Psych Flashcards Preview

Year 5 > Psych > Flashcards

Flashcards in Psych Deck (28):
1

A 24-year-old man presents with what appears to be an acute psychotic episode. Which of the clinical features below is most likely to discriminate between this being a schizophreniform psychosis or a manic episode?

The presence of auditory hallucinations
The presence of persecutory delusions
The presence of delusions that are incongruent with the patient's mood
The presence of cognitive impairment
The presence of a disorder of the form of thought

The presence of delusions that are incongruent with the patient's mood

2

A 32-year old man presents to his general practitioner with a 5-week history of worsening low mood, which he attributes to tensions within his marriage. On direct questioning, he admits that he finds it very difficult to concentrate on his work, and finds no interest in it. He routinely wakes 3 hours before he was accustomed to previously, and feels unrefreshed when he wakes. He now feels hopeless about the future, and says that life isnt worth living, although on questioning, he has made no plans to end his life. Direct questioning reveals no relevant past or family history. Physical examination reveals no abnormalities. What would be the most appropriate management plan?


Ask him to return to the surgery in a week's time to review
Refer him to the practice counsellor
Prescribe temazepam to help with his sleep, and ask him to return for review in a week's time
Prescribe fluoxetine 20 mg once a day and ask him to return for review in a week's time
Refer him to the local community mental health team for an urgent assessment, in view of his thoughts about ending it all

Prescribe fluoxetine 20 mg once a day and ask him to return for review in a week's time

3

Among patients on an acute medical inpatient ward, what is the likely prevalence of clinical depression?

1%
5%
10%
25%
60%

25%

4

A 28-year old woman lives in supported accommodation. She is able to manage most tasks of self-care, but needs help with taking her medications (in the form of a dosette box, filled by a carer). She has a flat occiput, and short, broad hands. On the basis of this information, what is the likelihood that she has an IQ under 50 and has multiple associated physical abnormalities?


0.1%
1%
10%
50%
80%

10%

5

A 18-year old girl presents to a general psychiatry outpatient clinic. She has had what her mother describes as an eating problem for some years, but it has become considerably worse over the past year. She has lost considerable weight, and at the clinic, her weight is 40 kg and her Body Mass Index is 15 kg/m2. She admits that she is very fastidious about her food, carefully choosing what to eat, and disregarding her mothers advice. She goes to the gym daily for a work-out lasting at least 90 minutes. Her periods had been regular, but she has had none for the last 3 months. At the appointment, she is accompanied by her mother, who is clearly exasperated by her daughters behaviour, and expresses considerable criticism of her. What would be the most appropriate initial intervention?

Refer her to a dietician for specialist dietetic counselling, and arrange to see her again in the clinic after she has seen the dietician
Explain to her the potential hazards of her current behaviour, give her appropriate self-help materials, and tell her that appropriate advice on further interventions will depend on how much progress she makes
Refer her, along with her mother, for family therapy, and arrange further follow-up in the clinic
Refer her to a specialist eating disorders clinic, so that she can receive a combination of nutritional advice, individual and family therapy
Arrange to have her admitted to a specialist eating disorders unit

Refer her to a specialist eating disorders clinic, so that she can receive a combination of nutritional advice, individual and family therapy

6

Which of the above medications is best applied to each of the following presentations? Each option can be used once, more than once, or not at all.

A 24 year old woman who is considerably handicapped by having to wash her hands repeatedly, in a particular way

A. Sertraline
B. Procyclidine
C. Temazepam
D. Diazepam
E. Haloperidol
F. Doneprazil
G. Olanzepine
H. Acamprosate
I. Methadone
J. None of the above

Sertraline

7

Which of the above professionals is most appropriate to take the lead in the following circumstances? Each option can be used once, more than once or not at all.

A 23 year old man has been an inpatient under Section 3. Who is responsible for arranging the Care Programme Approach meeting?

A. Approved social worker
B. Consultant psychiatrist
C. General practitioner
D. Nurse (based at mental health unit)
E. Key worker
F. Occupational therapist
G. Patient advocate
H. Community psychiatric nurse
I. Music therapist
J. Clinical psychologist

Key worker

8

Which of the above professionals is most appropriate to take the lead in the following circumstances? Each option can be used once, more than once or not at all.

A 23 year old man has been an inpatient under Section 3. Who is responsible for arranging the Care Programme Approach meeting?

A. Approved social worker
B. Consultant psychiatrist
C. General practitioner
D. Nurse (based at mental health unit)
E. Key worker
F. Occupational therapist
G. Patient advocate
H. Community psychiatric nurse
I. Music therapist
J. Clinical psychologist

Key worker

9

Which of the above professionals is most appropriate to take the lead in the following circumstances? Each option can be used once, more than once or not at all.

A 17 year old man with severe learning disability shows repeated self-injurious behaviour, that has not responded to any pharmacological intervention

A. Approved social worker
B. Consultant psychiatrist
C. General practitioner
D. Nurse (based at mental health unit)
E. Key worker
F. Occupational therapist
G. Patient advocate
H. Community psychiatric nurse
I. Music therapist
J. Clinical psychologist

Clinical psychologist.

