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3rd yr clinical > Psych > Flashcards

Psych Flashcards

1
Q

What are the features of schizoid personality disorder

A

Solitary, lack of interest detached
Symptoms start in adolescence
Odd/eccentric
No desire to interact with others

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2
Q

What are the features of schizotypical personality disorder

A

Odd speech and beliefs, magical thinking, eccentric behaviour

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3
Q

What are the features of antisocial personality disorder

A

Don’t conform to social norms lie, aggressive and irresponsible

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4
Q

What are the features of histrionic personality disorder

A

Sexual seductive, dramatic, need to be centre of attention

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5
Q

What are the main poor prognostic indicators in Schizophrenia

A

Fam history
Gradual onset
Low IQ
Prodromal social withdrawal
No precipitant

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6
Q

What are some side effects of Clozapine

A

Treats schizophrenia
If you stop smoking this will increase levels of clozapine in the blood- notify Dr if you stop smoking

Risk of agranulocytosis so need FBP monitoring
Reduced seizure threshold
Constipation
Myocarditis
Hypersalivation

Atypical antipsychotics like clozapine can cause weight gain and hyperprolactinaemia

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7
Q

What is the timeline for alcohol withdrawal

A

Seizures 36 hrs after
Delirium Tremes 72 hrs after

Management
Long acting benzos- diazepam or chlordiazepoxide

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8
Q

What are the two different types of bipolar disorder and how are they managed

A

Type 1 - mania and depression
Type 2- hypomania and depression

Mania- Psychotic symptoms for 7 days or more - hallucinations/ delusions

Hypomania-Decreased or increased functioning for 4 days or more

Management of mania/ hypomania- stop antidepressant and give antipsychotic eg. Olanzapine or haloperidol

Don’t give an antidepressant without a mood stabaliser- antidepressant alone can worsen mania

Manage depression- fluoxetine

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9
Q

What are some increased risks for people with bipolar disorder

A

Increased risk diabetes, CVD and COPD

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10
Q

What is a brief psychotic disorder

A

Psychotic symptoms last less than a month

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11
Q

What is schizoaffective disorder

A

Psychotic and mood disorders present together in an episode or within 2 weeks of each other

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12
Q

What is tangentiality

A

Answers diverge from a topic - psychotic feature

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13
Q

Why are triptans and SSRI’s contraindicated

A

Risk of Serotonin syndrome

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14
Q

What are the side effects of tricyclic antidepressants

A

Drowsy, dry mouth, blurred vision, constipation, urinary retention causing frequent leaking
-Overflow incontinence due to anticholinergic effect

Amitryptylline is a TCA

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15
Q

What is illness anxiety disorder

A

Persistent belief in an underlying disease and doesn’t accept reassurance

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16
Q

What is conversion disorder

A

Loss of motor or sensory function not faking them

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17
Q

What is dissociative disorder

A

Disassociating memories - psych symptoms- amnesia
Multiple personality disorder

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18
Q

What is factitious disorder

A

Mucnhausans - physical and psychological symptoms produced

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19
Q

What is malingering

A

Exaggerating symptoms for financial gain

20
Q

What are somatic symptoms in depression

A

More biological depressive episode
More severe than an episode with no somatic symptoms

Loss of emotional reactivity
Diurinal mood variation
Anhedonia
Early morning waking
Psychomotor agitation/ retardation
Loss of appetite/ weight
Loss of libido

21
Q

What are the features of avoidant personality disorder

A

Fearful/ anxious
View themselves as inferior and reluctant to engage
Still a strong desire to have interaction with others

22
Q

What is the most common treatment for panic disorder

A

SSRI (sertraline) and CBT
If SSRI’s no response/ contra use Imipramine or clomipramine

Symptoms need to be present for at least 1 month

23
Q

What are some side effects of antipsychotics

A

Parkinsonism
Acute dystonia (sustained muscle contraction)
Akathisia- restlessness
Tardive dyskinesia - abnormal involuntary movements eg. pouting or chewing

Increased risk of stroke and VTE

Anti-muscarinic effects- dry mouth, urinary retention, constipation
Sedation, weight gain
Raised prolactin
Neuroleptic malignant syndrome- pyrexia and muscle stiffness
Prolonged QT
Reduced seizure threshold

Apiprazole- has the best side effect profile- if patients are suffering from side effects on the other medications

24
Q

When are personality disorders diagnosed

A

At 18
BPD is the only one that can be diagnosed before if sufficient evidence

25
Q

What is the treatment for OCD

A

Use Ybocs scale- severe if they spend more than 3 hrs per day on obsession and compulsion
1. CBT
2. SSRI and CBT
3. Clomipramine if SSRI contraindicated

