mallory-weiss tear
3. malnutrition causing pancreatitis
4. cardiac complications inc. sudden death
5. intestinal obstruction/perforation/infection
151
What is refeeding syndrome?
A potentially fatal shift of electrolytes and water into the cells in response to refeeding after malnutrution
152
Presentation of refeeding syndrome:(7)
1. Rhabdomyolysis
2. Resp or cvs failure
3. Low BP
4. Arrhythmia
5. Seizure
6. Coma
7. Sudden death
153
What is Russel's sign?
Calluses on the knuckles or back of the hand due to repeated self-induced vomiting seen in bulimia nervosa
154
A patient is prescribed sertraline, what is it important to look out for in their drug history?
Any use of NSAIDs. SSRIs increase the risk of GI bleeding, a PPI must also be prescribed if the patient is taking an NSAID.
155
Why might a patient taking benzos become worried that they are suffering with dementia?
Benzos can cause anterograde amnesia
156
Which type of antidepressants can cause urinary retention?
TCAs
157
What is hoover's sign?
Hoover's sign is a quick and useful clinical tool to differentiate organic from non-organic leg paresis. In non-organic paresis, pressure is felt under the paretic leg when lifting the non-paretic leg against pressure, this is due to involuntary contralateral hip extension
158
How do you manage an acute dystonic episode?
Give an anti-cholinergic: procyclidine
159
What baseline and monitoring tests are needed when taking clozapine? Why?
FBC due to adverse effect of agranulocytosis and neutropenia
ECG due to risk of myocarditis
160
What is 'word salad' and what is it commonly associated with?
Disorganised speech associated with psychosis and mania
161
What are neologisms?
Made up new words
162
What is the maximum dose of sertraline per day?
200mg
163
A patient with GAD has been taking sertraline for 3 months and feels no improvement, what medication should you try next?
A different SSRI or an SNRI
164
What is echolalia?
Repetition of someon else's speech
165
What is echopraxia?
Echopraxia is the meaningless repetition or imitation of the movements of others
166
What is palilalia?
Automatic repetition of one's own words, phrases or senstences
167
What is copropraxia?
Involuntary performing of obscene or forbidden gestures or inappropriate touching
168
What are 'z drugs'?
Drugs with a similar effect to benzos but a different structure, they act on alpha-2 subunit of the GABA receptor
169
Adverse effects of z drugs e.g. zolpidem, zopiclone: (1)
Increased risk of falls in the elderly
170
4 adverse effects of atypical antipsychotics:
Weight gain
Clozapine causes agranulocytosis
Hyperprolacinaemia
Long term use can cause glucose dysregulation and diabetes
171
How do you differentiate between acute stress disorder and PTSD?
Acute stress disorder = reaction to a traumatic event in the first four weeks
PTSD = diagnosed after 4 weeks
172
What is malingering?
Fraudulent simulation or exaggeration of symptoms for financial or other gain
173
Criteria for somatisation disorder:
Multiple symptoms present for at least 2 years
Patient does not accept reassurance or negative test results
174
Short term side effects of ECT:
```
Headache
Nausea
Short term memory loss
Memory loss of events prior to ECT
Cardiac arrhythmia
```
175
What is Cotard syndrome?
A rare subset of nihilistic delusions in which the patient believes they are dead or do not exist
Most commonly seen in severe depression
176
What is considered a normal MMSE score?
25 to 30/30
177
What is delusional parasitosis?
Patient with a fixed, false belief (delusion) that they are infested by 'bugs'
178
Discontinuations symptoms with SSRIs:
1. GI symptoms (D&V, pain, cramping)
2. Increased mood change
3. Reslessness
4. Sweating
5. Unsteadiness
6. Paraesthesia
179
Risks to pregnancy when taking an SSRI in the first and third trimester:
1st trimester:
- small increase in risk of congenital heart defects
- increased risk of congenital malformations with paroextine
3rd trimester:
- increased risk of persistent pulmonary hypertension of the newborn
180
5 factors associated with poor prognosis in schizophrenia:
1. Strong family hx
2. Gradual onset
3. Low IQ
4. Prodromal phase of social withdrawal
5. Lack of obvious precipitant
181
Name 6 things raised by anorexia:
```
Gs & Cs:
Growth hormone
Glucose
salivary Gland activity
Cortisol
Cholesterol
Carotinaemia
```
182
What is the SSRI of choice in children and adolescents?
fluoxetine
183
What is a delusional perception?
a true perception, to which a patient attributes a false meaning. For example, a perfectly normal event such as the traffic lights turning red may be interpreted by the patient as meaning that the martians are about to land
184
What is a section 5(2) used for?
Section 5(2) gives doctors the ability to detain someone in hospital for up to 72 hours, during which time you should receive an assessment that decides if further detention under the Mental Health Act is necessary
185
How long can someone be detained for under section 2?
28 days (cannotbe renewed)
186
What is a section 2 used for?
An 'assessment section' used to detain someone for up to 28 days whilst they require an assessment in hospital
187
What is a section 3 used for?
A 'treatment section' used to detain someone for 6 months whilst they receive treatment. Can be renewed as often as needed.
188
What is a section 4 used for?
An emergency order to detain someone for 72 hours whilst waiting for a second doctor to become available to implement a longer section.
189
When do you use a section 5(2)?
To detain a patient who is already admitted but wants to leave.
190
What section is used by the police to detain someone in public or in their own home?
S136 - public
| S135 - home
191
How can you remove a section? (3)
3 different ways:
1. Consultant in charge removes it
2. Mental health review tribunal
3. Patient's nearest relative removes it