10

Which of the above professionals is most appropriate to take the lead in the following circumstances? Each option can be used once, more than once or not at all.

A 20 year old woman is presents in the Accident and Emergency Department after an impulsive overdose of 10 aspirin tablets, taken during an argument with her mother. Assessment reveals no mental state abnormality, and no suicidal intent is elicited.

A. Approved social worker
B. Consultant psychiatrist
C. General practitioner
D. Nurse (based at mental health unit)
E. Key worker
F. Occupational therapist
G. Patient advocate
H. Community psychiatric nurse
I. Music therapist
J. Clinical psychologist

GP

11

Which of the above terms is best applied to the following presentations? Each option can be used once, more than once or not at all.

Needs clinical monitoring, particularly when treatment is first started, for extra-pyramidal effects

A. Diazepam
B. Temazepam
C. Olanzepine
D. Lithium
E. Procyclidine
F. Clozapine
G. Sertraline
H. Amitryptyline
I. Zolpidem
J. Haloperidol

Haloperidol

12

Which of the above is the initial treatment of choice for the following presentations? Each option can be used once, more than once or not at all.

A 36 year old unemployed single man who has been dependent on alcohol for some years presents in the Accident and Emergency Department having been hit by a car when he wandered into the road while drunk. He has undergone two previous detoxifications, but resumed drinking soon after each had ended. He is now asking for further treatment

A. Prescribe naloxone
B. Prescribe acamprosate
C. Recommend gradual reduction in amount of drug consumed
D. Give intravenous vitamin B1
E. Outpatient detoxification
F. Prescribe methadone
G. Give intravenous flumazanil
H. Inpatient detoxification

Inpatient detoxification

13

A 54 year old man sees his GP complaining of gradually worsening impotence over the last year. He is in debt and had found out 2 months ago that his wife was having an affair. He admitted to drinking up to 40 units of alcohol per week. His PMHx includes HTN, for which he is taking atenolol.

Most appropriate initial management

A Psychosexual counselling
B Self-help exercises
C Sildenafil
D Stop atenolol and reduce alcohol consumption
E Use of a vacuum constriction device.

Stop atenolol and reduce alcohol consumption

Psychosexual disorders are non-organic problems preventing an individual from participating in satisfactory sexual relationship. However, there is frequently a combination of physical and psychological factors contributing to the impairment of function. In this scenario, these include marital difficulties, financial strain, excessive alcohol use and prescription drugs (atenolol). Other drugs can cause erectile dysfunction including TCAs, BDZs, antihistamines, oestrogen, statins and anti-Parkinson medication.

Stopping atenolol and reducing alcohol consumption are sensible initial measures in this case. Appropriate investigation will depend on the history. Biological causes should be ruled out (e.g. neuropathy, ischaemic vascular dysfunction, HTN) and specialist referral may be needed. However, if psychological factors are involved, referral to a sexual and relationship clinic may be helpful. In cases of erectile failure, intracaversonal injection of papaverine or PGE1 can be used. Other physical treatments include vacuum device, nitrate creams and rod insertion!

14

On an MMSE which of the following scores is suggestive of cognitive impairment?

A

27 = normal

15

Echopraxia

Copying another's movements, even when asked to stop.

Seen in schizophrenia along with ambitendency, mannerisms, stereotypies, negativism, posturing and waxy flexibility.

16

A 33 year old man living in Malaysia had a gun in his house which used to belong to his father. One day, he grabbed it, shot his family and ran outside shooting passersby before finally taking his own life. He had no previous psychiatric history, and there was no obvious motive.

A) Amok
B) Dhat
C) Koro
D) Latah
E Susto

Amok

Amok is seen in SE Asia, usually in Malaysian men. The features are acquisition of a weapon followed by a series of frenzied attacks, killing or seriously injuring anyone within reach. The attacks last several hours and are frequently only terminated by the attacker being killed by someone else or themself. If he is not killed, amok is followed by a stupor/sleep lasting one day, followed by amnesia of the event. It is thought to be a form of dissociative disorder.

Koro is seen in Asian men, especially Chinese. It is fear that the penis is retracting into the abdomen. Some have a secondary worry that full retraction will lead to death. Koro is common in people who have limited access to education.

Dhat occurs in young Indian males. It is associated with anxiety and a belief that semen is being lost in the urine. It often accompanies excessive guilt about masturbation. There may be a belief that semen is 'vital fluid', more so than blood, and the loss of it leads to fatigue.

Latah is a culture-bound condition found in women of North africa and the Far East. There is an exaggerated startle response, in which some women start repeating the words of another person (echolalia), or obeying their commands. There is frequently amnesia after the event.

Susto usually occurs in people living in South America. It is a severe depressive episode usually occurring after a traumatic event. There are often physical symptoms such as diarrhoea and nervous tics. It is thought (within the culture in which it exists) to be caused by the separation of the soul from the body. It is has features in common with acute stress reaction.