26
Q

What is the difference between Formication and delusional parasitosis

A

Formication- feeling fo paraesthesia which feels like bugs under the skin

Delusional parasitosis- fixed delusion that there are bugs under the skin

27
Q

When are lithium levels checked

A

12 hrs after last dose taken

5 days after any dose changes made

Want levels between0.6-0.8

Once stable on dose check every 3 months

Gets toxic at around 1.2

Not recommended in pregnancy but not completely contraindicated

28
Q

What is acute stress disorder and how is it managed

A

Stress reaction in the first 4 weeks after a traumatic event

PTSD diagnosed after 4 weeks

CBT and benzos to treat

29
Q

What is the criteria for anorexia nervosa diagnosis

A
  1. Restriction of energy intake - low body weight
  2. intense fear of gaining weight/ becoming fat
  3. Disturbance in the body weight or shape is experienced- in denial of low weight
30
Q

What are the symptoms of anorexia nervosa

A

Low BMI
Bradycardia
Hypotension
Enlarged salivary glands

Hypokalaemia
Low FSH, LH, oestrogen and testosterone
Impaired glucose tolerance
Hypercholesterolaemia
Low T3

31
Q

What is Charles Bonnet syndrome

A

Recurrent hallucinations in clear consciousness usually with visual impairment

No other neuropsychiatric disturbance

Risk factors
Advanced age
Peripheral visual impairment
Social isolation / sensory deprivation
Early cognitive impairment

32
Q

What is the criteria for bulimia diagnosis

A

-Binge eating episodes
-Lack of control over eating
-Innappropirate compensatory behaviour to prevent weight gain - Exercise/ vomiting
-Once a week for 3 months at least

CBT and fluoxetine

33
Q

What is the diagnostic criteria for depression

A

Less severe- PHQ of less than 16
More severe PHQ over 16

PHQ- patient health questionnaire

34
Q

What are the rules around switching from SSRIs

A

First SSRI withdrawal before alternative is started

35
Q

What are the rules around fluoxetine switching to another SSRI

A

Withdraw then leave a gap 4-7 days before starting a low dose alternative SSRI

36
Q

What are the rules around switching from an SSRI to a TCA

A

Cross taper- current drug reduce slowly whilst dose of new drug increase

37
Q

What are the contraindications and side effects of ETC

A

Useful in severe depression refractory to medication

Absolute contraindication is raised ICP

Side effects
Headache, nausea, short term memory impairment, cardiac arrhythmia x

38
Q

What is the stepwise management of generalised anxiety disorder

A
  1. Recognition and pyschological interventions- self help or CBT
  2. SSRI
  3. Another SSRI or SNRI (duloxetine or venlafaxine)
39
Q

What are the side effects of lithium

A

Mood stabiliser in bipolar
Narrow therapeutic range

Nausea and vomiting
Fine tremor
Nephrotoxicity
Thyroid enlargement
ECG- T wave flattening/ inversion
Weight gain
Idiopathic intracranial HTN
Leucocytosis
Hyperparathyroidism and hypercalcaemia

When checking lithium levels check 12 hrs post dose

40
Q

What are the features and management of PTSD

A

re-experiencing- flash backs, nightmares
Avoidance- situations and people
Hyperarousal- exaggerated startle, irritable
Emotional numbing

Trauma focussed CBT
Venlafaxine or SSRI like sertraline

If severe
Risperidone

41
Q

What are the features of Schizophrenia

A

Auditory hallucinations
-2 or more voices discussing the patient in the third person
-Though echo
-Voices commenting on patients behaviour

Body sensations being controlled by external influence
Actions/impulses/feelings

Delusional perceptions- perceive a normal object then be delusional- the light is green so I am the king

Thought broadcasting/ withdrawal/insertion

Made up words

Impaired insight, negative symptoms- anhedonia, poor speech and motivation, catatonia

Management
Oral atypical antipsychotics
CBT
Check CVD risk factors

42
Q

What drugs interact with SSRIs

A

NSAIDs - need to give a PPI if prescribing both together
Warfarin/ heparin
Aspirin
Triptans
Monoamine oxidase inhibitors

43
Q

What is somatisation disorder

A

Multiple physical symptoms for at least 2 yrs
Won’t accept reassurance of negative tests

44
Q

What is tangentiality

A

wandering from a topic on a tangent without returning to it

45
Q

What medications need cautioned in lithium

A

ACE inhibis, diuretics- anything that increases risk of AKI

46
Q

What are the side effects of olanzapine

A

A 2nd line antipsychotic

High BP
High BMI
Diabetes
Weight gain
Hyperprolactinaemia

3rd yr clinical (22 decks)

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