Psych Flashcards
(14 cards)
A 32-year-old man presents to the Emergency Department with confusion, drowsiness and an unstable gait. He was treated with amoxicillin for an upper respiratory-tract infection 3 days ago. He has a history of schizophrenia and is taking clozapine. He never smokes and does not drink alcohol.
His observations are as follows:
Temperature 37 °C
Heart rate 120 bpm
Respiratory rate 16 breaths/min
Blood pressure 106/72 mmHg
SpO2 97%
Chest examination is normal. Neurological examination reveals no focal neurological deficits.
Which is the most appropriate investigation to confirm the diagnosis?
Clozipine levels:
his man has symptoms of clozapine toxicity – confusion, drowsiness, ataxia and tachycardia. Clozapine toxicity in this man is likely to be precipitated by an acute infection, ie. pneumonia. As clozapine is metabolised by CYP450 enzymes, it is postulated that downregulation of these enzymes by cytokines in an infection/inflammation decreases the metabolism of clozapine, leading to a raised clozapine level. It is recommended to measure a clozapine level in the presence of an infection in anticipation of toxicity.
A 24-year-old female presents to her GP 10 days after the birth of her first child, accompanied by her partner. She has a past medical history of bipolar disorder, but her partner reports this has been well managed for years. The partner expresses concerns that she has been behaving strangely for the past few days, crying often, and becoming increasingly anxious and paranoid. More recently, the patient has expressed doubts about the identity of her baby. She repeatedly queries whether it is really their child or has been exchanged with an identical ‘changeling’.
Given the presentation and likely diagnosis, what type of eponymous syndrome is described here?
Capgras
Refeeding syndrome after anorexa ECG changes?
Hypokalaemia, a common complication in refeeding syndrome, may result in prominent U waves observed on an ECG.
Cardiac arrhythmias:
These patients are at higher risk of arrhythmias and an ECG should be performed periodically, especially if they are complaining of cardiac symptoms (eg. palpitations, fainting episodes or dizzy/light-headed spells)
Bradycardia and prolonged QTc are often seen
Osteoporosis‚ a long-term complication
An 18 year old woman presents to her GP with feelings of tiredness. She describes a six month history of exercising every day despite having very little energy, and deliberately trying to lose weight because she believes she is fat. She reports deliberately restricting her food intake to 500 - 800 calories per day because she does not want to gain any more weight. She does not self-induce vomiting and denies use of any laxatives. On examination she is markedly underweight, with lanugo hair.
Which of the following options is the most likely finding on routine blood tests?
low WCC
low calcium, magnesium, phosphate and potassium
A 22-year-old woman presents with a 3-hour history of confusion. She is disorientated to time and place. She was admitted to the ward 2 days ago for treatment of anorexia nervosa. She is agitated and wants to leave the ward. She has an ataxic gait; however, her observations are normal. Her capillary blood glucose is 5.0 mmol/l.
High suspicion index for wernicke’s as out of the triad u often only get one thing
Thiamine deficiency leading to Wernicke’s encephalopathy has a variety of causes, eg. prolonged starvation, anorexia nervosa, hyperemesis gravidarum, gastrointestinal diseases and malabsorption, other than chronic alcoholism
A 10 year old boy is brought to the GP by his mother because of problematic behaviour. She says that he just ‘bounces off the walls’ and that there is nothing that she can do to control him. He is constantly running around, interrupting people in conversation and switching from one activity to another at lightning speed. He often gets frustrated because he can’t sit down long enough to finish his homework.
At school, he gets into trouble every day for shouting out or disrupting other children while they are working. His mother notes that the boy’s father had similar problems when he was at school and still can’t read the newspaper without getting distracted every other minute.
What area of the brain shows reduced function in the boy’s condition?
FRONTAL LOBE
A 10 year old boy with a diagnosis of attention-deficit hyperactivity disorder (ADHD) attends the outpatient psychiatry clinic for review. He was recently started on Methylphenidate to control his symptoms. His behaviour has improved, however, he has developed facial tics which he finds distressing.
Which of the following is the most appropriate drug to switch to for long-term management of his condition?
Atomoxetine is a noradrenaline reuptake inhibitor. It is recommended for ADHD refractory to Methylphenidate or in those who it is not appropriate due to risk factors or development of side effects. Development of facial tics is an indication to change medications
What drug is phenalzine?
older type of monoamine oxidase inhibitor
if on MAOI and eating amine rich food can cause hypertensive crisis
What type of drug is lofepramine?
Tricylic antidepressant
A 74-year-old female is noted to have poor self-care with symptoms of early morning wakening and decreased appetite. She gets agitated easily. There is a history of recent death in the family. She also recently lost her job. She has difficultyanswering short-term recall questions. Routine physical examination is unremarkable, apart from the fact that her BMI is significantly reduced at 19.
What is the most likely diagnosis?
Depressive pseudodementia
Indications for ECT – Major depression with the following components:
high risk of suicide
psychotic features
catatonic stupor
food refusal, severe weight loss or dehydration
refractory to antidepressants
previous response to ECT.
what is splitting
This is a classic borderline patient. Borderline personality disorder, or emotionally unstable personality disorder, is typified by explosive interpersonal relationships, emptiness, lack of identity, unstable moods, impulsiveness, inappropriate sexual relationships, unstable relationships and splitting. When you think of borderline personality, you should think of a splitting defence mechanism. Splitting is a common immature defence mechanism where the patient is unable to reconcile both good and bad traits in a given person, and therefore sees people as either all good or all bad. This patient is prone to explosive relationships, and ultimately driving most close relationships away.