17

Which of the following is not a common feature of neuroleptic malignant syndrome?

A Altered consciousness
B Hypothermia
C Increased creatine kinase
D Muscle rigidity
E Tachycardia

Hypothermia

Neuroleptic malignant syndrome is a life-threatneing neurological condition that can occur with the use of typical and atypical antipsychotics, particularly after an increase in dosage. Symptoms include pyrexia, fluctuating consciousness, muscle rigidity and autonomic dysfunction. Investigations may reveal a raised creatine kinase, raised WCC and abnormal liver function tests. Managements includes BDZs, stopping the precipitating agent and supportive measures such as O2, maintaining fluid balance and reducing core body temperature. IV sodium bicarbonate can be used in cases of rhabdomyolysis, dantrolene or lorazepam can be used to reduce rigidity.

18

Fregoli syndrome

A delusion that a persecutor is able to change into many forms and disguises themself to look like different people, much like an actor.

It is named after Leopold Fregoli, an Italian actor, who was famous for being able to make quick changes in appearances during stage acts.

19

de Clerambault's syndrome

Aka erotomania or amorous delusions

A delusional belief that someone of higher social status is in love with them. It is more common in women.

20

Couvade syndrome

Occurs in males around the time of birth of their child. They experience symptoms similar to that of pregnancy, like nausea and dyspepsia. They may even suffer abdominal distension and labour-like contraction pains. The cause is not well understood, but symptoms usually resolve soon after birth.

21

A 30 year old soldier returns from 6 months duty in Afghanistan, during which time he witnessed a close friend being killed by a landline explosion. He now describes poor sleep, 'flashbacks' of the event and irritability.

Which of the following is a risk factor for developing this condition?

A) Caucasian ethnicity
B) Low self esteem
C) Higher social class
D) Male sex
E) Psychopathic traits

Low self esteem

This man has developed PTSD. Diagnostic features include:

- experience of a major traumatic event
- re-experiencing the trauma
- avoidance behaviour
- increased arousal: hyper vigilance, insomnia
- Delayed onset (within 6m) that persist >1 month

Risk factors
- Low social class and education
- Afro-caribbean/hispanic ethnicity
- Female
- low self esteem
- Personal, FHx of psychiatric or traumatic events

Protective
- high IQ and social class
- Caucasian
- Male
- Chance to view body of the deceased.

22

A 23 year old woman has had a string of intense and unstable relationships. She is often unpredictable. She also has a history of deliberate self harm.

Which PD?

A) Anankastic
B) Avoidant
C) Emotionally unstable, borderline type
D) Emotionally unstable, impulsive type
E) Histrionic

Emotionally unstable, borderine type.

This is characterised by emotional instability, disturbed views of self-image, feelings of emptiness, and intense but easily broken relationships. Self harm is a common feature, often in an attempt to avoid abandonment.

Emotionaly unstable, impulsive type PD is similar, but a lack of self control and violent outbursts are more prominent features.

23

Pseudocyesis

Pseudo pregnancy

24

Ganser syndrome

A factitious disorder where people give approximate answers to simple questions that show they understand the underlying theme of the question asked. Individuals mimic what they believe to be psychotic behaviour. It was first described in prison inmates awaiting trial.

Example: when asked how many legs a donkey has they will answer '12' as opposed to 'blue'. Although 12 is wrong it is a number and a reasonable answer to a 'how many' question.

25

A 30 year old woman is admitted to hospital after taking an overdose of paracetamol. This her first such episode.

Risk of completed suicide over the next year.

A 0.1%
B 1%
C 5%
D 10%
E 40%

1%

Suicide is important to consider because it is one of the most extreme negative outcomes in psychiatry. It is important to know the RFs in order to identify and manage those at risk.

After an act of self harm the risk of completed suicide with in the next year is 1%. 100x more than the risk of the general population.

26

A 28 year old woman living in the Arctic circle has a sudden-onset episode of bizarre behaviour. Her friends say that she began crying and shouting hysterically, took off her clothes and started throwing large objects. She had to be physically restrained. Later, she had no recollection of the episode.

A Generalised anxiety disorder
B Latah
C Piblokto
D Susto
E Windigo

Piblokto

Piblokto is described in Inuit women living within the Arctic circle. There is sudden onset hysteria and bizarre behaviour. This may include removal of clothes, coprophagia (ingestion of faeces) and violence. Attacks last a couple of hours and there is often amnesia after the event. It is thought that piblokto may be related to vitamin A toxicity, as the native Eskimo provides large quantities of it.

Windigo is recognised in native North American tribes. Affected people believe that their body is possessed with a spirit that craves human flesh. This results in obsessive thoughts and compulsions regarding violence and cannibalism.

27

Cotard syndrome

A nihilistic delusion that one is dead, has lost all their possesssions, does not exist or is decaying etc.

28

A 42 year old woman presents to A&E with sweating, fever, agitation and confusion. O/E she is shocked and has overactive reflexes. Routine observations reveal a heart rate of 118bpm and a BP of 186/106. She denies illicit drug use but has recently had

.